创伤后抑郁症.doc

中国创新医学网 脑外伤后抑郁/焦虑对脑外伤预后的影响及综合治疗 发表时间：2008-10-14 9:43:36 浏览次数： 8 来源：治疗 作者：戴宏伟??? 作者单位：250001 山东济南，山东中医药大学第二附属医院神经外科 【摘要】? 目的 探讨卒中脑外伤后抑郁/焦虑对脑外伤患者日常生活能力和神经功能康复的影响以及文拉法新合并早期心理干预的临床疗效。方法 采用抑郁自评量表（SDS）、焦虑自评量表（SAS）对272例脑外伤患者进行抑郁/焦虑状态评定，其中患有脑外伤后抑郁合并焦虑的81例患者随机分成3组，分别接受单用文拉法新治疗、文拉法新合并心理治疗以及不干预治疗。采用斯堪的那维亚脑卒中量表（SSS）、Barthel指数（BI）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评测治疗前后的疗效。结果 脑外伤患者脑外伤后抑郁并焦虑患病率为29.78%，抑郁与焦虑共病率为65.85%，额叶、左侧大脑半球与脑外伤后抑郁/焦虑的发生相关；治疗组Ⅰ和治疗组Ⅱ HAMD、HAMA、SSS评分减少和BI评分增加与对照组比较差异均有显著性（P0.01）,治疗组Ⅱ HAMD、HAMA、SSS评分减少和BI评分增加较治疗组Ⅰ差异有显著性（P均0.05）。结论 脑外伤后抑郁/焦虑的发生与脑外伤部位相关；脑外伤后抑郁/焦虑障碍明显降低患者神经功能康复程度和生活能力恢复；对脑外伤后抑郁/焦虑患者单用药物文拉法新或给予文拉法新合并心理干预治疗均能提高患者神经功能康复程度和生活能力恢复，而且文拉法新合并心理干预治疗疗效更满意。 【关键词】? 脑外伤 抑郁 焦虑 预后 文拉法新 心理干预 ?? The effect of depression and anxiety after craniocerebral trauma on its prognosis and combined therapy ??? DAI Hong-wei, YU Jun, HAN Ke-jie, et al.Department of Neurosurgery,Sencond Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,China ??? 【Abstract】? Objective? To study the effect of depression and anxiety after craniocerebral trauma on ability of daily life and neurologic functional rehabilitation, and the clinical curative effect of Venlafaxine combined with psychotherapy. Methods? 81 patients suffered with depression and anxiety were found according to SDS and SAS among 272 patients. They were randomly divided into 3 groups and treated with Venlafaxine singly or Venlafaxine combined with psychotherapy or untreated. SSS, BI, HAMD and HAMA were used to assess the curative effect before and after treatment.Results? The prevalence of depression combined with anxiety after craniocerebral trauma was 29.78% and the comorbidity rate was 65.85%. Depression and anxiety after craniocerebral trauma were related to the disease of frontal cortex and left brain. The reducing of SSS, HAMD and HAMA grade and increasing of BI grade in treatment groupⅠandⅡ was more obvious than that in control group (P0.01). The reducing of SSS, HAMD and HAMA grade and