氟西汀对急性脑梗死患者运动功能影响的研究

发布时间：2018-06-16 04:52

本文选题：急性脑梗死 + 氟西汀　；参考：《新乡医学院》2013年硕士论文

【摘要】：脑卒中(Stroke)亦称脑血管意外——由于急性脑血流循环障碍所导致的局限性或弥漫性脑功能缺损的临床事件。该病具有发病率、病死率及致残率高的特点,目前已跃居我国第一大死亡原因。调查结果显示,我国脑卒中患者中缺血性脑卒中患者(以脑梗死为主)约占总数的70-85%,远高于出血性脑卒中患者的人数。可见,脑梗死对我国国民危害之重。而我国目前现有的脑卒中存活患者中约75%的患者有不同程度的残疾,其中重度致残者约占40%,脑卒中后患者的神经功能康复己成为当前一项刻不容缓的重要任务。近年来,国外研究发现,氟西汀(Fluoxetine)—一种选择性5-羟色胺再摄取抑制剂(Selective Serotonin Reuptake Inhibitor, SSRI)——作为经典的抗抑郁药物的同时,对于伴有中到重度运动功能障碍的急性缺血性脑卒中患者,早期给予盐酸氟西汀小剂量(20mg/天)口服并配合物理疗法,能够促进患者的神经重塑,对于患者的运动功能恢复有一定帮助,这使得急性缺血性脑卒中患者的运动功能恢复的治疗前景充满希望。目的本研究主要以伴有重度运动功能障碍的急性脑梗死患者为研究对象,以探索氟西汀是否具有改善急性脑梗死患者偏瘫肢体运动功能的作用。方法选择2012年1月至2012年6月期间在安阳市人民医院神经内科住院的急性脑梗死患者60例,所有参与研究的患者偏瘫侧肢体的运动功能经弗戈梅尔运动评分量表(Fugl-Meyer motor function rating scale,FMMS)评分均在65分以下,并且符合在1995年我国第四届中华医学会全国脑血管病学术会议上通过的“各类脑血管疾病诊断要点”。对60例入选患者采用密封、不透光信封随机单、双数分组的方法,将其平均分为氟西汀组和对照组(各30例)。其中氟西汀组30例患者中,男性16例,女性14例,年龄45-77岁,平均62.11±8.51岁,起病到入组时间3-20天,平均11.48±6.20天；对照组30例患者中,男性17例,女性13例,年龄43-78岁,平均60.35±7.86岁,起病到入组时间5-18天,平均13.54±6.58天。氟西汀组患者均使用氟西汀片(商品名：开克片)20mg/天口服,并给予急性脑梗死的常规药物治疗及物理治疗(包括针灸和/或基本的康复训练指导),而对照组除不使用氟西汀外其余治疗与氟西汀组相同。分别在给药前、给药后30天及给药后90天时,对所有入选患者的偏瘫侧肢体运动功能评分—Fugl-Meyer运动功能量表(FMMS量表)、神经功能缺损评分—美国国立卫生院卒中量表(NIHSS量表)、抑郁状态评定—汉密尔顿抑郁量表(HAMD量表)、日常生活能力—改良Rankin量表(MRS量表)进行评分。在90天观察期结束后,对患者的基线资料及各项量表评分结果进行统计学分析：对基线资料采用描述性统计进行分析；计量资料采用均数±标准差(x±s)表示,所有资料均进行正态性检验；两组间均数比较采用t-检验；自身前后比较用配对检验；非正态分布资料采用非参数检验法中的Mann-Whitney U-test(秩和检验中的一种)。根据评分变化情况(主要是运动功能评分),判断氟西汀是否具有改善急性脑梗死患者肢体运动功能的作用。结果 (1)两组患者的基线资料(如性别、年龄、文化程度、家庭关系情况、经济情况及既往疾病史等)方面无明显差异(P0.05),说明两组患者存在可比性。 (2)给药前比较：给药前,氟西汀组患者FMMS、NIHSS及HAMD评分分别为17.6+7.4、12.3±4.2及6.7±4.3,对照组患者FMMS、NIHSS及HAMD评分分别为14.4±5.2、12.7±3.9及6.2±4.7,两组患者上述评分比较的t值分别为0.078、0.063及0.059,评分差异无统计学意义(P0.05),提示两组患者之间存在可比性。 (3) FMMS评分比较：给药后30天时,氟西汀组患者FMMS评分为36.7±15.7,对照组患者FMMS评分为32.6±14.9,两组患者30天时FMMS评分比较t值为0.083,差异无统计学意义(P0.05),提示两组患者30天时运动功能恢复情况无明显差别；给药后90天时,氟西汀组患者FMMS评分(55.7±22.8)明显高于对照组(38.1士19.3),两组患者FMMS评分t值为3.223,统计学差异显著(P0.01),提示90天时氟西汀组患者运动功能恢复较对照组明显。 (4) HAMD评分比较：给药后30天时,氟西汀组HAMD分值为6.5±4.1,对照组患者HAMD分值为6.6±3.8,两组患者HAMD评分比较t值为0.051,差异无统计学意义(P0.05)；给药后90天时,氟西汀组HAMD分值为6.4±5.1,对照组患者HAMD分值为9.3±7.9,两组患者HAMD评分比较t值为0.101,差异无统计学意义(P0.05),提示两组患者在观察期内均无明显抑郁症状发生。 (5) NIHSS评分比较；给药后30天时,氟西汀组NIHSS评分为9.7±3.9,对照组NIHSS评分为9.9±±3.7,t值为0.108,两组患者NIHSS评分差异无统计学意义(P0.05)；给药后90天时,氟西汀组NIHSS评分为6.1±3.7,对照组NIHSS评分为7.5±±4.4,t值为0.151,两组患者NIHSS评分差异无统计学意义(P0.05),提示90天时两组患者神经功能缺损恢复程度无明显差别。 (6)在患者生活自理能力方面的比较：给药后30天时,氟西汀组中重度残疾(即MRS评分在4-5分)患者由给药前的27例(90%)减少为给药后30天的20例(67%),对照组中重度残疾患者由给药前的28例(93%)减少为给药后30天的22例(73%),提示两组患者的生活能力较前有所好转；给药后90天时MRS评分均较入院时有明显降低,具体到个体病人的分值为0-2分表示治疗有效,氟西汀组8例(27%)明显高于对照组2例(7%),提示随患者运动功能恢复,患者日常生活能力较前亦有所好转。结论 1.氟西汀可明显改善急性脑梗死患者重度瘫痪肢体的运动功能,能够长效的促进运动功能恢复,对上肢的运动功能改善优于下肢,可能重点改善患者肢体的协同运动及精细运动功能。 2.氟西汀可以改善急性脑梗死患者的日常生活能力情况。 3.氟西汀改善患者运动功能作用可能有其特殊机制,而非抗抑郁机制。
[Abstract]:Cerebral apoplexy (Stroke), also known as cerebrovascular accident, a clinical event of limited or diffuse brain dysfunction due to acute cerebral blood circulation disorder. The disease has the characteristics of morbidity, mortality and high disability rate. It is now the first leading cause of death in China. The number of patients (mainly with cerebral infarction) is about 70-85%, which is much higher than the number of hemorrhagic stroke patients. It can be seen that cerebral infarction is very harmful to our national people. And about 75% of the existing stroke survivors in our country have different degrees of disability, of which 40% are severely disabled, and the neurological rehabilitation of patients after stroke has been rehabilitating. In recent years, foreign studies have found that fluoxetine (Fluoxetine) - a selective 5- serotonin reuptake inhibitor (Selective Serotonin Reuptake Inhibitor, SSRI) - as a classic antidepressant, has an acute ischemic brain associated with moderate to severe dyskinesia The early administration of fluoxetine hydrochloride (20mg/ days) and combined with physical therapy can promote nerve remodeling in patients with stroke. It is helpful to the recovery of motor function in patients, which makes the treatment of motor function recovery in patients with acute ischemic stroke full of hope.
objective
The purpose of this study is to explore the effect of fluoxetine on improving the movement function of hemiplegic limbs in patients with acute cerebral infarction with acute cerebral infarction with severe motor dysfunction as the research object.
Method
60 patients with acute cerebral infarction hospitalized in the Department of Neurology of Anyang People's Hospital from January 2012 to June 2012 were selected. All the patients who participated in the study had the motor function of the hemiplegic side limbs (Fugl-Meyer motor function rating scale, FMMS). The scores were below 65 points, and they were in accordance with our country in 1995. The "main points of diagnosis of all kinds of cerebrovascular diseases" adopted at the National Conference on cerebrovascular disease of the four Chinese Medical Association. 60 cases were divided into fluoxetine group and control group (30 cases each). Among the 30 patients of fluoxetine group, 16 cases of male, 14 women, age, and age. 45-77 years old, the average 62.11 + 8.51 years, the onset to the group time 3-20 days, an average of 11.48 + 6.20 days, 30 patients in the control group, 17 men, 13 women, age 43-78 years, average 60.35 + 7.86 years, onset to 5-18 days, average 13.54 + days. Fluoxetine group patients were all used fluoxetine tablets (commodity name: Kake tablet) 20mg/ days, and given The routine drug treatment and physical therapy for acute cerebral infarction (including acupuncture and / or basic rehabilitation training) were given, while the control group was the same as that of the fluoxetine group except fluoxetine. 30 days after the administration, 30 days after the administration and 90 days after the administration, the scores of the hemiplegic limb movement function of all the selected patients were Fugl-Meyer. The exercise function scale (FMMS scale), the nerve function defect score, the National Institutes of Health Stroke Scale (NIHSS scale), the depressive state assessment - the Hamilton Depression Scale (HAMD scale), the daily living ability - the modified Rankin scale (MRS scale) were scored. After the 90 day observation period, the baseline data and the scale of the patients were scored. Results the statistical analysis was carried out: the baseline data were analyzed with descriptive statistics; the measurement data were represented by mean number + standard deviation (x + s). All the data were tested in normality; the average number between the two groups was compared with the t- test; the matching test was used before and after the comparison, and the non normal distribution data were Mann-W in the non parametric test method. Hitney U-test (one of the rank and test). Judging whether fluoxetine has the effect of improving the motor function of the patients with acute cerebral infarction according to the change of the score (mainly the motor function score).
Result
(1) there was no significant difference in baseline data between the two groups (such as gender, age, educational level, family relationship, economic situation, and previous history of disease) (P0.05), indicating the comparability of the two groups.
(2) before administration, the scores of FMMS, NIHSS and HAMD in the fluoxetine group were 17.6+7.4,12.3 + 4.2 and 6.7 + 4.3 respectively. The FMMS, NIHSS and HAMD scores in the control group were 14.4 + 5.2,12.7 + 3.9 and 6.2 + 4.7 respectively. The T values of the two groups were 0.078,0.063 and 0.059, respectively, and the difference was not statistically significant (P0.05). There was a comparability between the two groups.
(3) FMMS score comparison: at 30 days after administration, the FMMS score of the fluoxetine group was 36.7 + 15.7, and the FMMS score of the control group was 32.6 + 14.9. The T value of the two group was 0.083 at 30 days, and the difference was not statistically significant (P0.05). It suggested that there was no significant difference in the recovery of motor function in two groups of patients at the time of 30 days, and 3 days after administration, fluoxetine. The FMMS score of the group (55.7 + 22.8) was significantly higher than that of the control group (38.1. 19.3). The T value of the two group was 3.223 and the statistical difference was significant (P0.01). It was suggested that the motor function recovery of the patients in the fluoxetine group was more obvious than that of the control group at 90 days.
(4) HAMD score comparison: at 30 days after administration, the score of HAMD in fluoxetine group was 6.5 + 4.1, and the score of HAMD in the control group was 6.6 + 3.8. The T value of the two groups was 0.051 and the difference was not statistically significant (P0.05). The HAMD score of the fluoxetine group was 6.4 + 5.1 at the 90 day after the administration, and the HAMD score of the control group was 9.3 + 7.9, and the HAMD scores of the patients in the groups were in the control group. The T value was 0.101, and the difference was not statistically significant (P0.05), suggesting that there was no significant depressive symptom in the two groups during the observation period.
(5) NIHSS score was compared. At 30 days after administration, the NIHSS score of fluoxetine group was 9.7 + 3.9, the NIHSS score of the control group was 9.9 + 3.7, the T value was 0.108, and the difference in the NIHSS score of the two groups was not statistically significant (P0.05); the NIHSS score of the fluoxetine group was 6.1 + 30 at 90 days after the administration, and the NIHSS score of the control group was 7.5 + 4.4, t was NIHSS. NIHSS There was no significant difference in scores between the two groups (P0.05), suggesting that there was no significant difference in the recovery of neurological deficits between the two groups.
(6) a comparison of the patient's self-care ability: at 30 days after the administration, the moderate and severe disability (that is, the MRS score of 4-5) in the fluoxetine group was reduced from 27 (90%) to 20 (67%) for the 30 day after the administration, and in the control group, 28 cases (93%) before the Administration (93%) were reduced to 22 (73%) on 30 days after the administration, prompting the patients in the group. The living ability was better than before, and the MRS score at 90 days after administration was significantly lower than that at admission. The score of individual patients was 0-2 points, 8 cases (27%) in fluoxetine group were significantly higher than that of the control group (7%), suggesting that with the recovery of motor function, the patient's daily living ability was also better than before.
conclusion
1. fluoxetine can significantly improve the motor function of severe paralyzed limbs in patients with acute cerebral infarction. It can promote the recovery of motor function and improve the movement function of the upper limb better than the lower extremities. It may improve the coordination movement and fine motor function of the limbs.
2. fluoxetine can improve the daily living ability of patients with acute cerebral infarction.
3. fluoxetine may improve the motor function of patients with special mechanisms, rather than antidepressant mechanisms.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.33

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