抗抑郁药氟西汀配合语言训练改善脑卒中失语患者语言神经功能及抑郁的研究

The study of antidepressive drugs Fluoxetine combined with language training in improvement of neurological function and depression in patients with stroke aphasia

目的探讨氟西汀联合语言训练改善脑卒中失语患者神经功能及抑郁状态的效果。方法选择本院收治的脑卒中伴失语患者96例,随机分为抗抑郁药组与药物加训练组。抗抑郁药组患者给予常规的脑卒中治疗及抗抑郁药氟西汀20 mg/d,共3个月;药物加训练组患者在抗抑郁药组基础上配合Schuell刺激法语言训练,30 min/次,每周2次,共2个月。采用爱丁堡-斯堪的那维亚量表(MESSS)评价患者神经功能缺损改善情况,采用日常生活能力量表(ADL)评价日常生活能力改善情况,采用HAMD抑郁量表和SDS抑郁自评量表评价患者抑郁改善情况。结果两组治疗前MESSS、ADL、HAMD、SDS评分差异无统计学意义(P>0.05);治疗2周后两组HAMD、SDS评分均较治疗前降低,药物加训练组明显低于抗抑郁药组,差异有统计学意义(P<0.05);治疗4周后两组MESSS、ADL较治疗前改善,但药物加训练组MESSS评分低于抗抑郁药组,ADL评分高于抗抑郁药组,组间差异有统计学意义(P<0.05)。结论抗抑郁药配合语言康复训练可改善脑卒中失语患者抑郁状态,减轻神经功能缺损,在脑卒中抑郁患者尤其是失语患者中有较好的应用意义。

Objective To investigate the effects of Fluoxetine combined with language training in improvement of neurologi- cal function and depression in patients with stroke aphasia. Methods 96 cases of stroke patients combined with aphasia were randomly divided into the antidepressant group and drugs combined with training group. Patients in the antidepressant group were given conventional treatment of stroke combined with Fluoxetine 20 mg/d, for 3 months; patients in the drugs combined with training group combined with Schuell stimulation language training treatment, 30 min/times, 2 times a week, a total of 2 months, on the basis of the antidepressant group. The improvement of neurological deficits was evaluated with Edinburgh Scandinavia scale （MESSS）; the improvement of activity of daily living was evaluated with activity of daily living scale （ADL）; the improvement of depression was evaluated with Hamilton depression rating scale （HAMD） and depression self rating scale （SDS）. Results The MESSS, ADL, HAMD, SDS scores of the two groups before treatment were not signifi- cantly different （P 〉 0.05）; after 2 weeks of treatment, HAMD, SDS scores were lower than before treatment in the two groups, and HAMD, SDS scores of the drugs combined with training group was significantly lower than that of the antide- pressant group, the differences were statistically significant （P 〈 0.05）; after 4 weeks of treatment, MESSS, ADL scores im- proved than before treatment, MESSS score of the drugs combined with training group was significantly lower than that of the antidepressant group, and ADL score of the drugs combined with training group was higher than that of the antidepres- sant group, differences were statistically significant （P 〈 0.05）. Conclusion Antidepressants combined with language reha- bilitation training may improve the depression state, reduce neurological deficits in stroke patients combined with aphasia, which has better application significance for stroke depression patients, especially for whom combined with aphasia.