重复经颅磁刺激联合度洛西汀在伴躯体症状老年抑郁症患者中的疗效

The clinical efficacy of repetitive rTMS combined with duloxetine in elderly patients with depressive disorder accompanied by somatic symptoms

目的评价重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合度洛西汀在伴躯体症状老年抑郁症患者中的疗效。方法选取2018年12月至2019年12月住院治疗的伴躯体症状老年抑郁症患者186例,随机数表法随机分为对照组及观察组,每组93例,分别采用度洛西汀及度洛西汀联合rTMS治疗。干预前及干预结束后2个月采用老年抑郁量表(GDS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、重复性成套神经心理状态测试(RBANS)以及不良反应量表(TESS)评价2组的干预效果,并采用临床疗效总量表评估治疗有效率。结果对照组和观察组治疗总有效率分别为93.55%及82.80%,观察组显著高于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者治疗前HAMD评分、GDS评分及HAMA评分对比差异无统计学意义(P>0.05),治疗后上述指标均显著低于下降且观察组均显著低于对照组(P<0.05)。治疗前2组患者即刻记忆、视觉广度、言语、注意、延迟记忆等评分比较差异无统计学意义(P>0.05),治疗后上述指标均显著升高且观察组显著高于对照组(P<0.05)。治疗前2组患者TESS评分对比差异无统计学意义(P>0.05),治疗后TESS评分均显著降低且观察组显著低于对照组(P<0.05)。结论重复经颅刺激联合度洛西汀可以显著改善伴躯体症状的老年抑郁症患者的心理状况,具有较高的有效性和安全性,值得进一步推广。

Objective To investigate the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)combined with duloxetine in elderly patients with depressive disorder accompanied by somatic symptoms.Methods A total of 186 elderly patients with depression accompanied by somatic symptoms who were treated in our hospital from December 2018 to December 2019 were enrolled in the study,who were randomly divided into control group and observation group,with 93 cases in each group.The patients in control group were treated by duloxetine only,however,thepatients in observation group were treated by duloxetine combined with rTMS.The Geriatric Depression Scale(GDS),Hamilton Anxiety Scale(HAMA),Geriatric Depression Scale(GDS),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)and Treatment Emergent Symptom Scale(TESS)were used to evaluate the therapeutic effects,and the total clinical efficacy table was used to evaluate the effective rate.Results The total effective rate observation group was 93.55%,which was significantly higher than that(82.80%)in control group(P<0.05).Before treatment,there were no significant differences in HAMD score,GDS score and HAMA score between the two groups(P>0.05).After treatment,the above indexes in observation group were significantly lower than those in control group(P<0.05).Before treatment,there were no significant differences in the scores of immediate memory,visual span,speech,attention,and delayed memory between the two groups(P>0.05).After treatment,the above indexes in observation group were significantly higher than those in control group(P<0.05).Moreover the TESS scores in observation group were significantly lower than those in control group(P<0.05).Conclusion The rTMS combined with duloxetine can significantly improve the psychological status of elderly patients with depression accompanied by somatic symptoms,with better effectiveness and safety,therefore,which is worthy of further promotion.