艾司西酞普兰联合rTMS对老年脑卒中后抑郁患者认知功能和负性情绪的影响

Impact of escitalopram combined with repetitive transcranial magnetic stimulation on cognitive function and negative emotions in elderly patients with post-stroke depression

目的评估艾司西酞普兰联合重复经颅磁刺激(rTMS)在老年脑卒中后抑郁患者中的应用效果。方法本研究为前瞻性、单中心、单盲、对照试验。选取榆林市星元医院在2021年1月至2023年12月收治的106例老年脑卒中后抑郁患者,通过随机数字表法分为两组,每组53例。对照组中,男29例、女24例,年龄(64.38±7.24)岁;观察组中,男27例、女26例,年龄(64.63±7.36)岁。对照组采用艾司西酞普兰治疗,观察组采用艾司西酞普兰联合rTMS治疗,4周为1个疗程,均治疗2个疗程。比较两组患者治疗前后单胺类神经递质水平、神经营养因子水平、脑血流状态[脑中动脉平均血流速度(Vm)、收缩期峰流速(Vs)、搏动指数(PI)]、脑白质结构变化,并通过蒙特利尔认知评估量表(MoCA)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、卒中患者生活质量量表评估患者治疗前后的认知功能、负性情绪和生活质量。统计学分析采用t检验、χ^(2)检验。结果治疗后,观察组单胺类神经递质水平、神经营养因子水平高于对照组,脑白质损伤评分低于对照组;观察组患者Vm、Vs、PI分别为(57.88±6.95)cm/s、(96.67±8.32)cm/s、(0.68±0.19),对照组分别为(50.17±6.03)cm/s、(90.14±7.83)cm/s、(0.87±0.26);观察组MoCA和生活质量评分分别为(24.18±3.01)分、(159.15±24.26)分,均高于对照组[(20.04±2.93)分、(130.52±20.18)分],HAMA和HAMD评分分别为(12.26±2.09)分、(13.81±2.13)分,均低于对照组[(17.45±2.43)分、(18.69±2.34)分];两组上述指标比较,差异均有统计学意义(均P<0.05)。结论艾司西酞普兰联合rTMS治疗有助于提高老年脑卒中后抑郁患者的认知功能,并降低负性情绪。

Objective To evaluate the effectiveness of escitalopram and repetitive transcranial magnetic stimulation(rTMS)for elderly patients with post-stroke depression.Methods One hundred and six elderly patients with post-stroke depression treated at Xingyuan Hospital of Yulin from January 2021 to December 2023 were selected for the randomized controlled trial,and were divided into a control group and an observation group,with 53 cases in each group.In the control group,there were 29 males and 24 females who were(64.38±7.24)years old.In the observation group,there were 27 males and 26 females who were(64.63±7.36)years old.The control group took escitalopram,while the observation group took escitalopram and rTMS.Four weeks was one treatment cycle,and both groups were treated two cycles.The levels of monoamine neurotransmitters and neurotrophic factors,cerebral blood flow status[mean cerebral artery flow velocity(Vm),peak systolic flow velocity(Vs),pulsatility index(PI)],and changes in white matter structure were compared between the two groups before and after the treatment.Their cognitive functions,negative emotions,and quality of life were assessed using the Montreal Cognitive Assessment(MoCA),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),and Stroke-Specific Quality of Life Scale.t andχ^(2)tests were used.Results After the treatment,the levels of monoamine neurotransmitters and neurotrophic factors and score of white matter injury in the observation group were better than those in the control group;the Vm,Vs,and PI in the observation group were(57.88±6.95)cm/s,(96.67±8.32)cm/s,and(0.68±0.19),and those in the control group(50.17±6.03),(90.14±7.83)cm/s,and(0.87±0.26);the scores of MoCA,life quality,HAMA,and HAMD in the observation group were better than those in the control group[(24.18±3.01)vs.(20.04±2.93),(159.15±24.26)vs.(130.52±20.18),(12.26±2.09)vs.(17.45±2.43),and(13.81±2.13)vs.(18.69±2.34)];there were statistical differences in the above indicators between the two groups(all P<0.05).Conclusion Escitalopram combined with rTMS for elderly patients with post-stroke depression can improve their cognitive function and reduce their negative emotions.