早期应用米氮平干预首发脑卒中患者卒中后抑郁
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[摘要] 目的 探讨早期应用小剂量米氮平对首发脑卒中后抑郁的干预作用。方法 选取132例首次发生脑卒中的患者，随机分为干预组和对照组。干预组连续1个月在常规治疗基础上每晚口服小剂量米氮平(15mg/d)，对照组仅常规治疗，观察两组患者入院时及入院1个月后的抑郁状态、神经功能缺损状态和日常生活能力。结果 干预治疗后干预组PSD的患病率(18.31%)明显低于对照组(53.73%)，干预组日常生活能力(ADL)评分(98.10±15.16)明显高于对照组(88.00±36.23)，神经功能缺损(MESSS)评分(17.13±1.32)明显低于对照组(22.87±3.42)。结论 小剂量米氮平早期干预治疗能降低首发脑卒中患者PSD的患病率，并使其神经功能缺损降低、日常生活能力提高。
[关键词] 卒中；抑郁；米氮平；神经功能缺损；日常生活能力
[中图分类号] R749.1 [文献标识码] B[文章编号] 1673-9701(2011)19-67-02
Early Application of Mirtazapine for Prevention of Post Stroke Depression in First Stroke Patients
FENG YanXU ChangshuiMA JianjunLI YanQI Yawei
Department of Neurology, Henan Provincial People's Hospital, Zhengzhou 450003, China
[Abstract] Objective To investigate the effects of early application of low-dose mirtazapine in prevention of post stroke depression in first stroke patients. Methods There were 132 first stroke patients were administrated with regular treatment alone or combined with mirtazapine (15 mg/d) respectively for a month period, and their effects on prevalence of depression, scores in neurological deficits and activities of daily living (ADL) were detected. Results The prevalence of PSD in mirtazapine group (18.31%) was significantly decreased as compared with that of control group (53.73%). The MESSS scores were significantly lower in mirtazapine group (17.13±1.32) than in control group (22.87±3.42) and the ADL scores were significantly higher in mirtazapine group (98.10±15.16) than in control group (88.00±36.23). Conclusion Early application of low-dose mirtazapine can decrease the prevalence of post stroke depression, reduce the neurologicimpirment and improve the activity of daily living.
[Key words] Stroke; Depression; Mirtazapine; MESSS; Activities of daily living
脑卒中后抑郁症(post stroke depression，PSD)是脑卒中患者常见并发症之一，卒中后抑郁患者常出现情绪低落，不配合康复锻炼和治疗，导致其生活质量下降，影响肢体和神经功能的康复，增加脑血管病患者的致残率、病死率，增加患者家庭和社会负担。越来越多的人意识到积极干预PSD的重要性，至今关于早期干预性治疗PSD是否有益尚未达成共识，本研究探讨早期应用小剂量米氮平对PSD的干预作用。
1 对象与方法
1.1 研究对象
共选取我院2007年2月～2009年12月神经内科住院患者中首次发生脑卒中者132例，所有入选患者均符合1995年全国第四届脑血管病会议制定的卒中诊断标准[1]，经头颅CT或MRI证实，均于起病3d内即入院患者。排除标准：①意识障碍，理解力下降，不能配合检查及治疗；②患有严重的心、肺、肾等重要脏器疾病；③既往有脑器质性疾患及精神病史；④有自杀倾向者；⑤排除青光眼、肠梗阻等不适合口服米氮平者 ......
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