曲唑酮联合氟西汀分散片治疗卒中后抑郁合并失眠的疗效

Effect of trazodone combined with fluoxetine in the treatment of post-stroke depression with insomnia

目的:探讨曲唑酮联合氟西汀分散片治疗卒中后抑郁合并失眠患者的疗效。方法:随机将62例卒中后抑郁伴失眠患者分为对照组(n=32)和治疗组(n=30)。对照组使用氟西汀分散片,治疗组使用曲唑酮联合氟西汀分散片。常规治疗12周,随访6~12个月。入组前及治疗后4,8,12周分别记录两组患者的临床症状,观察药物的不良反应,并进行抑郁自评量表(Self-Rating Depression Scale,SDS)、匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)及日常生活自理能力自评量表(Activity of Daily Living Scale,ADL)总分评定。结果:治疗组有效率87%,对照组有效率73%,两组比较差异具有统计学意义(χ^2=4.565,P<0.05);6个月和12个月随访,治疗组有2例反复(2例脱失),而对照组有反复(1例脱失),差异具有统计学意义(χ^2=5.163,P<0.05)。治疗12周后2组SDS,PQSI,HAMD量表评分下降幅度和ADL评分上升治疗组明显高于对照组。结论:曲唑酮联合氟西汀分散片治疗卒中后抑郁合并失眠患者,临床症状改善明显,不良反应小,复发率低。

Objective: To explore the combination effect of trazodone and fluoxetine in the treatment of post stroke depression with insomnia. Methods: Sixty-two patients with post-stroke depression were randomly divided into a control group(n=32) and a treatment group(n=30). The control group was treated with fluoxetine;the treatment group was treated with the combination of trazodone and fluoxetine dispersible tablets. The patients were treated for 12 weeks and followed-up for 6 to 12 months. Clinical symptoms, adverse reactions were recorded. The SelfDepression Scale(SDS), Pittsburgh Sleep Quality Index(PSQI), Hamilton Depression Scale(HAMD) andActivity of Daily Life Scale(ADL) were used. Results: The effective rate was significantly different between the two groups(87% in the treatment group, 73% in the control group, χ^2=4.565, P<0.05). During the follow-up, 2 cases repeated in the treatment group, and 10 cases in the control group, the difference was statistically significant(χ^2=5.163, P<0.05). After the 12-week treatment, the decrease of SDS, PQSI, HAMD scale, and increase of ADL in the treatment group were significantly higher than those of the control group. Conclusion: Trazodone combined with fluoxetine can significantly improve the clinical symptoms of patients with post stroke depression with insomnia, with less adverse reactions, lower recurrence rate.