早期应用小剂量阿米替林干预首发脑卒中患者脑卒中后抑郁

Prophylactic small dose amitriptyline in prevention of poststroke depression in first stroke patients

目的 通过临床试验研究证实早期应用小剂量阿米替林对首发脑卒中后抑郁（PSD）的干预作用.方法 选取123例首发脑卒中患者并随机分为干预组和对照组.干预组连续1个月以上每晚口服小剂量（12.5 mg）阿米替林,对照组为空白对照.调查患者的入院时及1个月后的基本情况、抑郁状态、神经功能缺损状态和日常生活能力.结果 干预治疗后,阿米替林干预组PSD的患病率为16.4%（10/61）,明显低于对照组的51.6%（32/62）.干预治疗结束时,阿米替林干预组的NIHSS评分为2.83±1.74,低于对照组（3.64±1.93）;而阿米替林干顶组的ADL评分为93.0±16.1,高于对照组的87.0±37.1.为排除混杂因素,多因素分析结果显示：ADL评分前后变化与首次脑卒中患者PSD患病率明显相关（RR=3.01,P=0.04）;NIHSS评分前后变化与首次脑卒中患者PSD患病率明显相关（RR=2.42,P=0.03）;是否应用小剂量阿米替林与首次脑卒中患者PSD患病率明显相关（RR=3.11,P=0.01）.结论 给予小剂量阿米替林干预性治疗能降低首次脑卒中患者PSD的患病率,并且使其神经功能缺损降低,日常生活能力提高.

Objective To test whether the prophylactic small dose amitriptyline has any beneficial influence on the rate of poststroke depression （PSD） by clinical experiment. Methods All 123 patients with first stroke were divided into the intervention group and the control group according to the block randomization tables. The patients in the intervention group were treated with 12. 5 mg amitriptyline every night for more than 1 month and the control group was blank Before and at the end of the observation, the rate of PSD and activities of daily living （ADL）, degree of neurological deficit （NIHSS） of all the subjects were assessed. Results At the end of the one-month treatment, the intervention group had lower rate of PSD （16. 4% ） than the control （51.6%）;and they had lower score in NIHSS （2. 83 ± 1.74 vs 3. 64 ±1.93） and higher score in ADL （93.0 ± 16. 1 vs 87.0 ± 37. 1） than the control. Multivariate Logistic regression analysis showed： the change of ADL score was closely related to the rate of PSD （RR =3.01 ,P =0. 04）; the change of NIHSS score was closely related to the rate of PSD （ RR = 2. 42, P = 0. 03 ）;prophylactic small dose amitriptyline was closely related to PSD （ RR = 3.11, P = 0. 01 ）. Conclusions Prophylactic small dose amitriptyline can decrease the rat of PSD, reduce the neurologic impairment and improve the activity of daily living.