高压氧联合氟哌噻吨美利曲辛治疗脑卒中后抑郁的临床观察

摘要

OBJECTIVE:To investigate the effects of hyperbaric oxygen combined with flupentixol and melitracen on depres-sion improvement,extremity motor function and ability of daily living and activity in patients with post-stroke depression (PSD). METHODS:60 PSD patients were divided into control group and observation group according to random number table,with 30 cases in each group. Both groups received routine clinical treatment,comprehensive rehabilitation therapy and psychotherapy. The control group was additionally given Flupentixol and melitracen tablets,orally,one tablet each time,in the morning;3 days later, one tablet each time,in the morning and noon,for 4 weeks. Other anti-depressive agents were not given during treatment. Observa-tion group was additionally given hyperbaric oxygen,0.12 MPa,for 90 min,qd,5 times a week,for 4 weeks,on the basis of control group. Depression degree [Hamilton depression scale (HAMD) and Self-rating depression scale(SDS)],extremity motor function [Fugl-Mayer motor function assessment (FMA)] and ability of daily living and activity [modified Barthel index (MBI)] were scored in 2 groups before and after treatment,and ADR was observed. RESULTS:After 4 weeks of treatment,HAMD and SDS of 2 groups were decreased significantly compared to before treatment,while FMA and MBI were increased significantly;the improvement of observation group was significantly better than that of control group,with statistical significance(P<0.05). No ob-vious ADR was found in 2 groups. CONCLUSIONS:Hyperbaric oxygen combined with flupentixol and melitracen can effectively improve PSD,relieve negative emotion and improve extremity motor function and ability of daily living and activity.%目的：探讨高压氧联合氟哌噻吨美利曲辛对脑卒中后抑郁（PSD）患者的抑郁改善效果，以及对患者肢体运动功能和日常生活活动能力的影响。方法：将60例PSD患者按随机数字表法分为对照组和观察组，各30例。两组患者均给予常规的临床治疗、综合康复治疗及心理治疗。在此基础上，对照组患者给予氟哌噻吨美利曲辛片口服，开始为每次1片，晨服；3d后为每次1片，晨、午各服1次，共服用4周；治疗过程中不合并给予其他抗抑郁药。观察组患者在对照组治疗基础上加用高压氧治疗方式，采用纯氧治疗，压力为0.12 MPa，治疗时间为90 min，qd，每周5次，共治疗4周。两组患者在治疗前后进行抑郁程度[采用汉密尔顿抑郁量表（HAMD）和抑郁自评量表（SDS）评价]、肢体运动功能[采用Fugl-Meyer运动功能评定量表（FMA）评价]和日常生活活动能力[采用改良Barthel指数评定量表（MBI）评价]评分，并观察不良反应发生情况。结果：治疗4周后，两组患者的HAMD和SDS评分均较治疗前明显降低，FMA和MBI评分均较治疗前明显升高，且观察组患者的改善程度明显优于对照组，差异均有统计学意义（P＜0.05）。两组患者均未见明显不良反应发生。结论：高压氧联合氟哌噻吨美利曲辛能有效改善PSD症状，减轻患者的负性情绪，提高其运动功能和日常生活活动能力。