卒中后抑郁的早期干预与神经功能恢复的临床研究

目的 探讨卒中后抑郁的早期干预对急性脑梗死患者神经功能、生活质量恢复的影响。方法 所选病例随机分为治疗组(舍曲林50 mg 每晚)和对照组(淀粉片1#每晚),两组均联合心理治疗,疗程12周,监测治疗前后血浆皮质醇(COR)水平,依据美国国立卫生研究院卒中量表(NIHSS)、9条目病人健康问卷(PHQ-9)、汉密尔顿抑郁量表(HAMD)、日常生活能力量表(ADL)标准进行评分,评价急性期脑梗死抑郁患者早期干预疗效、神经功能的恢复及生活质量的改善及随访观察卒中后抑郁(PSD)的发生率。结果 两组患者治疗有效率前后对比差异均具有统计学意义 (P<0.05),尤以治疗组明显,治疗后治疗组与对照组对比差异有统计学意义 (P<0.05);治疗后治疗组NIHSS、HAMD评分及COR水平均低于对照组; ADL评分高于对照组,PSD发生率明显低于对照组,差异均具有统计学意义 (P<0.05)。结论 卒中后抑郁的早期干预能促进患者神经功能恢复,提高生活质量,降低COR水平和PSD发生率。应重视卒中后急性期内抑郁的早期筛查。

A clinical research of relationship between early intervention of PSD and nerve function recovery

Objective To discuss the relationship between the early intervention of PSD, recovery of neurological deficits and life quality. Methods The selected cases were randomly divided into treatment group(with sertraline 50mg every night) and control group(placebo 1# every night), both two groups received combined psychotherapy, and after 12 weeks of treatment, based on NIHSS, PHQ-9, HAMD, ADL rating standards, the level of COR was monitored, the effect of early intervention in depression of patients with acute cerebral infarction was evaluated, the recovery of neural function, the improvement of the quality of life and the incidence of PSD were followed. Results The treatment efficiency of two groups before and after treatment had significant difference (P<0.05), especially that of the treatment group was obvious, and the difference had statistical significance (P<0.05). After treatment, NIHSS, COR and HAMD in treatment group were all lower, ADL rating was higher, and the incidence of PSD was lower than those in control group, and the difference had statistical significance (P<0.05). Conclusion Conventional antidepressant and early psychological intervention in cerebral infarction patients with depression can promote nerve functional recovery in patients, improve the quality of life, and reduce the level of COR and the incidence of PSD. Attention should be paid to depression in acute cerebral infarction.