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1、重复经颅磁刺激联合氟西汀治疗老年抑郁症的临床对照研宄茅卫兵江飞朱圣洁徐健(南通市第四人民医院江苏南通226005)FI的：探讨rTMS治疗老年抑郁症首次发病患者的有效性及安全性。方法：采用随机、单盲对照法，将63例年龄大于60岁的抑郁症首发患者分为rTMS组和氟西汀组，两组均服用氟西汀20mg/d，rTMS组加用6周rTMS真性刺激，以10Hz、90%运动阈值刺激患者左前额叶背外侧，氟西汀组加用6周rTMS伪刺激治疗。治疗前后用汉密顿抑郁量表(HAMD-17)和副反应量表(TESS)评价疗效和不良反应。结果：实际完成
2、观察63例，其屮rTMS组31例，氟西汀组32例。治疗第1周末，rTMS组的HAMD总分较治疗前明显卜降(P<0.01),有效率及减分率均高于氟西汀组(P<0.05)。氟西汀组HAMD总分在治疗第2周末较治疗前明显下降(P<0.01);治疗第1,2周末，rTMS组有效率高于氟西汀组，组间差异均有统计学意义(P<0.05)。治疗第4,6周末，rTMS组治愈率高于氟西汀组，组间差异均有统计学意义(P<0.05),而两组有效率的差异无统计学意义(P>O.05)。两组患者出现药物不良反应者各4例，差异无统计学意义(P&
3、gt;O.05)。结论:rTMS联合氟西汀治疗老年首发抑郁症患者起效较快、安全、疗效肯定,治愈率更高。【关键词】抑郁症；老年人；氟西汀；重复经颅磁刺激【屮图分类号】R453A1007-8231(2016)09-0037-03Theefficacyandtolerabilitylofrepetitivetranseranialmagneticstimulation(rTMS)combinedwithfluoxetineintreatmentofelderlypatientswithfirst-episodedepres
4、sionMaoWeibing,JiangFei,ZhuShengjie,XuJian.TheForthHospitalofNantong,Nantong226005,China[Abstract]ObjectiveTostudytheefficacyandsafetyofrepetitivetranseranialmagneticstimulation(rTMS)combinedwithfluoxetineintreatingtheelderlypatientswithfirst-episodedepression.
5、MethodsArandom,singleblindstudywasconductedin63first-episodedepressivepatientsaged60yearsorover.Thepatientswereassignedtofluoxetinetreatment(20mg/d)incombinationwithasix-weekperiodofeitherrTMS(rTMSgroup)orshamprocedure(fIuoxetinegroup)onleftdorsolateralprefront
6、cortex(10Hz,90%motorthreshold).Theefficacywasevaluatedwiththehumiltonratingscalefordepression(HAMD).ThesafetyprofileswereassessedwithTESS.Results63caseswerefinishedthestudy.Attheendofweeks1,significantlymoreHAMDscorereductionwasinrTMSgroupthaninfluoxetinegroup.
7、Atweeks1and2,theresponseratesinrTMSgroupweresignificantlyhigherthanfluoxetinegroup(P<0.01).Atweeks4and6,theremissionratesinrTMSgroupweresignificantlyhigherthanfluoxetinegroup(P<0.01),theresponserateswerenotsignificant(P>0.05).ConclusionrTMSisanewoptionforthe
8、elderlydepressionpatients.【Keywords]Depression;Aged;Fluoxetine;Repetitivetranseranialmagneticstimulation(rTMS)随着社会的老龄化，老年人U不断增加，老年抑郁症的患病率也呈现上升趋势，这引起了医学界的广泛重视和关注。选择性5-羟色胺再摄取抑
