高频重复经颅磁刺激治疗脑梗死后抑郁的效果观察

Therapeutic effect of high frequency repetitive transcranial magnetic stimulation for post stroke depression

目的观察高频重复经颅磁刺激联合氟西汀治疗脑梗死后抑郁患者与单用氟西汀治疗的效果和起效时间.方法选取2017年4月至2019年3月在本院康复医学科住院、符合纳入标准的脑梗死后抑郁患者40例,随机分为治疗组和对照组,各20例.在常规治疗的基础上,对照组仅单用氟西汀治疗,治疗组在对照组的基础上加用高频重复经颅磁刺激治疗,共治疗4周,每周治疗5次.采用汉密尔顿抑制量表(HAMD)和生活质量评定量表(ADL)分别评估两组治疗前、后抑郁症状和生活依赖程度.结果治疗后两组HAMD评分均显著下降,且治疗组较对照组下降更为明显(均P<0.001).治疗组ADL第2周开始改善,而对照组第4周开始改善(P<0.001).治疗过程中,两组均未发生相应的不良反应.结论高频重复经颅磁刺激在早期(第2周)即起到改善脑梗死后抑郁患者的抑郁心境和生活状态,提高患者的康复效果,且经颅磁刺激治疗安全性高.

Objective To explore the efficacies and onset times of high frequency repetitive transcranial magnetic stimulation combined with fluoxetine versus fluoxetine alone for post-infarction depression.Methods Forty patients with post-infarction depression who met the inclusion criteria were selected from April,2017 to March,2019 in the Department of Rehabilitation Medicine of our hospital.They were randomly divided into a treatment group and a control group,with 20 cases in each group.On the basis of routine treatment,the control group was treated with fluoxetine,while the treatment group with high frequency rTMS and fluoxetine.Repeated transcranial magnetic stimulation therapy was given for 4 weeks,5 times a week.Hamilton Inhibition Scale(HAMD)and ability of daily life(ADL)were used to evaluate the depressive symptoms and life dependence before and after the treatment in the two groups.Results After the treatment,the HAMD scores of both groups decreased significantly,and decreased more in the treatment group than in the control group(all P<0.001).The ADL of the treatment group was improved from the 2nd week,while that the control group from the 4th week(P<0.001).No corresponding adverse reactions occurred in both groups during the treatment.Conclusion High frequency rTMS can improve the depressive mood,life state,and rehabilitation effect of patients with postinfarction depression in the early stage(2nd week),and is safe.