中风后抗抑郁治疗对神经功能康复疗效的临床意义

Clinical significance on recovery of nerves functional rehabilitation under treatment of post-stroke depression

目的探讨治疗中风后抑郁对神经功能康复疗效的临床意义。方法选取脑卒中后并发抑郁症的患者81例,随机分为治疗组41例(男23例,女18例),对照组40例(男21例,女19例),对照组按病情分别给予抗凝、溶栓、脱水、利尿、降压、降血糖及营养脑神经等常规治疗;治疗组则在此基础上加服氟西汀(百忧解)胶囊(20 mg/d)。疗程3个月。治疗前和治疗后1个月、3个月和6个月进行汉密尔顿抑郁量表(HAMD)和神经功能缺损评分(NIHSS)进行评定,并观察并发症情况。结果两组患者治疗后1个月、3个月和6个月的HAMD评分和NIHSS评分较治疗前明显下降(P<0.05或<0.01),对照组治疗后1个月NIHSS评分差异无统计学意义(P>0.05),且治疗组评分明显低于对照组(P<0.05或<0.01)。治疗3个月后,治疗组抑郁康复痊愈率和总有效率分别为36.6%和95.1%,明显高于对照组的15.0%、72.5%;治疗组神经功能康复痊愈率和总有效率分别为24.4%和92.7%,明显高于对照组的7.5%、75.0%,差异有统计学意义(P<0.05)。无严重并发症病例。结论脑卒中后抗抑郁治疗有利于患者神经功能恢复,改善患者的抑郁症状。

Objective To explore the clinical significance on the recovery of nerves functional rehabilitation under the treatment of post-stroke depression（PSD）. Methods Eighty-one eases with post-stroke depression were selected and divided into study group （41 eases,men 23 vs wemen 18） and control group （40 cases,men 21 vs wemen 19）. For control group, antieoagulation, thrombolysis, anhydration, diuresis, depressurization, lower blood sugar and nutrition cranial nerves were conventionally given. And for study group,the fluoxetine （20 mg/d） was given besides the eonvetional therapy for three months. Hamilton depression seale（HAMD） and national institute healthy stroke scale （NIHSS） were evaluated pretreatment and one month, three months and six months after treatment. And the complication was also observed. Results In both groups,NIHSS scores and HAMD scores were lowered at the time one month,three months and six months treatment than those of the pretreatment（ P 〈0.05 or 〈0.01）, except for NIHSS scores in control group at the time after one month treatment（ P 〉0.05） ;and NIHSS scores and HAMD scores of study group were significantly lower than those of control group（ P 〈0.05 or 〈0.01 respectively）. After three months＇ treatment, the effectiveness of study group was better than that of control group. The total effective rate （92.7 % vs 75.0% ）and the recovery rate （24.4 % vs 7.5 %） of the nerves functional rehabilitation of study group were significantly better than those of control group （ P 〈 0.05） ; and the same results occurred in the total effective rate （95.1% vs 72.5%）and the recovery rate （36.6% vs 15.0% ） of PSD（P〈0.05）. There was no serious complication in two groups. Conclusion For stroke patients the treatment for PSD with fluoxetine is useful for the nerves functional rehabilitation with good recovery of depression symptom. It should be widely used in the clinic.