重复经颅磁刺激联合帕罗西汀治疗创伤后应激障碍的效果观察

摘要

目的：观察重复经颅磁刺激（rTMS）联合帕罗西汀对创伤后应激障碍（PTSD）的疗效及安全性。方法将56例PTSD患者随机分为研究组（帕罗西汀联合rTMS治疗）28例和对照组（帕罗西汀治疗）28例，均治疗4周。于治疗前及治疗后第4周末采用创伤后应激障碍检查表（PCL）及汉密尔顿焦虑量表（HAMA）评定。结果两组治疗后第4周末PCL总分评分差及各因子分均较各自治疗前降低（P＜0．05），研究组PCL总分评分差及各因子评分差均高于对照组（P＜0．05）；治疗后第4周末两组HAMA评分均较各自治疗前低（P＜0．05），研究组HAMA评分低于对照组（P＜0．05）；两组间总不良反应发生率比较差异无统计学意义（P＞0．05）。结论联用rTMS能够增加帕罗西汀对PTSD的重现、回避、高警觉核心症状以及焦虑症状的疗效。%Objective To observe the effect and safety of repetitive transcranial magnetic stimulation (rTMS)combined with paroxetine in the treatment of post-traumatic stress disorder (PTSD).Methods 56 patients with PTSD were randomized into study group(28 cases)treated with rTMS combined with paroxetine and control group (28 cases)treated with paroxetine monotherapy for 4 weeks.All patients in both groups were assessed with PTSD Checklist (PCL)and Hamilton Anxiety Rating Scale (HAMA)at baseline and at the end of the treatment.Results At the end of the 4-week treatment,total score and all factor scores of PCL in both groups decreased significantly when compared with the baseline (P<0.05 ).The decrease of total score and all factor scores of PCL in study group were significantly higher than those in control group (P<0.05).At the end of the treatment,total scores of HAMA in both groups were significantly lower than the baseline (P<0.05 ),and total score of HAMA in study group was significantly lower than that in control group (P<0.05 ).No significant difference was found in incidence rate of side effects between the two groups (P<0.05).Conclusion Combination with rTMS can enhance the effect of paroxetine on symptoms of flash-back,evasion,hyperarousal and anxiety in PTSD.