氟西汀对卒中后抑郁的预防性研究

Preventive Effects of Fluoxetine on Post-stroke Depression

目的探讨氟西汀对卒中后抑郁(PSD)的预防及神经功能康复的影响。方法随机选择一周内住院的76例急性脑卒中患者,治疗组36例,在进行急性脑卒中常规药物治疗同时加用氟西汀治疗8周,对照组40例,仅进行常规药物治疗8周,采用改良爱丁堡斯堪的那维亚评分量表(MESS)、日常生活能力量表(ADL)、汉密尔顿抑郁量表(HAMD)评定脑卒中患者治疗前及治疗4周、8周后神经功能缺损程度、日常生活能力及PSD发生率。结果两组治疗4、8周后,MESS和ADL评分与治疗前比较均降低,差异有显著性(P<0.01),HAMD评分较治疗前均升高,治疗组差异无显著性(P>0.05),对照组差异有显著性(P<0.01),治疗组与对照组同期比较MESS,ADL,HAMD评分差异有显著性(P<0.05,P<0.01)。治疗组与对照组同期比较PSD发生率降低,差异有显著性(P<0.01),且未发现明显不良反应。结论预防性应用氟西汀有利于急性脑卒中患者的神经功能康复,降低PSD发生率。

OBJECTIVE To study the effect of early prophylactic treatment by fluoxetine on the rate of post-stroke depression （PSD） and rehabilitation of stroke patients. METHODS A total of 76 patients were randomly assigned to receive a 8-week course of fluoxetine（ n = 36） or routine drug therapy （n = 40 ） within one week after a stroke. Degree of neurological deficit, activities of daily living （ADL） and the rate of PSD were assessed with modified Edinburgh-scandinavia Scale （MESS）, ADL and Hamilton depression rating scales（HAMD） before treatment ,4 and 8 weeks after treatment respectively. RESULTS Compared with the baseline, MESS, ADL scores decreased significantly in the two groups after 4 weeks and 8 weeks of treatment （ P 〈 0.01 ）. HAMD scores increased in the two groups,HAMD scores of control group increased significantly compared with the baseline （P 〈 0.01 ）. MESS, ADL and HAMD scores of treatment group were different significantly compared with control group （P 〈0.05 ,P 〈0.01 ）. At the end of 4 weeks and 8 weeks treatment,the treatment group has lower rate of PSD than that of control respectively. No obvious adverse reaction occurred in the treatment group. CONCLUSION Prophylactic treatment by fluoxetine can improve the neurological function of post-stroke patients and decrease the rate of PSD