抗抑郁治疗对老年脑卒中后抑郁及康复的影响

The effects of anti-depression therapy on post-stroke depression and neurologic rehabilitation in the elderly patients

目的 观察抗抑郁治疗对老年缺血性脑卒中后抑郁症状及神经功能康复的影响。 方法 老年脑卒中后抑郁患者 178例分为百忧解 (氟西汀 )治疗组 6 4例、阿米替林治疗组 5 8例及对照组 5 6例 ;3组均行常规脑血管病治疗 ,百忧解治疗组加用百忧解每天 1次晨服 ,剂量 2 0～ 80mg ;阿米替林治疗组加用阿米替林每天 2次 ,剂量 5 0～ 10 0mg。于治疗前 ,治疗后第 1、2、4、8周 ,3、6、12个月分别进行汉密尔顿抑郁量表 (HAMD)评分和神经功能缺损、日常生活能力 (ADL)评定。 结果 第 2周HAMD评分百忧解治疗组从 2 7 7± 6 9降至 17 3± 5 9,阿米替林组从 2 6 9± 6 9降至 15 7± 4 2 ,较治疗前和对照组明显降低 (P <0 0 5 ) ;第 12周神经功能缺损百忧解组降至 11 8± 5 7,阿米替林组降至 11 9± 6 1,较治疗前及对照组均明显降低 (P <0 0 5 ) ;3个月后日常生活能力指数百忧解组上升到 6 9 0± 5 1,阿米替林组上升到 6 7 0± 6 2 ,较治疗前及对照组亦明显改善 (P <0 0 5 ) ;而且治疗组并发症明显少于对照组 (P <0 0 1) ,脑卒中复发及死亡均低于对照组 (P <0 0 1)。百忧解与阿米替林疗效相近 ,但不良反应明显低于阿米替林。 结论 抗抑郁治疗能有效地控制老年脑卒中后抑郁症状 ,百忧解对老年卒中后?

Objective To observe the effects of anti depression therapy on post stroke and neurological rehabilitation in the elderly. Methods There were 178 post stroke depression (PSD) cases. They were divided into 3 groups: 64 cases taking Prozac once every morning about 20 80 mg daily; 58 cases taking amitriptyline twice everyday about 50 100 mg daily and 56 cases taking placebo as control group. All of them were on the regular treatment of cerebrovascular disease. All the cases were evaluated according to the HAMD score, neurological function impairment and ADL before treatment and 1 st , 2 nd , 4 th , 8 th week and 3 rd , 6 th , 12 th month after the treatment. Results At the 2 nd week, HAMD score dropped obviously from 27 7±6 9 to 17 3±5 9 in Prozac group, from 26 9± 6 9 to 15 7±4 2 in amitriptyline group, with significant difference vs pre treatment and the control groups ( P <0 05). At the 12 th week, the neurological function impairment score of the Prozac group dropped to 11 8±5 7, and that of amitriptyline group dropped to 11 9±6 1, both of them declined significantly ( P <0 01). After 3 months, the ADL index climbed to 69±5 1 in Prozac group, and 67 0± 6 2 in amitriptyline group, which showed much improvement than before ( P <0 05). And the treatment groups had fewer complications than the control group ( P <0 01). Both of the recurrence and death post stroke were lower ( P <0 01). Prozac and amitriptyline were similar on curative effect, but Prozac had lower side effects than amitriptyline. Conclusions Anti depression therapy may control the post stroke depression in the elderly effectively. Prozac is safe during the treatment period; anti depression therapy is in favor of not only rehabilitating neurological function but also improving the living ability and reducing the complications, recurrence and death of stroke.