【摘要】 目的观察脑波同步、重复经颅磁刺激(r TMS)联合氟西汀药物治疗产后抑郁的疗效。方法以48例产后抑郁症患者为研究对象,其中脑波同步、r TMS联合氟西汀药物治疗25例(联合组),单纯氟西汀药物治疗23例(氟西汀组)。在治疗前以及治疗第1、2、4和6周末,采用汉密尔顿抑郁量表(HAMD)、爱丁堡产后抑郁量表(EPDS)、临床疗效总评量表(CGI)和不良反应量表(TESS)进行评分,比较两组患者的疗效与不良反应;在治疗前和治疗第6周末检测并比较两组患者的血清皮质醇(COR)、T3、T4、促甲状腺激素(TSH)和雌二醇(E2)水平。结果两组患者治疗前HAMD、EPDS评分比较,差异均无统计学差异(均P>0.05)。与治疗前比较,两组患者自治疗第2周末至第6周末HAMD、EPDS评分均明显下降(均P<0.01)。治疗第2、4和6周末的HAMD、EPDS评分均为联合组低于氟西汀组(均P<0.05)。治疗第4、6周末TESS评分均为联合组低于氟西汀组(均P<0.05)。联合组患者治疗第2、6周末疗效指数(CGI-EI)评分均分别高于氟西汀组(均P<0.05),治疗第6周末疗效总评(CGI-GI)评分高于氟西汀组(P<0.05)。两组患者治疗前血清T3、T4、TSH、COR、E2水平比较,差异均无统计学意义(均P>0.05);治疗第6周末,联合组血清TSH、COR水平低于氟西汀组,E2水平高于氟西汀组,差异均有统计学意义(均P<0.05)。结论脑波同步、r TMS联合氟西汀药物治疗产后抑郁,具有起效快、用药量少、不良反应少、患者依从性好等优点。更多还原

【Abstract】 Objective To assess the efficacy ofrepetitive trans cranial magnetic stimulation（rTMS） combined with fluoxetine therapy in treatment ofpostpartum depression.Methods Forty- eight patients with postpartum depression were randomized into two groups:25 cases received rTMS in combination with fluoxetine therapy（combination group）,and 23 cases received fluoxetine therapy alone（fluoxetine group）.Patients were evaluated with Hamilton Depression Scale（HAMD）,Edinburgh Postnatal Depression Scale（EPDS）,Clinical Global Impression（CGI） and Treatment Emergent Symptom Scale（TESS） before and 1,2,4,6wks after treatment in two groups.Serum cortisol（COR）,three iodine thyroid glycine（T₃）,four iodine glycine（T₄）,thyroid- stimulating hormone（TSH）,and plasma estradiol levels were measured before and 6 wks after treatment.Results There were no significant differences in HAMD and EPDS scores before treatment between two groups（P >0.05）.The HAMD and EPDS scores were significantly decreased after 2⁶ wks of treatment in both group s（P< 0.01）.However,the scores in combination group were decreased more markedly than those in fluoxetine group after 2,4,6 wks of treatment（P<0.05）.The TESS scores in combination group were significantly lower than those in fluoxetine group in after 4 and 6 wks oftreatment（P<0.05）.The scores of CGI efficacy index（EI） in combination group were higher than those in fluoxetine group after 2 and 6 wks of treatment（P<0.05）.The CGI scores in combination group were higher than those in fluoxetine group after 6 wks oftreatment（P<0.05）.There were no significant differences in serum T₃,T₄,TSH,COR,and plasma estradiollevels between two groups before treatment（P > 0.05）.The serum levels of TSH,COR in combination group were lower than those in fluoxetine group,plasma estradiol levels in combination group were higher than those in fluoxetine group after 6 wks oftreatment（P<0.05）.Conclusion Repetitive transcranial magnetic stimulation combined with fluoxetine therapy has advantages of quick response,low drug dosage,less side-effect and better compliance in treatment ofpostpartum depression.更多还原