左洛复治疗老年脑卒中后抑郁的前瞻性临床随机对照研究

目的探讨老年脑卒中后抑郁患者用左洛复治疗的临床疗效和对脑卒中预后的影响。方法老年脑卒中后抑郁患者随机入选治疗组、对照组各65例,脑卒中均经临床、影像证实6个月内,抑郁诊断为Zung量表≥40分,或GDS量表5~10分。两组患者均给予类似的规范脑卒中治疗,而治疗组加用抗抑郁剂左洛复,连续12周。观察两组患者的Zung量表、GDS量表和ADL评分变化。结果Zung量表、GDS量表评价发现治疗组总体疗效优于对照组,治疗组在治疗后4、8和12周末均有好转,以12周末最明显,亚组分析提示左半球、多灶患者抑郁症状较明显,其治疗组的效果优于对照组。ADL评定发现,治疗组总体康复疗效优于对照组,治疗组在4、8和12周末均有进步,以12周末最明显,亚组分析提示左半球、单灶患者的ADL康复效果在治疗组优于对照组。结论左洛复治疗老年脑卒中后抑郁有效,也促进ADL康复,副反应少,有延时增效作用。

A Prospective Random Clinical Contrast Study of Treatment with Sertraline in Elderly Patients with Post-Stroke Depression

Objective To study the effect of treatment with Sertraline in elderly patients with post-stroke depression. Methods A total of 130 patients age 65 years or older with post-stroke depression, confirmed with clinical, CT/MRI, were selected in this study. Post-stroke depression was defined as a ZUNG score >40 or GDS=5-10. The cases were randomly assigned to 12 weeks of treatment with a daily dose of 50mg of Sertraline or contrast group. Similar formal therapies were given to all patients. Results Each 65 cases assigned to Sertraline treatment or contrast group. At 12 weeks endpoint, the patients receiving Sertraline evidenced significantly greater improvements than those in contrast group on ZUNG or GDS scores. And the effect at 12 weeks endpoint was better than that at 4 or 8 weeks. Investigation in subgroups suggested that the depressive mood and therapeutic effect were evidently found in cases with left hemisphere and multi-focus lesion. The improvement of ADL was found at 4, 8 and )2 weeks endpoint in two groups, and the rehabilitation of ADL in Sertraline treatment group was better than that in contrast group. Subgroups study showed that the difference between treatment and contrast group was found in cases with left hemisphere and single-focus lesion. Conclusion Sertraline was effective in improvement of depression and well tolerated by elderly patients with post-stroke depression, and lead to good rehabilitation of ADL from stroke. Compared to baseline, the magnitude of response with Sertraline continues to increase when elderly cases receive a longer course of treatment in the 4 to 12 weeks.