度洛西汀治疗体位性低血压伴焦虑抑郁的疗效观察

Clinical Observation on Duloxetine in the Treatment of Orthostatic Hypotension with Anxiety and Depression

目的观察度洛西汀对伴有焦虑抑郁的体位性低血压的疗效和安全性。方法筛选2013年3月—2015年3月河北医科大学第一医院门诊或病房收治的体位性低血压病人30例,其中合并焦虑抑郁情绪者16例,采用度洛西汀治疗(度洛西汀组),另14例采用盐酸米多君治疗(米多君组)。在用药前及用药2周、8周后,根据1周内头晕、晕厥发生的次数、立卧位血压的变化、皮肤交感反应(SSR)、汉密尔顿焦虑量表(HAMA)14、汉密尔顿抑郁量表(HAMD)24的变化评定药物疗效,用不良反应量表(TESS)评定用药的安全性。结果药物疗效评价:头晕、晕厥的每周发生次数:两组治疗后均较治疗前有明显下降(P<0.001),在治疗第8周末,度洛西汀组1周内头晕、晕厥发生的次数明显低于米多君组[(2.05±1.98)次/周vs(6.28±2.15)次/周,t=5.609,P<0.001]。立卧位血压:度洛西汀组和米多君组收缩压及舒张压与用药前相比均明显降低(P<0.01)。皮肤交感反应变化:两组治疗后潜伏期较治疗前缩短(P<0.05),波幅较治疗前升高(P<0.05)。度洛西汀组治疗后HAMA14分值(F=297.57,P<0.001)、HAMD24分值(F=180.16,P<0.001)与治疗前相比均有明显下降。TESS评定:两组间的药物不良反应比较差异无统计学意义(P>0.05)。结论度洛西汀不但能改善体位性低血压病人的焦虑抑郁情绪,而且通过提高立位血压,可有效缓解体位性低血压导致的眩晕及晕厥,改善自主神经功能。

Objective To investigate the efficacy and security of duloxetine in the treatment of orthostatic hypotension with anxiety and depression.Methods Thirty patients with orthostatic hypotension in the First Hospital of Hebei Medical University from March2013 to March 2015 were screened.Sixteen patients with anxiety and depression were treated with duloxetine,and 14 cases were treated with midodrine hydrochloride.The drug efficacy was evaluated by the times of dizziness or syncope occurred within one week,orthostatic blood pressure changes,sympathetic skin response（SSR）,the changes of Hamilton Anxiety Rating Scale（HAMA14）and Hamilton Depression Rating Scale（HAMD）24 before and 2 weeks,8 weeks after treatment.Treatment Emergent Symptom Scale（TESS）was used to evaluate the drug safety.Results Drug efficacy evaluation showed that the weekly occurrence times of dizziness and syncope were significantly decreased after treatment in two groups（P〈0.001）.At the 8nd weekend after treatment,the weekly occurrence times of dizziness and syncope in duloxetine group was obviously lower than that in midodrine group[（2.05±1.98）times/week vs（6.28±2.15）times/week,t=5.609,P〈0.001].Orthostatic hypotension showed that the systolic and diastolic blood pressure were decreased after treatment in two groups（P〈0.01）.The SSR showed that the latency were shorter and the amplitude were higher in two groups compared with before treatment（P〈0.05）.The scores of HAMA14 and HAMD24 were significantly decreased in duloxetine group compared with before treatment（F =297.57,180.16,P〈0.001）.There was no significant difference in the levels of the incidence of adverse drug reactions between two groups（P〉0.05）.Conclusion Duloxetine can improve the anxiety and depression of patients with orthostatic hypotension,relieve dizziness and syncope caused by orthostatic hypotension,promote autonomic nerve function,especially applicable to the orthostatic hypotension patients complicated with anxiety and depression.