摘要
目的观察盐酸度洛西汀联合盐酸曲唑酮治疗缺血性脑卒中后焦虑抑郁共病状态(PSCAD)的效果。方法前瞻性选取2018年1月至2021年12月保定市第一中心医院收治的80例PSCAD患者为对象,根据随机数字表法分为观察组和对照组两组,每组40例。所有患者在卒中基础治疗的同时给予康复训练,对照组加用盐酸曲唑酮治疗,而观察组加用盐酸度洛西汀+盐酸曲唑酮治疗,连续治疗4周。比较两组焦虑抑郁程度评分、改良Barthel指数(MBI)、血清相关因子[去甲肾上腺素(NE)、5-羟色胺(5-HT)、雷帕霉素靶蛋白(mTOR)、神经生长因子(NGF)]、睡眠结构[总卧床时间(TIB)、总睡眠时间(TST)、实际睡眠时间(AST)]的差异,评估用药安全性。结果治疗后,两组PSCAD者MBI评分明显升高,24项汉密尔顿抑郁量表(HAMD-24)、汉密尔顿焦虑量表(HAMA)评分明显下降,且观察组的MBI评分为(78.51±5.17)分,高于对照组[(67.52±6.22)分],HAMD-24评分、HAMA评分(16.53±1.37)、(13.25±1.74)分,均低于对照组[(20.12±2.74)、(15.12±2.13)分],差异均有统计学意义(P<0.05)。治疗后,两组PSCAD者血清因子及睡眠结构指标均明显升高,且观察组的血清NE、5-HT、mTOR、NGF水平及TIB、TST、AST分别为(65.86±7.13)μL、(46.96±4.15)ng/mL、(2.24±0.31)U/L、(12.73±1.23)ng/L、(445.58±15.08)、(434.25±19.52)、(389.25±18.63)min,均高于对照组[(59.32±6.47)μg/L、(37.25±5.46)ng/mL、(1.78±0.26)U/L、(9.93±1.14)ng/L、(421.13±12.42)、(413.15±14.77)、(366.22±15.25)min],差异均有统计学意义(P<0.05)。观察组用药期间不良反应为7.50%,与对照组的10.00%比较,差异无统计学意义(P>0.05)。结论盐酸度洛西汀联合盐酸曲唑酮治疗PSCAD可通过调节血清NE、5-HT、mTOR、NGF的表达,减轻焦虑抑郁程度,改善睡眠结构,且不增加不良反应。
Objective To observe the effect of duloxetine hydrochloride combined with trazodone hydrochloride in the treatment of post-ischemic stroke anxiety and depression comorbid state(PSCAD).Methods Eighty patients with PSCAD admitted to Baoding First Central Hospital from January 2018 to December 2021 were prospectively selected and randomly divided into two groups with 40 cases in each group.All patients were given rehabilitation training at the same time as basic stroke treatment,the control group was additionally treated with trazodone hydrochloride,while the observation group was additionally treated with duloxetine hydrochloride+trazodone hydrochloride treatment for 4 weeks.The differences in anxiety and depression score,modified Barthel index(MBI),serum-related factors[norepinephrine(NE),5-hydroxytryptamine(5-HT),target of rapamycin(mTOR),nerve growth factor(NGF)],and sleep structure[total time in bed(TIB),total sleep time(TST),actual sleep time(AST)]were compared between the two groups,and the safety of the drug was evaluated.Results After treatment,the MBI scores of PSCAD patients in the two groups were significantly increased,the 24-item Hamilton Depression Scale(HAMD-24)and Hamilton Anxiety Scale(HAMA)scores were significantly decreased,the MBI score in the observation group was(78.51±5.17)points,which was higher than that in the control group[(67.52±6.22)points],HAMD-24 score and HAMA score were(16.53±1.37),(13.25±1.74)points,which were lower than those in the control group[(20.12±2.74),(15.12±2.13)points],the differences were statistically significant(P<0.05).After treatment,serum factors and sleep structure in the two groups of PSCAD patients were significantly increased,the levels of serum NE,5-HT,mTOR,NGF,TIB,TST and AST in observation group were(65.86±7.13)μg/L,(46.96±4.15)ng/mL,(2.24±0.31)U/L,(12.73±1.23)ng/L,(445.58±15.08)min,(434.25±19.52)min,(389.25±18.63)min,which were higher than those in the control group[(59.32±6.47)μg/L,(37.25±5.46)ng/mL,(1.78±0.26)U/L,(9.93±1.14)ng/L,(421.13±12.42)min,(413.15±14.77)min,(366.22±15.25)min],the differences were statistically significant(P<0.05).Adverse reactions in the observation group during medication were 7.50%,compared with 10.00%in the control group,the difference was not statistically significant(P>0.05).Conclusion Duloxetine hydrochloride combined with trazodone hydrochloride in the treatment of PSCAD can reduce the degree of anxiety and depression and improve sleep structure by regulating the expressions of serum NE,5-HT,mTOR and NGF,without increasing adverse reactions.
作者
刘璐
李晓军
张潇潇
商伟伟
张雪
刘永刚
边慧晶
王姗姗
LIU Lu;LI Xiao-jun;ZHANG Xiao-xiao(Department of Clinical Psychology,Baoding First Central Hospital,Baoding Hebei 071000,China.;Department of Emergency,Baoding First Central Hospital,Baoding Hebei 071000,China.)
出处
《临床和实验医学杂志》
2022年第20期2155-2159,共5页
Journal of Clinical and Experimental Medicine
基金
保定市科技计划项目(编号:2141ZF082)。
关键词
缺血性脑卒中
焦虑抑郁共病状态
盐酸度洛西汀
盐酸曲唑酮
睡眠结构
Ischemic stroke
Anxiety and depressive comorbid state
Duloxetine hydrochloride
Trazodone hydrochloride
Sleep structure
