【摘要】 目的 探讨药物联合重复经颅磁刺激（rTMS）及认知行为疗法（CBT）治疗青少年抑郁障碍的临床效果。方法 选取首发抑郁障碍青少年患者100例，采用随机数字表法分成4组。药物治疗组给予抗抑郁药物治疗；药物+rTMS组在药物治疗的基础上联合rTMS治疗；药物+CBT组在药物治疗的基础上联合CBT治疗；药物+rTMS+CBT组在药物治疗的基础上联合rTMS及CBT治疗。4组患者分别在治疗前、治疗后2、4和8周采用汉密尔顿抑郁量表（HAMD）24项版、汉密尔顿焦虑量表（HAMA）、匹兹堡睡眠质量指数（PSQI）进行评价；治疗前、治疗后2周和4周采用自杀风险评估量表（NGASR）进行评估；治疗4周和8周后采用临床疗效总评量表中的疗效指数（CGI-EI）评价治疗效果。结果 治疗8周后，药物+rTMS+CBT组的HAMA、HAMD评分均低于其他组（P均<0.001），临床疗效高于其他组（P<0.05）。结论 药物联合rTMS及CBT治疗青少年抑郁障碍，对比其他治疗方法能够更好地改善患者抑郁、焦虑情绪，提高睡眠质量，减少强迫性思维，有效率更高。更多还原

【Abstract】 Objective To investigate the clinical effect of repeated transcranial magnetic stimulation(rTMS)and cognitive behavioral therapy(CBT)in the treatment of adolescent depressive disorder. Methods A total of100 adolescent patients with first episode depressive disorder were selected and divided into four groups by random number table method. The drug treatment group was treated with antidepressant drugs;Drug+rTMS group was combined with rTMS on the basis of drug therapy;Drug+CBT group was combined with CBT on the basis of drug therapy;Drug+rTMS+CBT group was combined with rTMS and CBT on the basis of drug therapy.The four groups were evaluated by 24-item Hamilton Depression Scale(HAMD-24),Hamilton Anxiety Scale(HAMA)and Pittsburgh Sleep Quality Index(PSQI)before treatment,2,4 and 8 weeks after treatment,respectively. The Suicide Risk Assessment Scale(NGASR)was used before,2 weeks and 4 weeks after treatment. Total Clinical Efficacy Scale(CGI-EI)was used to evaluate the therapeutic effect after 4 and 8 weeks of treatment. Results After 8 weeks of treatment,HAMA scores,HAMD scores in the drug+rTMS+CBT group were significantly lower than those in the other groups(P all<0.001),and the clinical efficacy was significantly higher than that in the other groups(P<0.05). Conclusion Drugs combined with rTMS and CBT can better improve depression and anxiety,improve sleep quality,reduce obsessive thinking and has higher efficiency than other treatment methods in the treatment of adolescent depressive disorder.更多还原