重复经颅磁刺激联合艾司西酞普兰对老年抑郁症的临床疗效分析

Clinical efficacy and adverse reactions of repetitive transcranial magnetic stimulation combined with escitalopram in treatment of senile depression

目的观察重复经颅磁刺激联合艾司西酞普兰对老年抑郁症的临床疗效和安全性。方法回顾性分析2016年3月—2019年3月南京医科大学附属脑科医院收治的老年抑郁症患者80例的临床资料。按治疗方案不同将患者分为观察组和对照组,每组40例。对照组采用艾司西酞普兰治疗,观察组在对照组治疗基础上联合重复经颅磁刺激治疗,比较两组治疗前后的Barthel指数、生活质量综合评定问卷(GQOLI-74)评分,采用负性认知加工偏向问卷(NCPBQ)评估负性认知偏向严重程度,采用副反应量表(TESS)跟踪测评不良反应。结果治疗后,观察组Barthel指数轻度以下患者百分比高于对照组,两组干预后同期比较,差异有统计学意义(P<0.05)。治疗前两组生活质量评分比较,差异无统计学意义(P>0.05);治疗后观察组生活质量各维度评分均高于对照组(P<0.05)。两组治疗前NCPBQ评分比较,差异无统计学意义(P>0.05),观察组治疗后NCPBQ评分4项参数值低于对照组(P<0.05)。观察组1例出现头晕,1例出现恶心,1例出现嗜睡1例,不良反应发生率为7.5%(3/40);对照组头晕2例,恶心1例、口干1例,嗜睡2例,不良反应发生率为15.0%(6/40);观察组不良反应发生率低于对照组(P<0.05)。结论重复经颅磁刺激联合艾司西酞普兰可提高老年抑郁症患者的临床疗效,改善临床症状、负性认知偏向,提高生活质量,同时具有较高的安全性。

Objective To observe the clinical efficacy and safety of repeated transcranial magnetic stimulation combined with escitalopram in the treatment of senile depression.Methods A retrospective analysis of clinical data from 80 elderly patients with depression in our hospital from March 2016 to March 2019 randomly divided into observation group and control group according to different treatment regimens,40 cases in each group,was performed.The control group was treated with escitalopram.The observation group was combined with transcranial magnetic stimulation on the basis of the control group.The Barthel index,the quality of life comprehensive assessment questionnaire(GQOLI-74)score of the two groups before and after treatment,and negative cognitive processing bias questionnaire(NCPBQ)was used to assess the severity of negative cognitive bias,and the adverse reactions were measured with symptom scale(TESS).Results After treatment,the percentage of patients with mild Barthel index in the observation group was higher than that in the control group,and the difference between the groups was statistically significant(P<0.05).There was no significant difference in the quality of life scores between the two groups before treatment(P>0.05).After treatment,the scores of life quality in the observation group were higher than those in the control group(P<0.05).There was no significant difference in NCPBQ scores between the two groups(P>0.05).The four parameters of NCPBQ scores in the observation group were significantly lower than those in the control group(P<0.05).In the observation group,1 patient developed dizziness,1 patient developed nausea,1 patient developed sleepiness,and the incidence of adverse reactions was 7.5%(3/40).In the control group,2 patients developed dizziness,1 patient with nausea and dry mouth,and 2 patients.The incidence of adverse reactions was 15%(6/40);the incidence of adverse reactions in the observation group was lower than that of the control group(χ^(2)=5.271,P<0.05).Conclusion Repetitive transcranial magnetic stimulation combined with escitalopram in the treatment of senile depression has a significant clinical effect,which can significantly improve clinical symptoms,negative cognitive bias,and quality of life,and has higher safety.