發(fā)布時(shí)間：2018-06-16 04:52

  本文選題：急性腦梗死 + 氟西汀��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2013年碩士論文

【摘要】：腦卒中(Stroke)亦稱腦血管意外——由于急性腦血流循環(huán)障礙所導(dǎo)致的局限性或彌漫性腦功能缺損的臨床事件。該病具有發(fā)病率、病死率及致殘率高的特點(diǎn),目前已躍居我國第一大死亡原因。調(diào)查結(jié)果顯示,我國腦卒中患者中缺血性腦卒中患者(以腦梗死為主)約占總數(shù)的70-85%,遠(yuǎn)高于出血性腦卒中患者的人數(shù)�？梢�,腦梗死對(duì)我國國民危害之重。而我國目前現(xiàn)有的腦卒中存活患者中約75%的患者有不同程度的殘疾,其中重度致殘者約占40%,腦卒中后患者的神經(jīng)功能康復(fù)己成為當(dāng)前一項(xiàng)刻不容緩的重要任務(wù)。近年來,國外研究發(fā)現(xiàn),氟西汀(Fluoxetine)—一種選擇性5-羥色胺再攝取抑制劑(Selective Serotonin Reuptake Inhibitor, SSRI)——作為經(jīng)典的抗抑郁藥物的同時(shí),對(duì)于伴有中到重度運(yùn)動(dòng)功能障礙的急性缺血性腦卒中患者,早期給予鹽酸氟西汀小劑量(20mg/天)口服并配合物理療法,能夠促進(jìn)患者的神經(jīng)重塑,對(duì)于患者的運(yùn)動(dòng)功能恢復(fù)有一定幫助,這使得急性缺血性腦卒中患者的運(yùn)動(dòng)功能恢復(fù)的治療前景充滿希望。 目的 本研究主要以伴有重度運(yùn)動(dòng)功能障礙的急性腦梗死患者為研究對(duì)象,以探索氟西汀是否具有改善急性腦梗死患者偏癱肢體運(yùn)動(dòng)功能的作用。 方法 選擇2012年1月至2012年6月期間在安陽市人民醫(yī)院神經(jīng)內(nèi)科住院的急性腦梗死患者60例,所有參與研究的患者偏癱側(cè)肢體的運(yùn)動(dòng)功能經(jīng)弗戈梅爾運(yùn)動(dòng)評(píng)分量表(Fugl-Meyer motor function rating scale,FMMS)評(píng)分均在65分以下,并且符合在1995年我國第四屆中華醫(yī)學(xué)會(huì)全國腦血管病學(xué)術(shù)會(huì)議上通過的“各類腦血管疾病診斷要點(diǎn)”。對(duì)60例入選患者采用密封、不透光信封隨機(jī)單、雙數(shù)分組的方法,將其平均分為氟西汀組和對(duì)照組(各30例)。其中氟西汀組30例患者中,男性16例,女性14例,年齡45-77歲,平均62.11±8.51歲,起病到入組時(shí)間3-20天,平均11.48±6.20天；對(duì)照組30例患者中,男性17例,女性13例,年齡43-78歲,平均60.35±7.86歲,起病到入組時(shí)間5-18天,平均13.54±6.58天。氟西汀組患者均使用氟西汀片(商品名：開克片)20mg/天口服,并給予急性腦梗死的常規(guī)藥物治療及物理治療(包括針灸和/或基本的康復(fù)訓(xùn)練指導(dǎo)),而對(duì)照組除不使用氟西汀外其余治療與氟西汀組相同。分別在給藥前、給藥后30天及給藥后90天時(shí),對(duì)所有入選患者的偏癱側(cè)肢體運(yùn)動(dòng)功能評(píng)分—Fugl-Meyer運(yùn)動(dòng)功能量表(FMMS量表)、神經(jīng)功能缺損評(píng)分—美國國立衛(wèi)生院卒中量表(NIHSS量表)、抑郁狀態(tài)評(píng)定—漢密爾頓抑郁量表(HAMD量表)、日常生活能力—改良Rankin量表(MRS量表)進(jìn)行評(píng)分。在90天觀察期結(jié)束后,對(duì)患者的基線資料及各項(xiàng)量表評(píng)分結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析：對(duì)基線資料采用描述性統(tǒng)計(jì)進(jìn)行分析；計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,所有資料均進(jìn)行正態(tài)性檢驗(yàn)；兩組間均數(shù)比較采用t-檢驗(yàn)；自身前后比較用配對(duì)檢驗(yàn)；非正態(tài)分布資料采用非參數(shù)檢驗(yàn)法中的Mann-Whitney U-test(秩和檢驗(yàn)中的一種)。根據(jù)評(píng)分變化情況(主要是運(yùn)動(dòng)功能評(píng)分),判斷氟西汀是否具有改善急性腦梗死患者肢體運(yùn)動(dòng)功能的作用。 結(jié)果 (1)兩組患者的基線資料(如性別、年齡、文化程度、家庭關(guān)系情況、經(jīng)濟(jì)情況及既往疾病史等)方面無明顯差異(P0.05),說明兩組患者存在可比性。 (2)給藥前比較：給藥前,氟西汀組患者FMMS、NIHSS及HAMD評(píng)分分別為17.6+7.4、12.3±4.2及6.7±4.3,對(duì)照組患者FMMS、NIHSS及HAMD評(píng)分分別為14.4±5.2、12.7±3.9及6.2±4.7,兩組患者上述評(píng)分比較的t值分別為0.078、0.063及0.059,評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組患者之間存在可比性。 (3) FMMS評(píng)分比較：給藥后30天時(shí),氟西汀組患者FMMS評(píng)分為36.7±15.7,對(duì)照組患者FMMS評(píng)分為32.6±14.9,兩組患者30天時(shí)FMMS評(píng)分比較t值為0.083,差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組患者30天時(shí)運(yùn)動(dòng)功能恢復(fù)情況無明顯差別；給藥后90天時(shí),氟西汀組患者FMMS評(píng)分(55.7±22.8)明顯高于對(duì)照組(38.1士19.3),兩組患者FMMS評(píng)分t值為3.223,統(tǒng)計(jì)學(xué)差異顯著(P0.01),提示90天時(shí)氟西汀組患者運(yùn)動(dòng)功能恢復(fù)較對(duì)照組明顯。 (4) HAMD評(píng)分比較：給藥后30天時(shí),氟西汀組HAMD分值為6.5±4.1,對(duì)照組患者HAMD分值為6.6±3.8,兩組患者HAMD評(píng)分比較t值為0.051,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；給藥后90天時(shí),氟西汀組HAMD分值為6.4±5.1,對(duì)照組患者HAMD分值為9.3±7.9,兩組患者HAMD評(píng)分比較t值為0.101,差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組患者在觀察期內(nèi)均無明顯抑郁癥狀發(fā)生。 (5) NIHSS評(píng)分比較；給藥后30天時(shí),氟西汀組NIHSS評(píng)分為9.7±3.9,對(duì)照組NIHSS評(píng)分為9.9±±3.7,t值為0.108,兩組患者NIHSS評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05)；給藥后90天時(shí),氟西汀組NIHSS評(píng)分為6.1±3.7,對(duì)照組NIHSS評(píng)分為7.5±±4.4,t值為0.151,兩組患者NIHSS評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示90天時(shí)兩組患者神經(jīng)功能缺損恢復(fù)程度無明顯差別。 (6)在患者生活自理能力方面的比較：給藥后30天時(shí),氟西汀組中重度殘疾(即MRS評(píng)分在4-5分)患者由給藥前的27例(90%)減少為給藥后30天的20例(67%),對(duì)照組中重度殘疾患者由給藥前的28例(93%)減少為給藥后30天的22例(73%),提示兩組患者的生活能力較前有所好轉(zhuǎn)；給藥后90天時(shí)MRS評(píng)分均較入院時(shí)有明顯降低,具體到個(gè)體病人的分值為0-2分表示治療有效,氟西汀組8例(27%)明顯高于對(duì)照組2例(7%),提示隨患者運(yùn)動(dòng)功能恢復(fù),患者日常生活能力較前亦有所好轉(zhuǎn)。 結(jié)論 1.氟西汀可明顯改善急性腦梗死患者重度癱瘓肢體的運(yùn)動(dòng)功能,能夠長效的促進(jìn)運(yùn)動(dòng)功能恢復(fù),對(duì)上肢的運(yùn)動(dòng)功能改善優(yōu)于下肢,可能重點(diǎn)改善患者肢體的協(xié)同運(yùn)動(dòng)及精細(xì)運(yùn)動(dòng)功能。 2.氟西汀可以改善急性腦梗死患者的日常生活能力情況。 3.氟西汀改善患者運(yùn)動(dòng)功能作用可能有其特殊機(jī)制,而非抗抑郁機(jī)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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R743.33

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