经颅磁刺激联合氟西汀治疗卒中后抑郁的临床效果

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Abstract Objective To observe the clinical effect of different modes of repetitive transcranial magnetic stimulation (rTMS) combined with Fluoxetine in the treatment of post-stroke depression (PSD). Methods A total of 60 PSD patients admitted to Beijing Boai Hospital of China Rehabilitation Research Center from January 2020 to November 2021 were selected and divided into low frequency treatment group, high frequency treatment group, and control group according to the random number table method, with 20 cases in each group. rTMS at 1, 5 Hz, and sham stimulation were given for 14 days, respectively. The three groups were also given Fluoxetine 20 mg/d, conventional drug therapy and rehabilitation therapy for 28 days. Before treatment, on the 7th, 14th, and 28th days of treatment, the scores of Hamilton depression scale (HAMD), National Institute of Health stroke scale (NHISS), modified Barthel index (MBI), and mini-mental state examination (MMSE) and adverse reactions were compared among the three groups. Results The overall analysis showed that there were significant differences in HAMD score time, between groups, and interaction among the three groups (P ＜ 0.05). Further pairwise comparison and intra-group comparison: the HAMD scores of the low and high frequency treatment groups on the 7th, 14th, and 28th days of treatment were lower than those before treatment in the same group, while the HAMD scores of the control group on the 14th and 28th days of treatment were lower than those before treatment in the same group, and the differences were statistically significant (P ＜ 0.05). Comparison between groups: before treatment, there was no significant difference in HAMD scores between groups (P ＞ 0.05). After treatment, the HAMD scores in the low and high frequency treatment groups were lower than those in the control group, and the differences were statistically significant (P ＜ 0.05). On the 28th day of treatment, the NHISS scores of the three groups were lower than those before treatment, while the scores of MBI and MMSE were higher than those before treatment, and the differences were statistically significant (P ＜ 0.05). On the 28th day of treatment, the differences in NHISS and MBI scores among the three groups were statistically significant (P ＜ 0.05). Among them, the NHISS score of the low and high frequency treatment groups were lower than that of the control group, while the MBI score was higher than that of the control group, and the differences were statistically significant (P ＜ 0.05). There were no adverse reactions in the control group and the low frequency treatment group during the treatment, and three patients in the high frequency treatment group developed mild to moderate transient headaches after treatment, which resolved spontaneously after rest. Conclusion rTMS combined with Fluoxetine therapy and Fluoxetine therapy alone can both improve mood, reduce neurological deficit, and improve activites of daily living and cognitive level in patients with PSD; combination therapy has a faster onset and more significant curative effect, and the curative effect is still sustainable after the magnetic stimulation is stopped, and the adverse reactions are small.

Key words： Repetitive transcranial magnetic stimulation Stroke Depression Fluoxetine

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	SUN Rong DU Xiaoxia XIAO Lin SONG Mingjie HE Jingjie▲

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SUN Rong DU Xiaoxia XIAO Lin SONG Mingjie HE Jingjie▲. Clinical effect of repetitive transcranial magnetic stimulation combined with Fluoxetine in the treatment of post-stroke depression[J]. 中国医药导报, 2022, 19(17): 76-79.

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https://www.yiyaodaobao.com.cn/EN/ OR https://www.yiyaodaobao.com.cn/EN/Y2022/V19/I17/76

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