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目的探讨抗抑郁药物早期干预对卒中后急性期抑郁状态及神经功能康复的影响。方法临床纳入卒中后急性期抑郁状态患者96例,根据随机数字表法将患者分为研究组与对照组,每组各为48例,研究组给予口服抗抑郁药物(西酞普兰)治疗,对照组仅给予空白安慰剂治疗。治疗前与治疗8后周采用汉密顿抑郁量表(Hamilton Depression Scale,HAMD)对患者的抑郁症状进行评估,美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)对患者的神经功能进行评估,采用Barthel指数(BI)对患者的日常生活活动能力(ADL)进行评估。此外,分别检测治疗前后患者的血浆P物质(SP)以及神经肽Y(NPY)水平。结果治疗后,研究组HAMD、NIHSS、ADL评分分别为(13.6±2.9)、(10.5±3.3)、(79.2±13.5),对照组HAMD、NIHSS、ADL评分分别为(23.7±5.2)、(16.3±4.0)、(57.2±8.9),差异均有显著性(P<0.05);治疗后研究组血浆SP水平为(35.6±12.2),明显低于对照组的(53.1±16.8),差异有显著性(P<0.05);治疗后研究组血浆NPY水平为(165.9±44.0),明显高于对照组的(129.3±28.5),差异有显著性(P<0.05)。结论卒中后急性期抑郁患者给予西酞普兰进行药物干预,能够有效改善卒中后急性期抑郁状态,缓解患者的负面情绪。而血浆SP水平降低,NPY水平升高,可能是西酞普兰起到抗抑郁作用的机制。
Objective To investigate the effect of early antidepressant medication on depression and neurological rehabilitation after acute stroke. Methods Ninety-six patients were randomly divided into study group and control group according to random number table method. Each group was 48 cases. The study group was given oral anti-depressant drug (citalopram), and the control group Groups were given blank placebo only. Pre-treatment and post-treatment 8 weeks were assessed for depressive symptoms using the Hamilton Depression Scale (HAMD). The National Institutes of Health Stroke Scale (NIHSS) Neurological function was assessed using the Barthel index (BI) to assess the patient’s daily living activity (ADL). In addition, the levels of plasma substance P (SP) and neuropeptide Y (NPY) in patients before and after treatment were measured. Results After treatment, the scores of HAMD, NIHSS and ADL in the study group were (13.6 ± 2.9) and (10.5 ± 3.3) and (79.2 ± 13.5), respectively. The scores of HAMD, NIHSS and ADL in the control group were (23.7 ± 5.2) and ± (P <0.05). After treatment, the level of plasma SP in the study group was (35.6 ± 12.2), which was significantly lower than that in the control group (53.1 ± 16.8), the difference was significant (P <0.05). After treatment, the level of plasma NPY in the study group was (165.9 ± 44.0), which was significantly higher than that in the control group (129.3 ± 28.5) (P <0.05). Conclusion Citalopram is administered in patients with acute post-stroke depression, which can effectively reduce the acute phase of post-stroke depression and relieve the negative emotions of patients. The plasma SP level decreased NPY levels may be citalopram antidepressant mechanism.