本文選題：無抽搐電休克 + 抗抑郁藥物��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2013年碩士論文

【摘要】：背景 重度抑郁癥是精神科臨床治療重點和難點,某些抑郁情緒嚴(yán)重、有強烈自殺觀念和行為的患者應(yīng)用抗抑郁藥物往往難以及時奏效,影響病情控制及預(yù)后。無抽搐電休克治療(MECT)在精神科臨床應(yīng)用廣泛,聯(lián)合藥物抗抑郁效果更好,但其對認(rèn)知功能的遠期影響目前仍不甚明了。P300和EEM已廣泛應(yīng)用于精神科臨床診斷,相比神經(jīng)心理學(xué)測驗,不易受外界環(huán)境影響,是較好的認(rèn)知功能評價指標(biāo),本研究通過對治療前后P300及EEM改變進行分析,更能說明治療方案對認(rèn)知功能的影響。 目的 分析藥物聯(lián)合MECT及單純藥物治療重度抑郁癥患者后神經(jīng)電生理指標(biāo)的改變,探討藥物聯(lián)合MECT對認(rèn)知功能的影響。 方法 1.選擇2011年5月至2011年11月在南陽市精神病醫(yī)院門診或住院治療的重度抑郁癥患者,符合入組標(biāo)準(zhǔn)的100例患者隨機分為聯(lián)合組和藥物組各50例,聯(lián)合組除給予基礎(chǔ)SSRI類抗抑郁藥物外,聯(lián)合MECT治療1個療程,MECT采用美國鷹賽特公司生產(chǎn)的醒脈通治療儀；藥物組單獨使用SSRI類抗抑郁藥治療6周； 2.應(yīng)用漢密爾頓抑郁量表(HAMD)17項版本對所有患者在治療前及療程結(jié)束后1d內(nèi)進行抑郁癥狀測定,記錄HAMD總分及治療后減分率改變； 3.采用廣州潤杰醫(yī)療器械有限公司生產(chǎn)的WJ-1A型事件相關(guān)電位儀對所有患者在治療前及療程結(jié)束后1d內(nèi)進行P300檢測,記錄P300潛伏期和波幅改變； 4.采用上海迪康醫(yī)學(xué)生物技術(shù)有限公司生產(chǎn)的DEM-2000型探索性眼動實驗儀對所有患者在治療前及療程結(jié)束后1d內(nèi)進行EEM檢測,記錄NEF和RSS指標(biāo)； 5.比較兩組患者治療前及治療后1dHAMD、P300及EEM指標(biāo)的改變,對各指標(biāo)進行組間和組內(nèi)比較,并單獨對聯(lián)合組HAMD總分同P300及EEM指標(biāo)進行相關(guān)性分析。 結(jié)果 1.治療前兩組患者的HAMD,總分、P300和EEM指標(biāo)及差異無統(tǒng)計學(xué)意義(P0.05)： 2.相比治療前,藥物組治療后HAMD總分降低,潛伏期縮短,P300波幅增高差異均有統(tǒng)計學(xué)意義(P0.01),EEM指標(biāo)RSS及NEF差異無統(tǒng)計學(xué)意義(P0.05)； 3.相比治療前,聯(lián)合組治療后HAMD總分降低,潛伏期縮短,P300波幅增高,差異均有統(tǒng)計學(xué)意義(P0.01),EEM指標(biāo)RSS及NEF數(shù)目增多,差異有統(tǒng)計學(xué)意義(P0.01)； 4.聯(lián)合組相比藥物組,HAMD總分降低及減分率改變差異有統(tǒng)計學(xué)意義(P0.01),P300潛伏期及EEM指標(biāo)差異有統(tǒng)計學(xué)意義(P0.01)； 5.聯(lián)合組HAMD總分與P300潛伏期相關(guān)度最高,結(jié)果顯示差異有統(tǒng)計學(xué)意義(P0.01),而其余三項指標(biāo)均是微弱相關(guān),差異未達到統(tǒng)計學(xué)意義(P0.05)。 結(jié)論 1.單純藥物治療抑郁癥有效,并可以改善P300指標(biāo),但對EEM指標(biāo)無影響。 2.藥物聯(lián)合MECT治療抑郁癥療效較好,并可同時改善P300及EEM指標(biāo)。 3.藥物聯(lián)合MECT治療相比單純藥物治療效果更好,顯著改善認(rèn)知相關(guān)電生理學(xué)指標(biāo),此治療方案對整體認(rèn)知功能無損害。 4.藥物聯(lián)合MECT治療抑郁癥可能通過有效緩解抑郁癥狀而改善認(rèn)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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.4

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