老年脑卒中后抑郁综合治疗对照研究

A control study of combined treatment for senile poststroke depression

目的探讨老年脑卒中后抑郁综合治疗的临床效果。方法将164例老年脑卒中患者中69例脑卒中后抑郁患者随机分为两组，研究组35例，对照组34例，两组均施以神经内科常规治疗，康复与针灸按摩等治疗；在此基础上研究组每日早晨口服盐酸帕罗西汀治疗及心理干预治疗。观察8w。于治疗前及治疗8w末采用抑郁自评量表、汉密顿抑郁量表评定两组患者抑郁状况，改良爱丁堡-斯堪的那维亚脑卒中评分量表评定神经功能缺损状况。结果老年脑卒中后抑郁发生率为42．07％，文化程度越高，抑郁发生率越高；与性别、年龄无明显相关。研究组治疗后抑郁自评量表、汉密顿抑郁量表及改良爱丁堡-斯堪的那维亚脑卒中量表均较治疗前有显著下降（P〈0.01），且均显著低于对照组（P〈0．01）。结论老年脑卒中患者抑郁发生率较高，是生物-心理-社会因素共同作用的结果，综合治疗对老年卒中后抑郁有重要意义。

Objective To explore the efficacy of combined treatment tor senile poststroke oepression（PSD）. Methods Of 164 senile patients with poststroke depression,69 ones were randomly divided into research （n =35） and control group （n =34）, both gouprs received neuromedical routine treatment, rehabilitation,acupuncture,massage and so on; in addition, research group was plus morning oral paroxetine hydrochloride quotidie and psychotherapy. They were observed for 8 weeks. Depressive conditions were assessed with the Self-rating Depression Scale （SDS） Hamilton Depression Scale （HAMD） and neurologic impairment with the Modified Edinberg-scandinavian Stroke Scale（MESSS） before treatment and at the end of the 8th week treatment. Results The incidence of PSD was 42. 07%, the higher eudcational level, the higher depression incidence; the incidence was not obviously related to gender and age. ;after treatment, the SDS, HAMD and MESSS scores lowered more significantly compared with pretreatment in the research group（P〈0.01） and all were significantly lower than in the control group（P〈0.01）. Conclusion The incidence of senile PSD is higher, which is the result of combined actions of biological-psychological-social factors,and combined treatment has great significance for the treatment of senile PSD.