卒中后抑郁合并症治疗进展.doc

卒中后抑郁合并症的治疗进展
[摘要] 卒中后抑郁(PSD)是脑卒中后常见的精神障碍并发症,临床上具有高发病率的特征。值得注意的是,相当多的患者除外抑郁为主要症状,同时常伴随一些合并症状,如认知障碍、焦虑障碍、睡眠障碍及运动障碍,严重影响了患者的日常生活及社会功能。目前,临床上将治疗方向主要集中在PSD患者抑郁症状的改善方面,而忽视了PSD患者的合并症状,这对患者的康复十分不利。本文就药物、心理康复及针灸等方法治疗卒中后抑郁及其合并症的疗效进行综述。
[关键词] 卒中后抑郁;认知障碍;焦虑障碍;睡眠障碍;运动障碍;治疗
[中图分类号] [文献标识码] A [文章编号] 1673-7210(2017)09(b)-0037-04
Advances in treatment of post stroke depression
of Mental Health, North China University of Science and Technology, Heibei Province, Tangshan 063000, China; School, North China University of Science and Technology, Heibei Province, Tangshan 063000, China; Medical College, Tangshan Vocational and Technical College, Heibei Province, Tangshan 063000, China
[Abstract] Post stroke depression is plication of mental disorder after stroke. It has a high incidence in clinic. It is worth noting that a significant number of patients except depression as the main symptom, and often panied by plications such as cognitive disorders, anxiety disorders, sleep disorders and movement disorders. plications seriously affect the patient's daily life and social function. At present, the direction of treatment is mainly focused on the improvement of depressive symptoms in PSD patients, while plications are ignored. In this case, the patient's recovery is very unfavorable. This article reviews the effects of drugs, psychological rehabilitation and acupuncture in the treatment of PSD and plications.
[Key words] Post stroke depression; Cognitive impairment; Anxiety disorders; Sleep disorders; Movement disorders; Treatment
卒中后抑郁(post stroke depression,PSD)是脑卒中后常见的精神障碍并发症[1],临床上具有高发病率的特征[2]。值得注意的是,相当多的患者除外心情低落、兴趣减退、反应迟钝等主要症状,常伴随一些合并症状,如认知障碍、焦虑障碍、睡眠障碍及运动障碍[3-5],严重影响了患者的日常生活及社会功能,使患者的病死率增高[3]。目前,临床上将治疗方向主要集中在PSD患者抑郁症状的改善方面,而忽视了PSD患者合并症状,这对患者的康?褪?分不利。本文通过对近年来治疗PSD患者同时合并上述情况时的临床研究证据进行疗效的综述,旨在为临床合理治疗PSD合并症提供理论指导。
1 PSD合并认知障碍
药物治疗
选择性5羟色***(5-HT)再摄取抑制剂(SSRIs) SSRIs可通过抑制突触间隙5-HT的再摄取,从而改善5-HT神经元及其所投射纤维所在部位的脑功能,使相应部位损