文拉法辛和艾司西酞普兰治疗抑郁症的效果及对心率变异性和自主神经功能的影响比较

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摘要目的研究文拉法辛和艾司西酞普兰对抑郁症患者临床疗效、心率变异性及自主神经功能的影响。方法选择2016年12月～2017年12月在宁波市康宁医院诊断为抑郁症的患者100例作为研究对象，采用随机信封法分为文拉法组和艾司西酞普兰组，每组各50例。治疗时间均为4周。治疗前后采用汉密尔顿抑郁量表（HAMD）及汉密尔顿焦虑量表（HAMA）评估临床疗效，采用动态心电图检测心率变异性，采用肌电图检测交感皮肤反应（SSR）评估自主神经功能。结果治疗后两组患者HAMD、HAMA评分均低于治疗前，差异均有统计学意义（P ＜ 0.05）；但治疗后两组HAMD、HAMA评分比较，差异均无统计学意义（P ＞ 0.05）。两组治疗后总有效率比较，差异无统计学意义（P ＞ 0.05）。治疗后两组心率变异性指标正常RR间期标准差（SDNN）、每5个正常RR间期平均值标准差（SDANN）、总频域值（TP）、低频值（LF）、高频值（HF）均高于治疗前，相差超过50 ms的相邻RR间期占据所有RR间期的百分数均低于治疗前，差异均有统计学意义（P ＜ 0.05）；且治疗后文拉法辛组改善更为显著，差异均有统计学意义（P ＜ 0.05）。治疗后两组SSR的起始波潜伏期均低于治疗前，波幅均高于治疗前，且文拉法辛组改善更为显著，差异均有统计学意义（P ＜ 0.05）。结论文拉法辛和艾司西酞普兰治疗抑郁症的效果相当，但文拉法辛对抑郁症患者的自主神经功能和心率变异性的改善作用优于艾司西酞普兰。

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	黄敏芳刘纪猛刘灵江黎兴兴周琪周东升

关键词 ：文拉法辛, 艾司西酞普兰, 抑郁症, 自主神经功能

Abstract：Objective To research the curative effect of Venlafaxine and Escitalopram in patients with depression and its influence on heart rate variability and autonomic nerve function. Methods From December 2016 to December 2017, 100 patients with depression admitted to Ningbo Kangning Hospital were selected and divided into Venlafaxine group and Escitalopram group by random envelope method, with 50 cases in each group. All patients were treated for 4 weeks. The Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were applied to evaluate the clinical efficacy before and after treatment. The heart rate variability was measured by dynamic electrocardiogram. The sympathetic skin response (SSR) was used to assess the autonomic nerve function. Results After treatment, the scores of HAMD and HAMA in the two groups were all lower than those of before treatment, with statistically significant differences (P ＜ 0.05), but there were no statistically significant differences between the two groups after treatment (P ＞ 0.05). There was no statistically significant difference between the two groups in the total effective rate (P ＞ 0.05). After treatment, the standard deviation of normal to normal R wave (SDNN), standard deviation of the averages of NN intervals in all 5-minute segments of the entire recording (SDANN), total power (TP), low frequency (LF) and high frequency (HF) were all significantly higher than those of before treatment, the percentage of intervals 50 ms different from preceding interval was significantly lower than that of before treatment, and the indicators above in the Venlafaxine group improved much more remarkably, with statistically significant differences (P ＜ 0.05). After treatment, the latency of SSR in the two groups was lower than that of before treatment, the amplitude of SSR was significantly higher than that of before treatment, and the indicators above in the Venlafaxine group improved much more remarkably, with statistically significant differences (P ＜ 0.05). Conclusion Venlafaxine and Escitalopram have equivalent effects on depression. The Venlafaxine is better than Escitalopram on heart rate variability and autonomic nerve function in depression patients.

Key words： Venlafaxine Escitalopram Depression Autonomic nerve function

基金资助:浙江省宁波市医学重点学科（2016-G02）；
浙江省宁波市科技计划项目（2016A610185）。

通讯作者: 周东升（1979.9-），男，硕士；研究方向：精神疾病防治及神经调控技术。

引用本文:

黄敏芳刘纪猛刘灵江黎兴兴周琪周东升. 文拉法辛和艾司西酞普兰治疗抑郁症的效果及对心率变异性和自主神经功能的影响比较[J]. 中国医药导报, 2018, 15(16): 130-133.
HUANG Minfang LIU Jimeng LIU Lingjiang LI Xingxing ZHOU Qi ZHOU Dongsheng. The effect of Venlafaxine and Escitalopram in patients with depression and its influence on heart rate variability and autonomic nervous function. 中国医药导报, 2018, 15(16): 130-133.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I16/130

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