杨子民　许环宇　潘卓瑜　叶健夫　刘锐芬

【摘要】 目的 探討重复经颅磁刺激（rTMS）联合碳酸锂、喹硫平治疗双相障碍抑郁发作患者的疗效。方法 40例双相障碍抑郁发作患者作为研究对象， 采用随机数字表法分为对照组和观察组， 各20例。

对照组患者采用喹硫平和碳酸锂治疗， 观察组在对照组基础上加用重复经颅磁刺激治疗。观察对比两组患者治疗不同时间段心理状态、治疗效果及不良反应发生情况。结果 治疗2周后， 观察组患者的汉密尔顿抑郁量表（HAMD）评分为（16.36±3.16）分， 对照组患者的HAMD评分为（18.87±3.76）分;治疗4周后， 观察组患者的HAMD评分为（11.25±2.86）分， 对照组患者的HAMD评分为（14.42±2.98）分;治疗2、4周后， 观察组患者的HAMD评分均低于对照组， 差异有统计学意义（P<0.05）。治疗2、4周后， 观察组患者的临床疗效总评量表（CGI）评分均低于对照组， 差异有统计学意义（P<0.05）。观察组患者发生肢体震颤2例， 不良反应发生率为10.00%;对照组患者发生静坐不能2例， 兴奋或激越4例， 肢体震颤2例， 不良反应发生率为40.00%;观察组不良反应发生率低于对照组， 差异有统计学意义（P<0.05）。结论 双相障碍抑郁发作患者采用重复经颅磁刺激联合碳酸锂、喹硫平治疗效果显著， 能够有效改善患者的焦虑和抑郁情况， 改善患者的精神状态， 适合在临床进行推广和使用。

【关键词】 双相障碍抑郁发作;重复经颅磁刺激;碳酸锂;喹硫平

DOI：10.14163/j.cnki.11-5547/r.2020.18.013

Efficacy of repeated transcranial magnetic stimulation combined with lithium carbonate and quetiapine in the treatment of bipolar disorder depressive episode   YANG Zi-min， XU Huan-yu， PAN Zhuo-yu， et al. Foshan Shunde District Wu Zhongpei Memorial Hospital， Foshan 528300， China

【Abstract】 Objective   To discuss the efficacy of repeated transcranial magnetic stimulation （r TMS） combined with lithium carbonate and quetiapine in the treatment of bipolar disorder depressive episode. Methods   A total of 40 patients with bipolar disorder depressive episode as study subjects were divided into control group and observation group by random numerical table， with 20 cases in each group. The control group was treated by lithium carbonate and quetiapine， and the observation group was treated by repeated transcranial magnetic stimulation on the basis of the control group. The psychological state， therapeutic effect in different treatment periods and occurrence of adverse reactions were observed and compared between the two groups. Results   2 weeks

after treatment， the Hamilton depression scale （HAMD） score of the observation group was （16.36±3.16） points， which was （18.87±3.76） points of the control group. 4 weeks after treatment， HAMD score of the observation group was （11.25±2.86） points， which was （14.42±2.98） points of the control group. 2 and 4 weeks after treatment， HAMD score of the observation group was lower than that of the control group， and the difference was statistically significant （P<0.05）. 2 and 4 weeks after treatment， the clinical global impression （CGI） score of the observation group was lower than that of the control group， and the difference was statistically sigificant （P<0.05）. The observation group had 2 cases of limb tremor， with incidence of adverse reactions as 10.00%， and the control group had 2 cases of akathisia， 4 cases of excitement or agitation， and 2 cases of limb tremor， with incidence of adverse reactions as 4 5%. The incidence of adverse reactions of the observation group was lower than that of the control group， and the difference was statistically significant （P<0.05）. Conclusion   Repeated transcranial magnetic stimulation combined with lithium carbonate and quetiapine shows remarkable effect in the treatment of bipolar disorder depressive episode， which can effectively improve the anxiety and depression of patients with bipolar disorder depressive episode， and improve their mental status. It is suitable for clinical promotion and application.

【Key words】 Bipolar disorder depressive episode; Repeated transcranial magnetic stimulation; Lithium carbonate; Quetiapine

随着人们生活节奏的加快， 生活压力的增大， 精神类疾病的发病率逐年升高， 其中， 双相障碍抑郁发作就是比较典型的一种[1]。临床上该病多表现为情绪低落、悲观、自卑、少语少动， 并且伴有情绪高涨、精力充沛、话多好强、暴躁易怒等。导致该病的发生因素较为复杂， 比如遗传因素、社会压力、心理承受能力等[2]。本文选取40例双相障碍抑郁发作患者， 分析重复经颅磁刺激联合碳酸锂、喹硫平治疗双相障碍抑郁发作患者的疗效。现报告如下。

1 资料与方法

1. 1 一般资料 选取2017年1月～ 2019年1月本院收治的40例双相障碍抑郁发作患者作为研究对象， 采用随机数字表法分为对照组和观察组， 各20例。对照组患者男女比例10∶10;平均年龄（46.9±2.3）岁;平均病程（3.9±2.1）年;平均HAMD评分（22.35±1.54）分;平均CGI评分（6.31±0.54）分。……