天津医药

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脑创伤康复期抑郁障碍的特征及治疗

罗兰兰1,柴艳2,江荣才2,陈心2   

  1. 1. 天津市环湖医院心理科
    2. 天津医科大学总医院神经外科
  • 收稿日期:2013-05-06 修回日期:2013-05-14 出版日期:2013-08-15 发布日期:2013-08-15
  • 通讯作者: 陈心

The Characteristics and Treatment of Major Depression in the Rehabilitation Phase of Traumatic Brain Injury

LUO LAN LAN ,CAIYAN ,JIANG RONG CAI ,CHENXIN   

  • Received:2013-05-06 Revised:2013-05-14 Published:2013-08-15 Online:2013-08-15
  • Contact: CHENXIN

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摘要： 【摘要】 目的 探讨脑创伤（TBI）患者康复期抑郁障碍的临床诊疗特征。 方法 选择 32 例 TBI 康复期抑郁障碍患者， TBI 严重程度根据入院时格拉斯哥昏迷评分（GCS）分轻、中、重型 TBI， TBI 恢复状况采用格拉斯哥预后评分（GOS）分Ⅰ 、Ⅱ 、Ⅲ、Ⅳ和Ⅴ 级， 抑郁障碍程度根据汉密顿抑郁量表（HAMD17）评价， 分为轻、中、重度抑郁， 比较抑郁障碍与 TBI 严重程度及预后的关系。 治疗方法采用支持性心理治疗， 4 例心理治疗后抑郁障碍明显改善， 未予药物治疗。 28 例给予抗抑郁药治疗， 对其中 15 例并发垂体功能减退者予以激素替代治疗， 并进行 0.5~2年随访。 结果 32例患者中轻、中、重度抑郁者分别有 10、18 和 4例， 主要临床表现为失眠（87.50%）、情绪低落（68.75%）、注意力集中困难（50.00%）。 抑郁障碍程度与 TBI患者损伤程度（r=0.128）、预后（r=0.206）无关（均 P＞ 0.05）。 15 例（46.88%）患者激素水平异常。 结论 下丘脑-垂体功能低下可能是诱发 TBI 康复期抑郁障碍的重要原因之一， 通过及时治疗可得到显著改善。

关键词: 脑损伤, 康复, 抑郁症, 治疗, 垂体功能减退症

Abstract: Objective   This study was designed to investigate the characteristics of clinical diagnosis and treatment of major depression in the rehabilitation phase of traumatic brain injury (TBI). Methods   32 patients, suffered from TBI and discharged with major depression, were recruited in this study. Their TBI characteristics, clinical manifestation and management of major depression were comprehensively analyzed. The therapeutic effects of different treating regimen were further compared as well. Results   10 cases presented with mild-to-moderate (31.25%); 18 cases with moderate (56.25%); and 4 cases with severe depression (12.5%). Their clinical manifestations are easy fatigue (22 cases), irritability (21 cases), hypologia (20 cases), insomnia (15 cases), and concentration deficits (14 cases). 15 patients suffered from reduced hormone level (12 cases with hypocortisolism, 10 with hypothyroidism, and 3 with hypogonadotropinism and hypoestrogenism). After supportive psychotherapy, hormone replacement and antidepressant treatment, 68.75% of depressive patients were in complete remission, 28.13% in partial remission, 3.13% with no obvious improvement. Conclusion    Major depression is a common complication in the rehabilitation phase of TBI, and post-traumatic hypopituitarism might be a major contribution factor. Appropriate and prompt treatment could significantly improve or even cure the major depression in TBI patients.

Key words: brain injury, Rehabilitation, Citalopram, treatment