认知行为疗法联合米氮平治疗脑卒中后抑郁疗效观察

Effect of mirtazapine combined with cognitive behavioral therapy on patients with post-stroke depression

目的探讨认知行为疗法联合米氮平治疗脑卒中后抑郁的治疗效果。方法将2014年3月至2016年3月新乡医学院第二附属医院收治的86例脑卒中后抑郁患者随机分为对照组和观察组,每组43例。对照组患者给予米氮平治疗,观察组患者在米氮平治疗基础上进行认知行为治疗,分别于治疗前及治疗2、4、6周使用汉密尔顿抑郁量表(HAMD)评估患者抑郁程度,使用威斯康星卡片分类测验(WCST)评估患者治疗前后的认知功能。结果 2组患者治疗前HAMD及WCST各项目评分比较差异无统计学意义(P>0.05)。治疗2、4、6周,2组患者HAMD评分均显著低于治疗前(P<0.05),且观察组患者HAMD评分显著低于对照组(P<0.05)。治疗4、6周,2组患者HAMD评分均显著低于治疗2周时(P<0.05);治疗6周,2组患者HAMD评分均显著低于治疗4周时(P<0.05)。治疗4周,2组患者持续应答数、错误应答数、持续错误数评分均显著低于治疗前(P<0.05),观察组患者完成分类数评分显著高于治疗前(P<0.05),对照组患者完成分类数评分与治疗前比较差异无统计学意义(P>0.05)。治疗6周,2组患者完成分类数评分显著高于治疗前(P<0.05),持续应答数、错误应答数、持续错误数评分均显著低于治疗前(P<0.05)。2组患者治疗2、4周时WCST各项目评分比较差异均无统计学意义(P>0.05);治疗6周时,观察组患者完成分类数评分显著高于对照组(P<0.05),持续应答数、错误应答数、持续错误数评分显著低于对照组(P<0.05)。治疗6周时,对照组与观察组患者的治疗有效率分别为79.1%(34/43)、86.0%(37/43),观察组患者治疗有效率显著高于对照组(χ2=1.247,P<0.05)。结论脑卒中后抑郁患者应用米氮平联合认知行为治疗及米氮平单药治疗均可改善抑郁症状,但米氮平联合治疗的临床效果更佳纯米氮平。

Objective To investigate the effect of mirtazapine combined with cognitive behavioral therapy on post-stroke depression.Methods A total of 86 patients with post-stroke depression in the Second Affiliated Hospital of Xinxiang Medical University from March 2014 to March 2016 were selected as the research subjects.The patients were divided into control group and observation group according to the treatment method,43 cases in each group.The patients in the control group were treated with mirtazapine,while the patients in the observation group were treated with cognitive behavioral therapy and mirtazapine.The degree of depression of all patients were assessed with Hamilton depression scale(HAMD)before treatment and 2,4 and 6 weeks after treatment.The cognitive function was evaluated by the Wisconsin card sorting test(WCST)before and after treatment.Results There was no significant difference in the scores of HAMD and WCST between the two groups before treatment(P>0.05).The HAMD score of the patients at 2,4 and 6 weeks after treatment was significantly lower than that before treatment in the two groups(P<0.05).The HAMD score of the patients in the observation group was significantly lower than that in the control group at 2,4 and 6 weeks after treatment(P<0.05).The HAMD score of the patients at 4 and 6 weeks after treatment was significantly lower than that at 2 weeks after treatment in the two groups(P<0.05).The HAMD score of the patients at 6 weeks after treatment was significantly lower than that at 4 weeks after treatment in the two groups(P<0.05).The scores of perseverative response,response errors and perseverative responses errors of the patients in the two groups at 4 weeks after treatment were significantly lower than those before treatment(P<0.05).The categories completed score of the patients in the observation group at 4 weeks after treatment was significantly higher than that before treatment(P<0.05).There was no significant difference in the categories completed score before and 4 weeks after treatment in the control group(P>0.05).Compared with before treatment,the categories completed score of the patients was significantly higher(P<0.05),and the scores of the perseverative response,response errors and persev-erative responses errors were significantly lower at 6 weeks after treatment in the two groups(P<0.05).There was no significant difference in WCST score between the two groups at 2 and 4 weeks after treatment(P>0.05).The categories completed score of the patients in the observation group was significantly higher than that in the control group at 6 weeks after treatment(P<0.05).The scores of perseverative response,response errors and perseverative responses errors of the patients in the observation group were significantly lower than those in the control group at 6 weeks after treatment(P<0.05).The effective rate in the control group and the observation group was 79.1%(34/43)and 86.0%(37/43)respectively after 6 weeks of treatment,the effective rate in the observation group was significantly higher than that in the control group(χ2=1.247,P<0.05).Conclusion Both mirtazapine combined with cognitive behavioral therapy and simple mirtazapine can improve depressive symptoms of patients with post-stroke depression,but the clinical effect of mirtazapine combined cognitive behavioral therapy is superior to simple mirtazapine.