温阳通脉颗粒治疗脾肾阳虚型缺血性中风后抑郁的临床疗效观察

发布时间：2018-08-17 19:41

【摘要】：目的:本研究应用“温阳通脉颗粒”结合度洛西汀治疗脾肾阳虚型缺血性中风后抑郁患者,通过观察治疗前后缺血性脑卒中后抑郁中医证候等级评分量表(脾肾阳虚型)、HAMD(汉密尔顿抑郁量表)、NIHSS(美国国立卫生研究院卒中量表)、MMSE(简易精神状态检查量表)、ADL(日常生活能力量表)、血清HCY(血清同型半胱氨酸)等指标的变化,评价“温阳通脉颗粒”结合度洛西汀治疗是否能使脾肾阳虚型缺血性中风后抑郁患者获益,为临床治疗提供依据和思路。方法:选取缺血性脑卒中后抑郁患者60例,病例全部来源于铜陵市中医医院康复科(神经内科)门诊就诊或病房收住的患者。随机分为治疗组和对照组,每组30例,两组均给予基础治疗(基础药物、康复治疗及心理干预等)+西药度洛西汀,治疗组以温补脾肾、养血通脉为法,加用温阳通脉颗粒(中药一日一剂,分早、中、晚三次口服)。疗程为4周。对比两组于治疗前、治疗2周、治疗4周及治疗8周后的自制缺血性脑卒中后抑郁中医证候等级评分量表(脾肾阳虚型)评分、HAMD(汉密尔顿抑郁量表)评分、NIHSS(神经功能缺损量表)评分、ADL(日常生活能力量表)、MMSE(简易精神状态检查量表)评分,探讨温补脾肾、养血通脉治疗缺血性脑卒中后抑郁的临床疗效,另辟中西药结合治疗缺血性脑卒中后抑郁的思路。结果:1.一般性资料:60例患者中,男性29例占48.3%,女性31例占51.7%,女性发病率高于男性;在病变部位的统计中基底节区所占比例最高达53.3%;吸烟者26例占43.3%;饮酒者24例占40%;有既往卒中史达23.3%;在既往病史中高血压病、糖尿病及血脂异常占前三位。治疗组及对照组患者年龄、性别、文化程度、烟酒史、病程及既往病史经卡方检验提示无统计学差异(P0.05),具有可比性。2.两组治疗前后评价量表分值变化(1)组内比较:两组治疗前后比较中医症状积分及减分率、HAMD分值及减分率、NIHSS分值、MMSE、ADL分值有统计学差异(P0.01或P0.05),提示两组均能改善缺血性脑卒中后抑郁患者的抑郁症状、神经功能及生活自理能力;(2)组间比较:治疗组和对照组治疗前与治疗后2周时中医症状积分及减分率、HAMD分值及减分率、NIHSS分值、ADL分值的比较有统计学差异(P0.01或P0.05),治疗组优于对照组;治疗4周时中医症状积分及减分率、HAMD分值、NIHSS分值、MMSE分值、ADL分值有统计学差异(P0.01或P0.05),治疗组优于对照组;治疗8周时,中医症状积分及减分率、HAMD分值、NIHSS分值有统计学差异(P0.01或P0.05),治疗组优于对照组。研究结果表明温阳通脉颗粒并用度洛西汀中西药结合治疗缺血性脑卒中后抑郁可从中医证候、抑郁症状的改善、神经功能缺损和认知功能的改善以及提高患者生活质量等方面起到一定疗效,且可明显看出起效时间较对照组早,且优势持久。3.实验室检查(血清HCY数值)治疗组和对照组治疗前后HCY有所下降,有统计学差异(P0.05);但对照组及治疗组治疗8周后比较未见有统计学差异(P0.05)。初步证实缺血性脑卒中患者发生PSD与血清HCY有相关性,温阳通脉颗粒并用度洛西汀中西医结合治疗缺血性脑卒中后抑郁治疗对患者HCY无负性影响。4.安全性评估:治疗过程中两组患者均未有明显不良事件的发生,治疗8周后复查血常规、血肝肾功能、心电图其结果与入院时相比未见明显差异。从而提示温阳通脉颗粒及西药度洛西汀治疗PSD安全性高。结论:温阳通脉颗粒并用度洛西汀中西医结合治疗缺血性脑卒中后抑郁较单用度洛西汀治疗缺血性脑卒中后抑郁患者起效早,效果持久、疗程缩短,安全性好,依从性佳,具有更好的疗效。另外缺血性脑卒中患者发生PSD与血清HCY有相关性,临床应重视对高同型半胱氨酸血症的治疗。
[Abstract]:Objective: To study the effect of Wenyang Tongmai Granule combined with Duloxetine on depression after ischemic stroke of spleen-kidney Yang deficiency type. The scores of TCM syndromes (spleen-kidney Yang deficiency type), HAMD (Hamilton Depression Scale), NIHSS (Stroke Scale of National Institutes of Health), MMSE (Stroke Scale of National Institutes of Health) were observed before and after treatment. Objective:To evaluate the effect of Wenyang Tongmai Granule combined with Duloxetine on depression after ischemic stroke of spleen-kidney Yang deficiency type and to provide evidence and ideas for clinical treatment. 60 cases of post-middle-term depression were randomly divided into treatment group and control group, 30 cases in each group. Both groups were given basic treatment (basic medicine, rehabilitation treatment and psychological intervention) + western drug duloxetine. The treatment group was given warm invigoration of spleen and kidney, Yangxuetong. Wenyang Tongmai Granule (one dose a day, divided into early, middle and late oral) was used for 4 weeks. The treatment course was 4 weeks. The two groups were compared before treatment, 2 weeks, 4 weeks and 8 weeks after treatment with the homemade Chinese Medicine Syndrome Rating Scale for Post-Ischemic Stroke Depression (Spleen-Kidney Yang Deficiency), HAMD (Hamilton Depression Scale), NIHSS (Neurological HSS). Functional Defect Scale (FDS), ADL (ADL), MMSE (Simple Mental State Examination Scale) score, explore the clinical efficacy of warming the spleen and kidney, nourishing blood and dredging pulse in the treatment of post-ischemic stroke depression, and explore the idea of combining traditional Chinese and Western medicine in the treatment of post-ischemic stroke depression. 31 cases were female, 51.7% were female, the incidence of female was higher than that of male; the highest proportion was 53.3% in the lesion site; 26 cases were smokers, 43.3%; 24 cases were alcoholics, 40%; 23.3% had a history of stroke; hypertension, diabetes mellitus and dyslipidemia accounted for the first three in the past history. There was no significant difference between the two groups (P 0.01 or P 0.05), suggesting that the two groups can improve depressive symptoms, neurological function and self-care ability of patients with post-ischemic stroke depression; (2) Comparison between the treatment group and the control group: before treatment and 2 weeks after treatment, TCM symptom score and reduction rate, HAMD score and reduction rate, NIHSS score, ADL score were statistically different (P 0.01 or P 0.05). The treatment group was superior to the control group; 4 weeks after treatment, TCM symptom score and reduction rate, HAMD score, NIHSS score, MMSE score, ADL score had statistical differences (P 0.01 or P 0.05), the treatment group was superior to the control group; 8 weeks after treatment, TCM symptom score and reduction rate, HAMD score, NIHSS score had statistical differences (P 0.01 or P 0.05), the treatment group was superior to the control group. The results showed that Wenyang Tongmai Granule combined with Duloxetine in the treatment of depression after ischemic stroke can improve the symptoms of traditional Chinese medicine, depressive symptoms, neurological deficits and cognitive function, and improve the quality of life of patients with certain efficacy, and can obviously see that the onset time is earlier than the control group, and the advantages of maintaining. Laboratory tests (serum HCY values) before and after treatment in the treatment group and the control group HCY decreased, there was a statistically significant difference (P 0.05); but the control group and the treatment group after 8 weeks of treatment there was no statistical difference (P 0.05). Preliminary confirmation of ischemic stroke patients with PSD and serum HCY correlation, Wenyang Tongmai Granules and Duloxetine in combination The treatment of depression after ischemic stroke with western medicine has no negative effect on HCY. 4. Safety evaluation: There were no significant adverse events in the two groups. After 8 weeks of treatment, the blood routine, liver and kidney function were reexamined. The results of electrocardiogram were not significantly different from those at admission. Conclusion: Wenyang Tongmai Granule combined with Duloxetine in the treatment of post-ischemic stroke depression has earlier onset, longer effect, shorter course of treatment, better safety, better compliance and better curative effect than Duloxetine alone in the treatment of post-ischemic stroke depression. There is a correlation between PSD and serum HCY, so we should pay attention to the treatment of hyperhomocysteinemia.
【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】：R743.3;R749.4

【相似文献】