不同治疗方法对卒中后抑郁患者的效果比较

A comparative study on the efficacy of different treatment methods in patients with post-stroke depression

目的比较不同治疗方法对卒中后抑郁患者的疗效差异。方法选取109例卒中后抑郁患者为研究对象,使用随机数字表法分为对照组(36例)、研究1组(38例)和研究2组(35例)。对照组单用药物治疗,研究1组为药物联合低频重复经颅磁刺激治疗,研究2组为药物联合认知行为治疗。观察治疗1、3、6个月后3组患者抑郁症状改善、神经功能缺损、日常生活能力及安全性等情况。结果基线时,3组蒙哥马利抑郁评定量表(MADRS)评分、中国卒中量表(CSS)评分、改良巴塞尔指数(MBI)评分差异均无统计学意义(P>0.05)。治疗1、3、6个月后研究1组、研究2组均较对照组MADRS评分下降更明显,差异有统计学意义(P<0.01),且研究1组与研究2组在治疗1、3个月后之间结果差异无统计学意义(P>0.05),在治疗6个月后研究1组仍较研究2组效果更好,差异有统计学意义(P<0.05)。治疗1、3、6个月后研究1组、研究2组与对照组比较,其CSS评分差异无统计学意义(P>0.05),但均较治疗前明显下降,差异有统计学意义(P<0.01)。治疗1、3、6个月后研究1组、研究2组MBI评分均显著高于对照组,差异有统计学意义(P<0.01),但研究1组与研究2组之间比较,差异无统计学意义(P>0.05)。结论药物联合低频重复经颅磁刺激治疗与药物联合认知行为治疗均能有效改善抑郁症状及日常生活能力,但药物联合经颅重复磁刺激治疗效果更明显,而药物联合认知行为治疗则可能需要更持续的心理治疗时间及观察时间。

Objective To compare the efficacy between different treatment methods in patients with post-stroke depression. Methods 109 cases of patients with post-stroke depression were divided into control group, observation Group 1 and observation Group 2. The control group were given medicine only, while the observation Group 1 were given low frequency repetitive transcranial magnetic stimulation combined with medicine and the observation Group 2 were given the cognitive behavioral therapy with medicine. The depressive symptoms, neurological defect, ability of daily living and security were observed after treatment of 1 month, 3 months and 6 months. Results There were no statistically significant differences of the scores of MADRS, CSS and MBI in different groups at baseline. The scores of MADRS in observation Group 1 and observation Group 2 had greater decreases after treatment of 1 month, 3 months and 6 months than the control group(P<0.01). There were also a statistically significant difference between the observation Group 1 and observation Group 2 after treatment of 6 month(P<0.01). The scores of CSS of all the three groups had no statistically significant differences after treatment of 1 month, 3 month and 6 month(P>0.05). The scores of MBI in observation Group 1 and observation Group 2 had greater increases after treatment of 1 month, 3 month and 6 month than the control group(P<0.01). There were no statistically significant difference between the observation Group 1 and observation Group 2 after treatment of 6 month(P>0.05). Conclusion The results showed that the treatment of both low frequency repetitive transcranial magnetic stimulation with medicine and cognitive behavioral therapy with medicine could improve symptoms of depression and ability of daily living. The impact of the former one is more pronounced while the latter one needs more application time and observing time.