艾司西酞普兰治疗慢性主观性头晕32例

Use of Escitalopram for Treatment of Chronic Subjective Dizziness: A Report of 32 Cases

目的探讨艾司西酞普兰治疗慢性主观性头晕的疗效与安全性。方法将90例慢性主观性头晕患者随机分为药物治疗组（32例）、前庭康复组（27例）和心理干预组（31例）。药物治疗组给予艾司西酞普兰10~20 mg·d-1,po;前庭康复组进行前庭功能康复训练;心理干预组进行认知行为疗法。疗程均为6周。治疗前后,3组患者分别进行眩晕残障程度评定量表（DHI）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评定疗效。结果治疗6周后,3组间HAMA、HAMD、DHI总评分及各因子分均较治疗前显著下降（P〈0.01）。药物治疗组与前庭康复组治疗后DHI总评分[分别为（30.45±15.84）和（36.15±13.07）分]、躯体因子分[分别为（10.06±4.49）和（10.23±4.64）分]及功能因子分[分别为（10.71±5.95）和（11.23±5.03）分]均差异无统计学意义（P〉0.05）,但均明显低于心理干预组[分别为（43.86±12.48）,（14.43±4.37）,（17.57±4.37）分]（P〈0.05,或P〈0.01）。药物治疗组与心理干预组治疗后DHI情感因子分[分别为（9.68±5.68）,（11.86±4.74）分]、HAMA[分别为（9.97±4.72）,（12.18±4.16）分]及HAMD[分别为（10.26±4.91）,（12.32±4.53）分]评分差异无统计学意义（P〉0.05）,均明显低于前庭康复组[分别为（14.69±4.76）,（14.96±4.77）,（14.88±4.65）分]（P〈0.05,或P〈0.01）。结论艾司西酞普兰可较全面改善慢性主观性头晕患者躯体、情感、功能等症状,前庭康复训练与认知行为疗法则有其各自的优势。

Objective To investigate the clinical efficacy and safety of escitalopram in the treatment of chronic subjective dizziness（ CSD）. Methods A total of 90 CSD patients randomly divided into medication group（ n = 32）,vestibular rehabilitation group（ n = 27） and psychological intervention group（ n = 31）.Patients in the medication group treated with escitalopram（ 10-20 mg·d-1,PO）,those in the vestibular rehabilitation group were underwent vestibular rehabilitation training and those in the psychological intervention group were given cognitive behavioral therapy. The treatment course lasted six weeks. All patients were evaluated by z DHI,HAMA and HAMD before and after the treatments. Results The total scores of HAMA,HAMD,DHI and the respective factor scores of DHI were significantly decreased in each group after 6-week treatment when compared with those before the treatment（ P〈0.01）.The total scores of DHI was（ 30.45± 15.84） in medication group and（ 36.15± 13.07） in vestibular rehabilitation group,the physical factor score was（ 10.06±4.49） in medication group and（ 10.23±4.64） in vestibular rehabilitation group,and the functional factor score was（ 10.71±5.95） in medication group and（ 11.23±5.03） in vestibular rehabilitation group,respectively.There were no significant differences in the three indices between medication group and vestibular rehabilitation group.But they were significantly lower than those in psychological intervention group [（ 43. 86 ± 12. 48）,（ 14.43±4.37）,and（ 17.57±4.37） for total scores of DHI,physical factor scores and functional factor scores,respectively]（ P〈 0.05,or P〈0.01）.The emotional factor scores of DHI were（ 9.68±5.68） and（ 11.86± 4.74）,HAMA scores（ 9.97± 4.72） and（ 12.18±4.16）,HAMD scores（ 10.26±4.91） and（ 12.32±4.53） in medication group and psychological intervention group（ P〉0.05）,respectively.They were significantly lower in the two groups than in vestibular rehabilitation group [（ 14.69±4.76）,（ 14.96±4.77）and（ 14.88±4.65） for the emotional factor score,HAMA score and HAMD score,respectively,P〈0.05 for all]. Conclusion Escitalopram can improve the symptoms of CSD involving the body,emotion and function.The vestibular rehabilitation training and cognitive behavioral therapy have their respective advantages.