重复经颅磁刺激联合帕罗西汀治疗产后抑郁患者的效果观察

Observation on the effect of repetitive transcranial magnetic stimulation combined with paroxetine in treatment of patients with postpartum depression

目的 探讨重复经颅磁刺激与帕罗西汀联合治疗产后抑郁(PPD)患者的临床效果。方法 选择湖州市第三人民医院2018年5月—2021年5月期间接收的80例PPD患者,按随机数字表法分为对照组与观察组,各40例。对照组患者给予帕罗西汀治疗,在此基础上,观察组患者加用重复经颅磁刺激治疗,连续治疗8周。对比两组临床疗效与不良反应发生状况,同时比较两组治疗前与治疗8周后抑郁症状[爱丁堡产后抑郁量表(EPDS)、汉密尔顿抑郁量表(HAMD-17)]、睡眠质量[匹兹堡睡眠质量指数(PSQI)]及多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)水平。结果 治疗8周后,观察组患者临床总有效率(97.50%)较对照组患者(77.50%)高(χ^(2)=7.314,P=0.007);治疗8周后,两组患者EPDS、HAMD-17评分均较治疗前低,且观察组患者EPDS评分(12.53±1.09)分、HAMD-17评分(27.75±2.08)分更低,差异有统计学意义(t=12.111、12.395,P<0.001);治疗8周后,两组患者PSQI评分较治疗前低,且观察组患者PSQI评分(6.45±1.35)分比对照组(8.75±2.03)分更低(t=5.967,P<0.001);治疗8周后,两组患者DA、5-HT及NE水平较治疗前高,且观察组患者DA(9.89±0.68)ng/L、5-HT(389.64±30.25)ng/L、NE(210.32±18.54)ng/L、水平比对照组[(7.29±0.57)ng/L、(344.51±27.46)ng/L、(167.59±19.67)ng/L]更高(t=18.533、6.986、9.998,均P<0.001);观察组不良反应发生率(17.50%)与对照组(7.50%)对比(χ^(2)=1.829,P=0.176)。结论 重复经颅磁刺激与帕罗西汀联合治疗PPD患者可有效提高临床疗效,减轻抑郁症状,改善睡眠质量,提高DA、5-HT、NE水平,同时具有较高的安全性。

Objective To investigate the clinical effect of repetitive transcranial magnetic stimulation combined with paroxetine in the treatment of patients with postpartum depression(PPD).Methods Select 80 PPD patients received in our hospital from May 2018 to May 2021,According to the random number table method,they were divided into control group and observation group,with 40 cases in each group.The patients in the control group were treated with paroxetine,and on this basis,the patients in the observation group were additionally treated with repetitive transcranial magnetic stimulation for 8 consecutive weeks.The clinical efficacy and adverse reactions were compared between the two groups,and the depressive symptoms[Edinburgh Postpartum Depression Scale(EPDS),Hamilton Depression Scale(HAMD-17)],and sleep quality pittsburgh sleep were compared between the two groups before treatment and after 8 weeks of treatment.quality index(PSQI)and dopamine(DA),serotonin(5-HT),and norepinephrine(NE)levels.Results After 8 weeks of treatment,the total clinical effective rate(97.50%)in the observation group was higher than that in the control group(77.50%)(χ^(2)=7.314,P=0.007).lower than before treatment,and the EPDS score(12.53±1.09)and HAMD-17 score(27.75±2.08)of the observation group were lower,and the difference was statistically significant(t=12.111,12.395,P<0.001);Weeks later,the PSQI scores of the two groups were lower than those before treatment,and the PSQI scores of the observation group(6.45±1.35)were lower than those of the control group(8.75±2.03)(t=5.967,P<0.001);after 8 weeks of treatment,the levels of DA,5-HT and NE in the two groups were higher than those before treatment,and the patients in the observation group were(9.89±0.68)ng/L,5-HT(389.64±30.25)ng/L,NE(210.32 ng/L)±18.54 ng/L,the level was higher than that of the control group[(7.29±0.57)ng/L,(344.51±27.46)ng/L,(167.59±19.67)ng/L](t=18.533,6.986,9.998,all P<0.001);the incidence of adverse reactions in the observation group(17.50%)was compared with that in the control group(7.50%)(χ^(2)=1.829,P=0.176).Conclusion Acupoint sticking has good clinical effects in the adjuvant treatment of depression and insomnia patients,relieves the depressive symptoms and improves the sleep quality of the patients.