目的 探究老年脑梗死患者抑郁与共病之间的相关性。方法 选择2021年9月—2023年7月于开封市第五人民医院接受治疗的80例老年脑梗死康复期患者,均使用老年抑郁量表（GDS）对其进行评测,按照评测结果将患者区分为无抑郁组（n=39,GDS≤10分）和抑郁组（n=41,GDS>10分）,并按照受试者是否存在共病区分为不同亚组（如并消化系统疾患、并发循环系统疾患等）,对比不同亚组患者占比差异,并采用Pearson相关性分析的方式,分析入组80例老年脑梗死患者GDS评分与其Charlson共病指数（CCI）评分的相关性。结果 80例患者中抑郁占比为51.25%,对比显示共病循环系统、内分泌系统以及运动系统疾病的老年脑梗死患者抑郁发生率明显更高（P<0.05）;Pearson相关性分析显示老年脑梗死患者GDS评分与其CCI评分呈正相关（r=0.180,P<0.001）。结论 老年脑梗死患者抑郁发生率较高,对并发循环系统疾病、内分泌系统疾病、运动系统疾病的老年脑梗死患者应予以更多关注,预防抑郁的发生。

Objective To explore the correlation between depression and comorbidity in elderly patients with cerebral infarction．Methods A total of 80 elderly patients treated from September 2021 to July 2023 were selected．The patients were evaluated using the Geriatric Depression Scale（GDS）,patients were divided into the non-depression group（n=39,GDS≤10 points）and the depression group（n=41,GDS>10 points）,and they were divided into different subgroups（such as concurrent digestive disorders,concurrent circulatory disorders,etc.）．Comparing the differences in patient proportions in different subgroups,and the correlation between the GDS score and its Charlson comorbidity index（CCI）score in 80 elderly patients with cerebral infarction was analyzed with Pearson correlation analysis．Results The proportion of depression in 80 patients was 51.25%,showing a significantly higher incidence of depression in elderly patients with a comorbid circulatory system,endocrine system and motor system disease（P<0.05）;Pearson correlation analysis showed that GDS score in elderly patients with a cerebral infarction was positively correlated with their CCI score（r=0.180,P<0.001）．Conclusions The incidence of depression in elderly patients with cerebral infarction is relatively high,and more attention should be paid to elderly patients with concurrent circulatory system diseases,endocrine system diseases and motor system diseases to prevent the occurrence of depression．

目的 本研究以脑卒中患者为研究对象,通过二代Illumina高通量测序平台对患者的粪便标本进行微生物群落多样性测序。选择物种丰度≥30%的24个门类（Phylum）作为肠道菌群的研究指标,进而研究肠道菌群与脑卒后抑郁（PSD）之间的相关关系。方法 以40位脑卒中患者的24个门类作为特征变量,抑郁组和对照组为二分类目标变量,建立以Logistic回归、随机森林、支持向量机和AdaBoost为基模型的Stacking分类模型。主成分分析方法作为该模型的特征选择方法选择恰当的主成分进行模型训练,通过二分类评价报告（precision、recall、f1-score）、ROC曲线和混淆矩阵等评价指标对其性能进行评价。结果 （1）通过差异性检验分析了两组（抑郁组和对照组）的基线一致（P<0.05）;（2）从Stacking模型融合的角度定量分析了影响脑卒中后抑郁情绪的具体肠道菌群。研究结果可知,放线菌门、拟杆菌门、变形菌门和酸杆菌门在PSD患者中均增加（P<0.001）;厚壁菌门,疣微菌门,绿弯菌门和软壁菌门在PSD患者中降低（P<0.001）。结论 以上菌群是影响脑卒中后抑郁患者情绪的主要影响因素,因此,在临床上通过恰当干预肠道菌群的变化来调节脑卒中后抑郁患者的抑郁水平,这为脑卒中后抑郁情绪的诊断和治疗方案提供科学依据。

Objective In this study,patients with stroke were selected as the research object,and the microbial community diversity of patients' stool samples was sequenced by the second-generation Illumina high-throughput sequencing platform． Twenty four phylum species with 30% species abundance were selected as indicators for the study of gut microbiota,and then the correlation between gut microbiota and post-stroke depression（PSD） was studied．Methods Taking 24 categories of 40 stroke patients as characteristic variables,depression group and control group as dichotomous target variables,a stacking classification model based on Logistic regression,random forest,support vector machine and AdaBoost was established．As the feature selection method of the model,principal component analysis selects the appropriate principal components for model training,and evaluates its performance through dichotomous evaluation reports（precision,recall,f1 score）,ROC curve and confusion matrix．Results The baseline of the two groups（depression group and control group）was consistent（P<0.05）through the difference test．From the perspective of stacking model fusion,the specific intestinal flora affecting post-stroke depression was quantitatively analyzed．The results showed that Actinobacteria,Bacteroidetes,Proteobacteria and Acidobacteria were significantly increased in PSD patients（P<0.001）,while Firmicutes,Verrucomicrobia,Chloroflexi and Tenericutes were significantly decreased in PSD patients（P<0.001）．Conclusions The above microbiota are the main factors affecting the mood of patients with post-stroke depression．Therefore,in clinical practice,we can adjust the depression level of patients with post-stroke depression by properly intervening the changes of intestinal microbiota,which provides a scientific basis for the diagnosis and treatment of PSD．

目的 探讨积极综合护理措施对早期宫颈癌术后患者性功能、抑郁和主观幸福感的影响。方法 对我院收治的84例50岁以下宫颈癌患者的临床资料进行回顾性分析,将行常规护理的43例患者作为对照组、行综合护理的41例患者作为治疗组,治疗组除了常规护理内容,还采用幸福理论框架模型下（PERMA模型）的性健康管理多学科团队干预方案。分别在干预前、干预后3个月、干预后6个月采用女性性功能指数、抑郁自评量表评分和幸福感指数,对性功能指数、抑郁评分和幸福指数进行评估。结果 与对照组相比,治疗组干预3个月及6个月患者的性功能改善（F=91.08,P<0.001）。干预3个月及6个月后,治疗组抑郁评分低于对照组（F=1 092.59,P<0.001）,幸福感改善指数高于对照组（F=107.90,P<0.001）。Spearman相关分析结果显示,女性性功能指数同抑郁自评量表得分呈负相关（r_s=-0.918,P<0.001）,同幸福感指数得分呈正相关（r_s=0.844,P<0.001）。结论 综合护理在性功能、抑郁和主观幸福感方面均有明显改善。通过PERMA模式下性健康管理的多学科团队干预方案,可以提高患者的性生活质量,降低患者的抑郁程度,及改善患者的主观幸福感。

Objective To explore the effects of active and comprehensive care measures on sexual function,depression and subjective well-being of patients after early cervical cancer surgery．Methods The clinical data of 84 cervical cancer patients（under 50 years old）admitted to our hospital were retrospectively analyzed．There were 43 cases with conventional care in control group and 41 cases with comprehensive care group in treatment group．Besides the conventional care components,the comprehensive care group also adopted a multidisciplinary team intervention program for sexual health management under the framework model of well-being theory（PERMA model）．We used the female sexual function index,depression self-rating scale score and happiness index to assess the sexual function index,depression score and happiness index before,3 months and 6 months after the intervention,respectively．Results In comparison with the control group,the patients in the treatment group had a significant improvement in sexual function at 3 and 6 months of intervention（F=91.08,P<0.001）．After 3 and 6 months of intervention,the depression score was significantly lower in the comprehensive care group than in the control group（F=1 092.59,P<0.001）,and the happiness improvement index was significantly higher than in the control group（F=107.90,P<0.001）．Spearman’s correlation analysis showed that the female sexual function index was negatively correlated with the depression self-rating scale score（r_s=-0.918,P<0.001）and positively correlated with the well-being index（r_s=0.844,P<0.001）．Conclusions The comprehensive care group showed significant improvements in sexual function,depression,and subjective well-being．A multidisciplinary team intervention program for sexual health management under the PERMA model can improve the quality of patients’ sexual life,reduce their depression,and improve their subjective well-being．

目的 分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统（RAAS）、产后抑郁情况发生的影响。方法 研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分（VAS评分）、肾素活性（PRA）、血管紧张素-II（AT-II）、醛固酮（ALD）、爱丁堡产后抑郁量表（EPDS）、不良反应的发生情况。结果 与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义（P<0.01）。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点（P<0.05）;研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义（P<0.05）。研究组术后3 d、术后6周EPDS评分均明显低于对照组（P<0.01）。2组不良反应总发生率比较无差异（P>0.05）。结论 艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。

Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system（RAAS）and the occurrence of postpartum depression after cesarean delivery．Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group．Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section．The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously．The postoperative pain scores（VAS score）,plasma renin activity（PRA）,angiotensin-II（AT-II）,aldosterone（ALD）,Edinburgh Postpartum Depression Scale（EPDS）,and the occurrence of adverse effects were compared between the two groups．Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant（P<0.01）．The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point（P<0.05）;the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant（P<0.05）．The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks（P<0.01）．There was no difference in the overall incidence of adverse reactions between the two groups（P>0.05）．Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions．

目的 探究青少年首发抑郁症患者治疗中联合应用艾司西酞普兰与重复经颅磁刺激(rTMS)的总疗效及应用价值。方法 选取东莞市第七人民医院2020年5月—2021年10月80例青少年首发抑郁症患者,参考“数字双盲法”,分为对照组和观察组(各40例)2组,对照组接受伪rTMS+艾司西酞普兰治疗,观察组接受rTMS+艾司西酞普兰治疗。评价指标:临床总疗效、抑郁评分(17项汉密尔顿抑郁量表,HAMD-17)、认知功能评分(威斯康星卡片分类测验,WCST)、生活质量(SF-36评分),不良反应发生率(副反应量表,TESS)。结果 观察组患者总有效率95.00%较对照组80.00%明显高(P＜0.05);且2组不良反应率比较(P＞0.05)。观察组治疗1周、2周、4周HAMD-17评分均较对照组低,同时治疗4周后WCST项目中完成分类评分较对照组更高(P＜0.05)。观察组SF-36(角色、社会、躯体、认知)评分均较对照组高(P＜0.05)。结论 青少年首发抑郁症患者,在艾司西酞普兰用药基础上联合rTMS,可获取更为显著的治疗效果,控制病情进展,减轻抑郁症状,同时对认知功能无影响,促进生活质量大幅度提高,且用药安全性有保障。

Objective To explore the total efficacy and application value of escitalopram combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of adolescent patients with first-episode depression.Methods A total of 80 adolescent patients with first-episode depression in Dongguan Seventh People's Hospital from May 2020 to October 2021 were selected.Referring to the “digital double-blind method”,they were divided into control group and observation group (40 cases each).The control group was treated with pseudo rTMS and escitalopram,and the observation group was treated with rTMS and escitalopram.Evaluation indexes: total clinical efficacy,depression score (17-item Hamilton Depression Scale,HAMD-17),cognitive function score (Wisconsin Card Sorting Test,WCST),quality of life (SF-36 score),adverse reaction rate (Treatment Emergent Symptom Scale,TESS).Results The total effective rate of 95.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05); the incidence of adverse reactions was compared between the two groups (P>0.05).The HAMD-17 scores of the observation group at 1 week,2 weeks and 4 weeks were significantly lower than those of the control group.At the same time,the classification scores of WCST items after 4 weeks of treatment were higher in observation group (P<0.05).The SF-36 (role,society,body and cognition) scores in the observation group were higher than those in the control group (P<0.05).Conclusions Adolescent patients with first-episode depression treated with rTMS on the basis of escitalopram can obtain more significant therapeutic effect,control the progress of the disease,reduce depressive symptoms,have no effect on cognitive function,greatly improve the quality of life,and ensure the safety of medication.

目的 研究电针治疗对重性抑郁障碍患者的抑郁状态的影响。方法 本研究共分为3组,药物组、和药物+电针组及对照组(每组各50 例),药物组给予艾司西酞普兰抗抑郁治疗连续6周,药物+电针组在给予艾司西酞普兰抗抑郁治疗的基础上,进行电针治疗6周。比较治疗前后三组的HAMD 24 项评分,并对三组的HAMD 24 项评分与血清细胞炎症因子IL-1β、IL-2、IL-6、TNF-α水平进行相关性分析。采用多元逐步回归法,分析影响基线药物组和药物+电针组HAMD 24 项评分的主要因素。结果 与治疗前比较,药物组和药物+电针组患者治疗后HAMD 24 项评分均降低,差异有统计学意义(P＜0.05或P＜0.01),与药物组比较,治疗后药物+电针组HAMD 24 项评分较低,差异有统计学意义(P＜0.05或P＜0.01)。药物组HAMD 24 项评分与血清细胞炎症因子IL-6(r=0.335,P<0.001)、TNF-α(r=0.269,P<0.001)、IL-2(r=0.257,P=0.001)和IL-1β(r=0.205,P=0.021)呈正相关。药物+电针组HAMD24 项评分与血清细胞炎症因子IL-6(r=0.338,P<0.001)、TNF-α(r=0.271,P<0.001)、IL-2(r=0.255,P=0.015)和IL-1β呈正相关(r=0.208,P=0.026)。影响药物组HAMD24 项评分的主要因素有:血清细胞炎症因子IL-6、TNF-α、IL-1β、IL-2、婚姻(已婚)、文化程度(受教育年限少),标准化回归系数分别为0.585、0.516、0.452、0.318、-0.290、0.262(P＜0.05或P＜0.01)。影响药物+电针组HAMD24 项评分的主要因素有:血清细胞炎症因子IL-6、TNF-α、IL-2、IL-1β、婚姻(已婚)、文化程度(受教育年限少),标准化回归系数分别为0.592、0.521、0.448、0.323、-0.295、0.271(P＜0.05或P＜0.01)。结论 药物联合电针治疗能有效改善重性抑郁障碍患者的抑郁状态,细胞炎症因子与HAMD24 项评分相关,可影响重性抑郁障碍患者的抑郁状态。

Objective To explore the effect of electroacupuncture on patients with severe depression. Methods Patients was divided into three groups, acupuncture group, drug group and the control group. Each group had 50 patients. The drug group was treated with escitalopram for 6 weeks.The acupuncture group were treated with escitalopram and electroacupuncture for 6 weeks. We compared the HAMD24 among 3 groups before or after treatment. The correlation of the levels of IL-1 β, IL- 2, IL- 6, TNF-α and the total HAMD24 score among 3 groups were taken by the correlation analysis. And the main factors influencing the total HAMD24 score before the study were analyzed by the multiple inear step regression method. Results Compared with the pre-treatment group, the HAMD score of the drug group and the acupuncture group decreased after treatment, the difference was statistically significant (P<0.05 or P<0.01). Compared with the drug group, the HAMD score of the acupuncture group was lower after treatment; the difference was statistically significant (P<0.05 or P<0.01). The drug group, HAMD scores were positively correlated with IL- 6, TNF-α, IL- 2 and IL-1 β (r=0.335, 0.269, 0.257 and 0.205, respectively, P<0.05 or P<0.01). The acupuncture group HAMD scores were positively correlated with IL- 6, TNF-α, IL- 2 and IL-1 β(r=0.338, 0.271, 0.255 and 0.208, respectively, P<0.05 or P<0.01). The main factors influencing the HAMD score before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.585,- 0.516, 0.452, 0.318, 0.290, 0.262, respectively (P<0.05 or P<0.01). The main factors influencing the HAMD score of the drug group before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.585,- 0.516, 0.452, 0.318, 0.290, 0.262, respectively (P<0.05 or P<0.01). The main factors of the acupuncture group influencing the HAMD score before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.592,0.521,0.448,0.323,- 0.295,0.271(P＜0.05 or P＜0.01). Conclusion Escitalopram combination with electroacupuncture may improve the the depressive state. Inflammatory cytokines were associated with HAMD24 scores and it affects the depressive state of patients with major depressive disorder.

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

目的 了解颈内动脉超声联合经颅多普勒对产后抑郁症患者的检测效果,为临床产后抑制治疗提供有价值的线索。方法 收集本院于2018年3月—2020年2月收治的78例符合抑郁障碍诊断标准的产妇资料,对资料予以回顾研究,并设为研究组,同时另择选78例健康产妇为对照组,应用颈内动脉超声对两组产妇的颈动脉血流参数[颈动脉内径(D)、收缩期峰值流速(PSV)、舒张末期流速(EDV)以及阻力指数(RI)]进行检测,同时联合经颅多普勒超声(TCD)对两组产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉与椎基底动脉(VA-BA)血流速度进行监测,并分析两组产妇阻力指数(RI)与搏动指数(PI)变化,对以上数据统计分析并给予组间比较分析。结果 与对照组比较,研究组D、EDV水平明显下降,而RI值升高,差异有统计学意义(P＜0.05);两组产妇的PSV比较,差异无统计学意义(P＞0.05);研究组抑郁产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉血流速度均加快且差异均有统计学意义(P均＜0.05);研究组抑郁产妇的椎基底动脉(VA-BA)血流速度与对照组比较减慢,差异有统计学意义(P＜0.05);研究组抑郁产妇的阻力指数(RI)与搏动指数(PI)值与对照组比较,差异均无统计学意义(P＞0.05);78例抑郁产妇中,62例呈现脑动脉血流异常。检测异常率为79.49%(62/78)。结论 经颅多普勒检测,可见产后抑郁产妇的3条脑动脉血流速度明显加快,而椎基底动脉血流减缓,由此提示抑郁产妇脑动脉痉挛且脑供血明显不足,颈内动脉超声显示抑郁产妇的颈动脉血流参数有一定变化,能够为产后抑郁患者的治疗提供一定参考。

Objective To understand the detection effect of internal carotid artery ultrasound combined with transcranial Doppler on patients with postpartum depression, and to provide valuable clues for clinical postpartum depression treatment. Methods The data of 78 parturients who met the diagnostic criteria for depression in our hospital from March 2018 to February 2020 were collected. The data were reviewed and set as the study group. At the same time, 78 healthy parturients were selected as the control group.We used internal carotid artery ultrasound to detect the carotid blood flow parameters [carotid artery diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI)] of the two groups of parturients, and combined transcranial color Doppler ultrasound (TCD) to monitor the blood flow velocity of the arteries and vertebrobasilar artery (VA-BA), middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) of the two groups of women. The changes in maternal RI and PI between the two groups were analyzed, and the above data were statistically analyzed and compared between groups. Results Compared with the control group, the D and EDV levels of the study group were decreased, while the RI value was increased, the difference was statistically significant (P<0.05). The comparison of PSV between the two groups was not statistically significant (P>0.05). The arterial blood flow velocity in MCA, ACA, and PCA of the depressed women in the study group were accelerated and the differences were statistically significant (P<0.05). The blood flow velocity of VA-BA of the depressed women in the study group was slower than that of the control group, and the difference was statistically significant (P＜0.05). RI and PI values of depressed women in the study group were compared with those of the control group. There was no statistically significant difference between the groups (P>0.05). Among 78 depressed women, 62 had abnormal cerebral artery blood flow. The abnormal detection rate was 79.49% (62/78). Conclusion Transcranial Doppler examination showed that the blood flow of the three cerebral arteries of the postpartum depressed women was increased, while the blood flow of the vertebrobasilar arteries slowed down, which indicated that the depressed women had cerebral artery spasm and the cerebral blood supply was obviously insufficient. The internal carotid artery ultrasound showed there were certain changes in carotid blood flow parameters of depressed mothers, which can provide a certain reference for the treatment of patients with postpartum depression.

目的 探讨高频经颅磁刺激治疗对 PSD 伴失眠患者的抑郁情绪及睡眠质量的疗效。方法 对63例PSD患者随机分为联合组32例(10Hz高频rTMS+艾司西酞普兰)及药物组31例(艾司西酞普兰+假刺激),每周5次,共治疗4周。于治疗前及治疗后4周末分别对两组患者进行HAMD、PSQI评分及多导睡眠监测。。结果 rTMS 治疗前,2组HAMD、PSQI评分及睡眠参数比较均无差异;治疗后第4周末,两组HAMD评分、PSQI评分、总睡眠时间、睡眠效率及快眼动睡眠期比例均较治疗前改善;研究组HAMD评分下降幅度较对照组明显,而PSQI评分下降幅度及相关睡眠参数改善无差异。结论 高频rTMS治疗对PSD的抑郁症状疗效更明显,而对睡眠质量及睡眠结构的改善则与药物治疗疗效相当。

Objective To investigate the effect of high frequency transcranial magnetic stimulation on depression and sleep quality in poststroke depression patients with insomnia. Methods 63 patients with PSD were randomly divided into observation group (n=32)and control group (n=31). Both groups were treated by 10~20 mg escitalopram citalopram for 4 weeks. The patients in observation group also accepted 10 Hz rTMS 10 times (i.e., as a course), while the patients in control group were treated by sham stimulation. At the baseline and 4th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI)and polysomnography (PSG)were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among two groups had no significant difference at baseline. After 4 weeks treatment, the HAMD score, PSQI score, total sleep duration, sleep efficiency and proportion of rapid eye movement sleep in both groups were improved compared with those before treatment. The descend range of HAMD score in observation group was larger than that in control group (t=2.590,P=0.012), while the descend range of PSQI scores(t=0.897,P=0.373)and the change of the sleep parameters in the two group had no obvious difference. Conclusion High frequency rTMS has better curative effect than antidepressant therapy on depressive symptoms of PSD,while there was no difference on the effect to improve the sleep quality and sleep structure of PSD between these two treatments.

目的 探讨中医妇科门诊患者的焦虑及抑郁的发生情况,优化诊治工作,更好地服务患者。方法 采用焦虑自评量表(SAS)和 抑郁自评量表(SDS)评定190名中医妇科门诊患者的心理状态。结果 中医妇科患者焦虑均分高于正常常模组(P＜0.05),抑郁评分与全国常模相比则无统计学差异(P＞0.05),有焦虑及抑郁症状的患者分别为6.3%及10%。结论 中医妇科门诊患者的焦虑症状较正常人群高,医生在临床诊治过程应重视对患者心理状态的评价,并进行相应的心理干预及人文关怀, 以提高患者对治疗的依从性和满意度,为其身体及心理健康打下良好基础。

Objective To explore the occurrences of anxiety and depression in female TCM gynecology outpatients, and thus to make improvements in diagnosis, treatment, and service for the patients. Methods We adopted Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) to evaluate the mental status of 190 TCM gynecology outpatients. Results Anxiety scores in TCM gynecology group were higher than those in the normal group (P＜0.05), while there was no statistical difference in depression scores between these two groups (P＞0.05). Among the outpatients, 6.3% had symptoms of anxiety, and 10% had symptoms of depression. Conclusion TCM gynecology outpatients show more anxiety symptoms than normal people. We should pay attention to the assessment of those patients' mental status in the process of diagnosis and treatment, and offer psychological intervention and humane care to those patients accordingly. In this way, we could enhance patients' compliance and satisfaction, and help them build a solid foundation in physical health as well as in mental health.