本文選題：老年抑郁癥　切入點(diǎn)：度洛西汀　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的比較老年抑郁癥患者服用度洛西汀與舍曲林后的治療效果和不良反應(yīng)并觀察病前生活負(fù)性事件與療效的關(guān)系。方法研究對(duì)象為97例符合ICD-10抑郁癥診斷,年齡≥60歲的老年抑郁癥患者。按照隨機(jī)數(shù)字表法分為度洛西汀組(49例)和舍曲林組(48例),分別給予度洛西汀(60mg/d)和舍曲林(50-100mg/d)進(jìn)行治療,為期6周。在治療前、治療后第1周末、第2周末、第4周末、第6周末分別采用漢密頓抑郁量表(Hamilton Depression Scale,HAMD-24)和漢密頓焦慮量表(Hamilton Anxiety Scale,HAMA)對(duì)患者進(jìn)行評(píng)定,治療中發(fā)生的不良反應(yīng)用治療副反應(yīng)量表(Treatment Emergent Symptom Scale,TESS)對(duì)患者進(jìn)行評(píng)定�；颊卟∏吧钬�(fù)性事件采用生活事件量表(Life Event Scale,LES)進(jìn)行測(cè)定。結(jié)果治療前對(duì)度洛西汀組和舍曲林組的漢密頓抑郁量表(HAMD)和漢密頓焦慮量表(HAMA)評(píng)分經(jīng)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組治療后第1周末、第2周末、第4周末、第6周末漢密頓抑郁量表(HAMD)、漢密頓焦慮量表(HAMA)評(píng)分均低于治療前,且度洛西汀組評(píng)分均低于舍曲林組,經(jīng)比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。度洛西汀組治愈19例,顯效14例,有效10例,無(wú)效6例,總有效率為87.76%;舍曲林組治愈10例,顯效15例,有效12例,無(wú)效11例,總有效率為77.08%,度洛西汀組的總有效率高于舍曲林組,經(jīng)比較差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。兩組治療初期均有不良反應(yīng)的發(fā)生,但癥狀輕微,沒(méi)有給予特殊處理,均隨著治療的進(jìn)程而自行緩解。度洛西汀組不良反應(yīng)發(fā)生率為16.33%(3例輕微胃部不適、3例惡心、2例嘔吐),舍曲林組不良反應(yīng)發(fā)生率為14.58%(3例輕微胃部不適、1例惡心、3例頭暈),度洛西汀組不良反應(yīng)發(fā)生率高于舍曲林組,但兩組差異經(jīng)比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。利用生活事件量表(LES)對(duì)兩組患者病前一年所經(jīng)歷的生活負(fù)性事件進(jìn)行分析,經(jīng)統(tǒng)計(jì)和比較可得,度洛西汀組病前負(fù)性生活事件得分與舍曲林組病前負(fù)性生活事件得分經(jīng)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),治療后對(duì)兩組老年抑郁癥患者病前負(fù)性生活事件分?jǐn)?shù)與漢密頓抑郁量表(HAMD)治療前后減分率進(jìn)行相關(guān)分析發(fā)現(xiàn),負(fù)性生活事件與患者的治療效果呈顯著負(fù)相關(guān),負(fù)性生活事件分?jǐn)?shù)越高,患者的漢密頓抑郁量表(HAMD)的減分率越低。結(jié)論老年抑郁癥患者病前負(fù)性生活事件與患者的治療效果呈顯著負(fù)相關(guān),及患者病前所遭受的負(fù)性生活事件對(duì)其造成的影響越大,其后的治療效果越差。老年抑郁癥采用度洛西汀治療,其臨床效果優(yōu)于舍曲林,且不良反應(yīng)輕微,是一種安全有效的治療方法。
[Abstract]:Objective to compare the efficacy and adverse reactions of doxicetine and sertraline in elderly patients with depression and to observe the relationship between pre-morbid negative events and efficacy. Methods 97 patients with ICD-10 depression were included in the study. Elderly patients with depression aged more than 60 years were divided into two groups according to random number table: doxoxetine group (49 cases) and sertraline group (48 cases) were treated with doloxetine 60 mg / d and sertraline 50-100 mg / d respectively for 6 weeks. The patients were assessed with Hamilton Depression scale (Hamd 24) and Hamilton Anxiety scale (Hama) at weekend 2, weekend 4 and weekend 6, respectively. Adverse reactions occurred during treatment were assessed with treatment Emergent Symptom scale (TESS). Negative life events before treatment were measured by Life Event ScaleLes. Results Doxetine group and sertrexil group were evaluated before treatment. There was no significant difference in the scores of Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hamma) between the two groups (P 0.05). At the end of the first week of treatment, there was no significant difference between the two groups. At weekend 2, weekend 4 and weekend 6, the scores of Hamilton Depression scale (Hamd) and Hamilton anxiety scale (Hamma) were lower than those before treatment, and the scores of Doxetine group were lower than those of sertraline group. There were significant differences between the two groups: 19 cases were cured, 14 cases were effective, 10 cases were effective, 6 cases were ineffective, the total effective rate was 87.766.In the sertraline group, 10 cases were cured, 15 cases were markedly effective, 12 cases were effective, 11 cases were ineffective. The total effective rate was 77.08, and the total effective rate of duloxetine group was higher than that of sertraline group, and the difference was statistically significant (P 0.05). There were adverse reactions in both groups at the early stage of treatment, but the symptoms were mild and no special treatment was given. The incidence of adverse reactions in the doxoxetine group was 16.33. 3 cases of mild stomach discomfort 3 cases of nausea and 2 cases of vomiting. The incidence of adverse reactions of sertraline group was 14.58 cases of mild stomach discomfort in 1 case and nausea in 3 cases. The incidence of adverse reactions in the group of dizziness and doxetine was higher than that in the group of sertraline. However, the difference between the two groups was not statistically significant (P 0.05). Life events scale (LES) was used to analyze the negative life events experienced by the two groups one year before the disease. There was no significant difference between the scores of negative life events before illness and sertraline group (P 0.05). After treatment, the scores of negative life events before illness and Hamilton depression in two groups of elderly depression patients were inhibited. The score reduction rate before and after treatment with HAMD-depression scale was found by correlation analysis. The negative life events were negatively correlated with the therapeutic effect of the patients. The higher the score of negative life events, the higher the scores of negative life events. Conclusion there is a significant negative correlation between the negative life events and the therapeutic effect of the elderly depression patients, and the more negative life events the patients suffer before their illness, the greater the impact of the negative life events on the patients. The worse the treatment was, the better the clinical effect was compared with sertraline, and the less adverse reaction was, it was a safe and effective treatment for senile depression.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.4

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