自拟解郁1号方联合帕罗西汀治疗以失眠为主症的抑郁状态的临床研究

发布时间：2018-06-15 10:26

本文选题：解郁1号方 + 失眠　；参考：《安徽中医药大学》2017年硕士论文

【摘要】：背景:随着城市化的进程,越来越多的人进入了更加快节奏的生活,伴随带来的是生活和精神上的压力,抑郁症在此前提下更加频繁的侵袭着现代人。抑郁症是一种以抑郁发作为特征的心境障碍,是一组临床综合征,抑郁发作的主要临床症状包括心境低落、兴趣和愉快感丧失、失眠、思维迟缓、意志活动减退和躯体不适等。据世界卫生组织(WHO)预测,到2020年,抑郁症将成为仅次于首位缺血性心脏病的第2位致残疾病。一项流行病学调查研究表明西方国家和我国抑郁症的终生患病率分别为13.23%和5.3%,其中患病的女性至少是男性的1.5倍,在我国近年来大量的文献报告显示这一比例正在不断增高。在抑郁状态的患者中,有不少患者失眠症状表现的尤为突出,长期的失眠使患者的心理负担更加严重,使抑郁状态的其他临床症状加重和增多,其他症状的加重与增多反过来又进一步影响患者入睡,最终形成一种恶性循环。目的:(1)观察自拟解郁1号方联合帕罗西汀治疗以失眠为主症的抑郁状态的临床效果;(2)评价中药辨证施治联合西药抗抑郁药治疗以失眠为主症的抑郁状态的可行性,并为中西医联合治疗抑郁症提供依据。方法:1.分组:采用随机分组法,纳入以失眠为主症的抑郁状态患者60例,分为治疗组30例,对照组30例。研究组予以自拟解郁1号方联合帕罗西汀治疗,对照组予以单药帕罗西汀治疗。2.指标与疗效:治疗周期为8周,检测治疗前和治疗后4周、8周两组患者中医症候积分、汉密尔顿抑郁量表(HAMD)评分、匹兹堡睡眠质量指数(PSQI)评分及观察治疗前后安全指标的变化。结果:(1)同期治疗前后比较,治疗组与对照组患者治疗后4周、8周的中医症候积分、HAMD评分和PSQI评分均不同程度的较治疗前减低,与治疗前相比具有统计学意义(P0.05或P0.01)。(2)同期两组比较,中医症候积分、HAMD评分和PSQI评分,与治疗前相比无明显差异(P㧐0.05);同期两组比较,治疗后4周中医症候积分治疗组较对照组减分更明显,两组之间比较具有统计学意义(P0.05),HAMD评分和PSQI评分治疗组较对照组减分不明显,比较无统计学意义(P㧐0.05);同期两组比较,治疗后8周,中医症候积分、HAMD评分和PSQI评分,治疗组均较对照组减分更明显,两组间比较具有明显差异(P0.05)。(3)同期治疗前后比较,中医症候积分、HAMD评分和PSQI评分各因子分治疗前后比较均有不同程度改善,在治疗后8周两组绝大部分因子分与治疗前相比具有统计学意义(P0.05或P0.01),治疗后4周部分因子分与治疗前相比具有统计学意义(P0.05),总体而言治疗组较对照组改善更明显。(4)两组患者用药后不良反应发生率治疗组较对照组更低,治疗组安全性更高。结论:对以失眠为主症的抑郁状态患者的治疗,临床上应用SSRI类抗抑郁药联合自拟解郁1号方治疗其临床疗效较单用SSRI类抗抑郁药更佳且副作用发生率降低。
[Abstract]:Background: with the process of urbanization, more and more people have entered a more rapid pace of life, accompanied by life and mental pressure, depression in this premise more frequent invasion of modern people. Depression is a kind of mood disorder characterized by depression, which is a group of clinical syndrome. The main clinical symptoms of depression include depression, loss of interest and pleasure, insomnia, mental retardation, decreased mental activity and physical discomfort. According to the World Health Organization (WHO), depression will become the second most disabled disease by 2020, second only to ischemic heart disease. An epidemiological study shows that the lifetime prevalence of depression in western countries and China is 13.23% and 5.3% respectively, in which women are at least 1.5 times as sick as men. In recent years, a large number of literature reports in China show that the proportion of depression is increasing. Among the patients with depressive state, many of them have especially prominent symptoms of insomnia. Long-term insomnia makes the psychological burden of the patients more serious, and other clinical symptoms of the state of depression are aggravated and increased. The exacerbation and increase of other symptoms, in turn, further affect the patient's sleep, and ultimately form a vicious circle. Objective to observe the clinical effect of Jieyu No. 1 prescription combined with paroxetine in the treatment of depressive state with insomnia. And provides the basis for the treatment of depression by the combination of traditional Chinese and western medicine. Method 1: 1. Group: 60 depressive patients with insomnia were randomly divided into treatment group (n = 30) and control group (n = 30). The study group was treated with Jieyu No. 1 prescription combined with paroxetine, while the control group was treated with paroxetine alone. Indexes and efficacy: the treatment cycle was 8 weeks. The scores of TCM symptoms, Hamilton Depression scale (Hamd), Pittsburgh Sleep quality Index (PSQI), and the changes of safety indexes before and after treatment were measured. Results compared with control group before and after treatment, the scores of TCM symptom scores, Hamd and PSQI in the treatment group and the control group were decreased in different degrees after 4 weeks and 8 weeks of treatment. There was no significant difference in TCM symptom score and PSQI score between the two groups in the same period compared with before treatment (P0.05 or P0.01U. 2) compared with before treatment, there was no significant difference between the two groups in the same period, and in the same period, there was no significant difference between the two groups. Four weeks after treatment, the score of TCM symptom score in the treatment group was significantly higher than that in the control group, and there was no significant difference between the two groups in P0.05 Hamd score and PSQI score, but there was no significant difference between the two groups. At 8 weeks after treatment, the scores of Hamd and PSQI of TCM symptoms were significantly lower in the treatment group than in the control group, and there was a significant difference between the two groups before and after treatment. The scores of TCM symptom scores and scores of Hamd and PSQI were improved to some extent before and after treatment. At 8 weeks after treatment, most of the factor scores in the two groups were statistically significant compared with those before treatment (P0.05 or P0.01), and at the 4th week after treatment, part of the factor scores were statistically significant compared with those before treatment. Overall, the improvement of the treatment group was more obvious than that of the control group. The incidence of adverse reactions in the treatment group was lower than that in the control group. The safety of the treatment group was higher. Conclusion: the clinical effect of SSRI combined with Jieyu No. 1 is better than that of SSRI antidepressant alone and the incidence of side effects is lower than that of SSRI antidepressant alone.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.4

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