药物联合MECT对重度抑郁症患者P300及EEM的影响

发布时间：2018-06-10 07:59

本文选题：无抽搐电休克 + 抗抑郁药物　；参考：《新乡医学院》2013年硕士论文

【摘要】：背景重度抑郁症是精神科临床治疗重点和难点,某些抑郁情绪严重、有强烈自杀观念和行为的患者应用抗抑郁药物往往难以及时奏效,影响病情控制及预后。无抽搐电休克治疗(MECT)在精神科临床应用广泛,联合药物抗抑郁效果更好,但其对认知功能的远期影响目前仍不甚明了。P300和EEM已广泛应用于精神科临床诊断,相比神经心理学测验,不易受外界环境影响,是较好的认知功能评价指标,本研究通过对治疗前后P300及EEM改变进行分析,更能说明治疗方案对认知功能的影响。目的分析药物联合MECT及单纯药物治疗重度抑郁症患者后神经电生理指标的改变,探讨药物联合MECT对认知功能的影响。方法 1.选择2011年5月至2011年11月在南阳市精神病医院门诊或住院治疗的重度抑郁症患者,符合入组标准的100例患者随机分为联合组和药物组各50例,联合组除给予基础SSRI类抗抑郁药物外,联合MECT治疗1个疗程,MECT采用美国鹰赛特公司生产的醒脉通治疗仪；药物组单独使用SSRI类抗抑郁药治疗6周； 2.应用汉密尔顿抑郁量表(HAMD)17项版本对所有患者在治疗前及疗程结束后1d内进行抑郁症状测定,记录HAMD总分及治疗后减分率改变； 3.采用广州润杰医疗器械有限公司生产的WJ-1A型事件相关电位仪对所有患者在治疗前及疗程结束后1d内进行P300检测,记录P300潜伏期和波幅改变； 4.采用上海迪康医学生物技术有限公司生产的DEM-2000型探索性眼动实验仪对所有患者在治疗前及疗程结束后1d内进行EEM检测,记录NEF和RSS指标； 5.比较两组患者治疗前及治疗后1dHAMD、P300及EEM指标的改变,对各指标进行组间和组内比较,并单独对联合组HAMD总分同P300及EEM指标进行相关性分析。结果 1.治疗前两组患者的HAMD,总分、P300和EEM指标及差异无统计学意义(P0.05)： 2.相比治疗前,药物组治疗后HAMD总分降低,潜伏期缩短,P300波幅增高差异均有统计学意义(P0.01),EEM指标RSS及NEF差异无统计学意义(P0.05)； 3.相比治疗前,联合组治疗后HAMD总分降低,潜伏期缩短,P300波幅增高,差异均有统计学意义(P0.01),EEM指标RSS及NEF数目增多,差异有统计学意义(P0.01)； 4.联合组相比药物组,HAMD总分降低及减分率改变差异有统计学意义(P0.01),P300潜伏期及EEM指标差异有统计学意义(P0.01)； 5.联合组HAMD总分与P300潜伏期相关度最高,结果显示差异有统计学意义(P0.01),而其余三项指标均是微弱相关,差异未达到统计学意义(P0.05)。结论 1.单纯药物治疗抑郁症有效,并可以改善P300指标,但对EEM指标无影响。 2.药物联合MECT治疗抑郁症疗效较好,并可同时改善P300及EEM指标。 3.药物联合MECT治疗相比单纯药物治疗效果更好,显著改善认知相关电生理学指标,此治疗方案对整体认知功能无损害。 4.药物联合MECT治疗抑郁症可能通过有效缓解抑郁症状而改善认知功能。
[Abstract]:background
Severe depression is the key and difficult point of clinical treatment in the Department of psychiatry. Some patients with severe depression, strong suicidal ideas and behaviors are often difficult to use antidepressant drugs in time to affect the disease control and prognosis. MECT (convulsive electroconvulsive therapy) should be widely used in the clinical psychiatry, and the combination of antidepressant effect is better, but the effect of antidepressant therapy is better The long-term effects of cognitive function are still unclear..P300 and EEM have been widely used in the clinical diagnosis of psychiatrists. Compared with the neuropsychological tests, it is not easy to be affected by the external environment. It is a better evaluation index of cognitive function. This study can explain the effect of the treatment scheme on the cognitive function by analyzing the changes of P300 and EEM before and after the treatment.
objective
Objective to analyze the changes of electrophysiological indexes in patients with severe depressive disorder treated by drugs combined with MECT and simple drugs, and to explore the effect of drugs combined with MECT on cognitive function.
Method
1. patients with severe depression treated in Nanyang Psychiatric Hospital from May 2011 to November 2011 were randomly divided into the combination group and the drug group of 100 patients who were in accordance with the standard of entry group. The combined group was treated with the basic SSRI antidepressant, combined with MECT for 1 courses, and MECT was produced by the American Eagle company. The patients in the drug group were treated with SSRI antidepressant for 6 weeks.
2. the 17 versions of the Hamilton Depression Scale (HAMD) were used to determine the depressive symptoms in all patients before and after the end of the course of treatment. The total score of HAMD and the reduction rate after treatment were recorded.
3. the WJ-1A type event related potentiometer produced by Guangzhou Yun Jie medical device Co., Ltd. was used to detect the changes of the latency and amplitude of P300 in all patients before and after the end of the course of treatment at the end of the course of 1D.
4. using the DEM-2000 exploratory eye movement test instrument produced by the Shanghai Dikang Medical Biotechnology Co., Ltd., all patients were detected by EEM before and after the end of the course of treatment at the end of the course of treatment, and the indexes of NEF and RSS were recorded.
5. compare the changes of the indexes of 1dHAMD, P300 and EEM before and after treatment in the two groups, compare the indexes between groups and groups, and analyze the correlation between the total score of HAMD and the P300 and EEM indexes in the combined group.
Result
1. there was no significant difference in HAMD, total score, P300 and EEM between the two groups before treatment (P0.05):
2. before treatment, the total score of HAMD in the drug group decreased, the incubation period was shortened, and the difference of P300 amplitude increased statistically (P0.01), and there was no statistical difference between the EEM index and RSS and NEF (P0.05).
3. before treatment, the total score of HAMD in the combined group was reduced, the latency was shortened and the amplitude of P300 increased, the difference was statistically significant (P0.01), the number of EEM indicators RSS and NEF increased, and the difference was statistically significant (P0.01).
4. compared with the drug group, the difference of the total score reduction and the reduction rate of HAMD was statistically significant (P0.01), and the difference between the P300 latency and the EEM index was statistically significant (P0.01).
The correlation between the total score of HAMD and the latency of P300 in the 5. group was the highest, and the results showed that the difference was statistically significant (P0.01), while the other three indexes were weakly correlated, and the difference was not statistically significant (P0.05).
conclusion
1. simple drug treatment is effective for depression, and can improve P300 index, but has no effect on EEM index.
2. drug combined with MECT is effective in the treatment of depression, and can improve P300 and EEM indexes simultaneously.
3. drug combination with MECT treatment is better than simple drug treatment, and significantly improves the cognitive related electrophysiological indicators. This treatment has no damage to the overall cognitive function.
4. the combination of drugs and MECT in the treatment of depression may improve cognitive function through effective relief of depressive symptoms.
【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】：R749.4

【参考文献】