帕罗西汀联合心理干预治疗卒中后抑郁/焦虑的前瞻性对照研究

Prospective Study of Effects of Paroxetine with Mental Intervention on Depression and Anxiety after Stroke

目的 探讨卒中后抑郁/焦虑对卒中患者日常生活能力和神经功能康复的影响,以及帕罗西汀联合早期心理干预的临床疗效。方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对272例脑卒中患者进行抑郁/焦虑状态评定,其中患有卒中后抑郁并发焦虑的81名患者随机分成3组,分别接受单用帕罗西汀治疗、帕罗西汀联合心理治疗以及不干预。采用斯堪的那维亚脑卒中量表(SSS)、Barthel指数(BI)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评测治疗前后的疗效。结果 急性脑卒中患者卒中后抑郁并焦虑患病率为29.78%,抑郁与焦虑共病率为65.85%,额叶、左侧大脑半球、基底节病灶与卒中后抑郁/焦虑的发生相关(额叶P <0.05、左侧大脑半球P <0.0001、基底节P <0.0001);治疗组I和治疗组II HAMD、HAMA、SSS评分减少和BI评分增加与对照组比较均有显著性差异(P均<0.01),治疗组II HAMD、HAMA、SSS评分减少和BI评分增加较治疗组I有显著性差异(P均<0.05)。结论 卒中后抑郁/焦虑的发生与脑卒中部位相关;卒中后抑郁/焦虑障碍明显降低患者神经功能康复程度和生活能力恢复;对卒中后抑郁/焦虑患者单用药物帕罗西汀或给予帕罗西汀联合心理干预治疗均能提高患者神经功能康复程度和生活能力恢复。

Objective To probe the influences of depression and anxiety on ability of daily life and neurologic functional rehabilitation, and the clinical curative effect of Paroxetine combined with psychotherapy. Methods 272 patients were assessed with SDS, SAS, the 81 patients with depression and anxiety were divided into 3 groups randomly, then treated with Paroxetine singly or Paroxetine combine with psychotherapy or not treated. SSS, BI, HAMD, HAMA were assessed to observe the curative effect before and after treatment. Results The attack rate of depression combined with anxiety in acute stroke was 29.78%, and the comorbidity was 65.85%. Depression and anxiety were related to the disease of frontal cortex, left brain and basal ganglia (frontal cortex P<0.05, left brain P<0.0001, basal ganglia P<0.0001). The reducing of SSS, HAMD, HAMA grade and increasing of BI grade in treatment group I and group II were more obvious than that in control group (P<0.01). The reducing of SSS, HAMD, HAMA grade and increasing of BI grade in treatment group II were more obvious than that in treatment group I (P all<0.05). Conclusions Depress and anxiety were related to the position of stroke; It can obvious reduce the ability of daily life and neurologic functional rehabilitation; The Patients’ ability of daily life and the degree of neurologic functional rehabilitation all can be increased by applying either Paroxetine singly or Paroxetine combined with psychotherapy, but the curative effect of Paroxetine combined with psychotherapy was better.