氟西汀对急性脑梗死患者抑郁及功能康复的疗效研究

Efficacy of fluoxetine in treatment of depression and functional rehabilitation in patients with acute cerebral infarction

目的探索氟西汀对急性脑梗死（ACI）患者抑郁及运动功能、认知功能障碍的疗效。方法选取长寿区人民医院2012年1-12月收治的186例确诊ACI患者为研究对象,将其随机分为对照组和观察组,各93例。对照组给予脱水、降糖等常规治疗,观察组在此基础上加用氟西汀20mg/d,两组患者均连续用药12个月。采用汉密尔顿抑郁量表（HAMD）对患者的抑郁状况进行测评,采用美国国立卫生研究院卒中量表（NIHSS）对运动功能进行测评,采用蒙特利尔认知评估量表（MoCA）对认知功能进行测评。比较治疗前后及两组间各项评分。结果两组患者治疗3个月后,NIHSS评分均较治疗前降低,比较差异均有统计学意义（P〈0.05）;且观察组治疗3、6、12个月后NIHSS评分均小于对照组,组间比较差异均有统计学意义（P〈0.05）。对照组患者治疗后MoCA评分和抑郁状况与治疗前比较,差异均无统计学意义（P〉0.05）;而观察组患者在治疗3个月后,MoCA评分均较治疗前增加,抑郁状况也较治疗前改善,与治疗前比较差异均有统计学意义（P〈0.05）。结论在常规治疗的基础上加用氟西汀,可有效减轻ACI患者的抑郁状况,改善患者的运动功能和认知功能,但需要坚持中长期用药。

Objective To investigate the efficacy of fluoxetine in treating depression,motor dysfunction and cognitive dysfunction in the patients with acute cerebral infarction（ACI）.Methods 186 patients with ACI hospitalized in our hospital from Jan 2012 to Dec 2012 were enrolled in this study and randomly assigned to the control group（n=93）and the observation group（n=93）.The control group received the conventional therapy,including dehydration and reducing blood glucose.On the basis of the control group treatment,the observation group was given additional fluoxetine（20mg/d）.The two groups were treated for 12 consecutive months.The depression status was evaluated by using the Hamilton Depression Scale（HAMD）,the motor function was evaluated by using the National Institutes of Health Stroke Scale（NIHSS）,and the cognitive function was evaluated by using the Montreal Cognitive Assessment Scale（MoCA）.The scores were compared before and after treatment and between the two groups.Results The NIHSS scores after 3-month treatment in the two groups were significant declined compared with before treatment,the difference had statistical significance（P〈0.05）,moreover the NIHSS scores after 3-,6-,12-month treatment in the observation group were significantly less than those in the control group,the differences between among groups had statistical significant（P〈0.05）.The MoCA scores and the depression status in the control group had no statistical differences between before and after treatment（P〉0.05）;while the MoCA scores after 3-months treatment in the observation group were increased than that before treatment（P〈0.05）,and the depression status was improved to some extent（P〈0.05）.Conclusion Adding fluoxetine on the basis of the conventional therapy could effectively relieve the depression status of the patients with ACI,improve their motor function and cognitive function,but it is needed to insist middle and long term medication.