重复经颅磁刺激联合帕罗西汀治疗老年抑郁症的疗效及对认知功能的影响

Effect of repetitive transcranial magnetic stimulation combined with paroxetine on the efficacy and cognitive function of elderly patients with depression

目的观察重复经颅磁刺激(rTMS)联合帕罗西汀治疗老年抑郁症病人的疗效及对认知功能的影响。方法 65例老年抑郁症病人随机分为rTMS组(n=33)和对照组(n=32),rTMS组给予rTMS联合帕罗西汀治疗,对照组给予伪rTMS联合帕罗西汀治疗。采用汉密尔顿抑郁量表(HAMD)评价2组的临床疗效,不良反应症状量表(TESS)评估病人不良反应发生情况,MMSE评估病人的认知功能。结果治疗后第1、2、4周末,rTMS组HAMD评分显著低于对照组及治疗前(P <0. 05)。与治疗前相比,对照组治疗后第1周末HAMD评分无明显变化(P> 0. 05);治疗后第2、4周末,HAMD评分显著降低,差异有统计学意义(P <0. 05)。治疗后第4周末,rTMS组MMSE评分显著高于对照组及治疗前(P <0. 05)。治疗期间2组不良反应发生率比较,差异无统计学意义(χ2=0. 502,P> 0. 05)。结论 rTMS联合帕罗西汀治疗老年抑郁症病人起效快、安全性高,且在改善病人认知功能方面疗效更优。

Objective To observe the effect of repetitive transcranial magnetic stimulation(rTMS) combined with paroxetine and the influencing on cognitive function in the elderly patients with depression.Methods Sixty-five elderly patients with depression were divided into rTMS group(n=33)and control group(n=32) randomly.The rTMS group was treated by rTMS combined with paroxetine,and the control group was treated by pseudo-rTMS combined with paroxetine.The clinical efficacy and adverse reactions were evaluated by Hamilton Depression Scale(HAMD) and Treatment Emergent Symptom Scale(TESS) respectively.The cognitive function was assessed by the Mini Mental State Examination(MMSE).Results At the first,second and fourth weekends after treatment,the HAMD score of the rTMS group was lower than that of the control group and before treatment(P <0.05).Compared with before treatment,there was no significant change in HAMD score of the control group at the first weekend after treatment(P> 0.05),but significantly lower at the second and fourth weekends after treatment(P <0.05).At the fourth weekends after treatment,the MMSE score of the rTMS group was higher than that of the control group and before treatment(P <0.05).There was no difference in the incidence rate of adverse reactions between the two groups(χ~2=0.502,P> 0.05).Conclusions rTMS combined with paroxetine is effective and safe in the treatment of senile depression,and has better effect in improving cognitive function.