目的 观察舍曲林预防老年脑卒中后抑郁症状及神经功能缺损的临床疗效.方法 选取保定市第一中心医院2013年1月—2014年1月符合纳入标准的脑卒中患者90例,随机分成对照组(30例)、干预一组(30例)、干预二组(30例).对照组给予基础治疗.干预一组在此基础上晨起口服盐酸舍曲林分散片,起始剂量50 mg/d,3 d后增至100 mg/d.干预二组在基础治疗上晨起口服盐酸舍曲林分散片,起始剂量50 mg/d,3 d后增至100 mg/d,1周内增加至150 mg/d.3组均持续用药2个月.在治疗前,治疗1、2个月分别测定汉密尔顿抑郁量表(HAMD)及神经功能缺损(NFI)评分,并计算患者的依从性.结果 治疗1、2个月后,2组干预组抑郁症发生率显著低于对照组,差异有统计学意义(P<0.05).治疗1、2个月后,3组患者的HAMD及NFI评分均较治疗前明显下降,同组治疗前后差异有统计学意义(P<0.05);且治疗后,两组干预组HAMD及NFI评分均较对照组下降更明显(P<0.05).治疗第1、2、4周两组干预组患者依从率均高于对照组,差异有统计学意义(P<0.05).结论 100 mg舍曲林能有效地降低脑卒中患者抑郁症的发生率,促进卒中后患者神经功能的恢复,并能提高患者的依从性,值得临床推广.

Objective To observe the clinical effects of sertraline for preventing depression and neurologic impairment of elderly post-stroke depression (PSD). Methods The patients (90 cases) diagnosed as cerebral apoplexy in the First Central Hospital of Baoding City from January 2013 to January 2014 were randomly divided into control (49 cases), intervention group one (30 cases), and intervention group two (30 cases) groups. The patients in the control group were treated with basic treatment. The patients in intervention group one were given Sertraline Hydrochloride Dispersible Tablets, 50 mg/d in the morning for 3 d, and the dosage was gradually increased to 100 mg/d. The patients in intervention group two were given Sertraline Hydrochloride Dispersible Tablets, 50 mg/d in the morning for 3 d, and the dosage was gradually increased to 100 mg/d, while the dosage was gradually increased to 150 mg/d in one week. The patients in three groups were treated for 2 months. Hamihon depression scale (HAMD) and neurologic function impairment (NFI) scores were assessed before the treatment, one and two months after the treatment, and the compliance of patients in two groups was calculated. Results One and two months after the treatment, the incidence of depression in two intervention groups was higher than that in the control group, with the significant difference (P < 0.05). One and two months after the treatment, HAMD and NFI scores of the three groups were more significantly decreased than those before the treatment, and the difference was statistically significant in the same group (P < 0.05). HAMD and NFI scores of the two intervention groups were decreased more obviously compared with those in the control group (P < 0.05). The compliance rates in the two intervention groups were higher than that in control group, with the significant difference (P < 0.05) on one, two, and four week after treatment. Conclusion Sertraline with 100 mg can effectively lower the incidence of depression in patients with cerebral apoplexy, and at the same time, the therapy could promote the recovery of the neuronal function after stroke. Sertraline also can improve the patients' compliance rate, which is worth in clinical promotion.

保定市科技攻关计划项目(13ZF016)