卒中单元中西医结合治疗对卒中后抑郁合并睡眠障碍的临床研究

发布时间：2018-03-26 02:46

本文选题：脑卒中后抑郁　切入点：睡眠障碍　出处：《湖北中医药大学》2017年硕士论文

【摘要】：目的比较卒中单元中西医结合治疗与中医或西医单一治疗对卒中后抑郁合并睡眠障碍患者的临床疗效,了解联合治疗是否等于或优于单一治疗的效果,探索针对卒中后抑郁合并睡眠障碍患者的最佳卒中单元中西医结合治疗方案,为其临床推广提供新依据。方法本研究将180例卒中后抑郁(PSD)合并睡眠障碍的患者运用完全随机对照设计分为中西医结合治疗组、中医治疗组、西医治疗组和对照组,每组45例。四组患者均给予卒中单元常规治疗(卒中单元治疗包括药物对症治疗、语言和肢体康复治疗、心理支持治疗、健康宣传教育等),中医治疗组加用安神合剂治疗,西医治疗组加用抗抑郁药物艾司西酞普兰治疗,中西医结合治疗组同时加用安神合剂及抗抑郁药物艾司西酞普兰治疗。治疗前、治疗第8及24周后分别评定患者的抑郁症状(汉密尔顿抑郁量表(HAMD))、患者的睡眠状态(匹兹堡睡眠质量指数量表(PSQI))、患者卒中后神经功能状况(美国国立卫生研究院卒中量表(NIHSS))、卒中患者的生活能力(Barthel指数量表)。同时在治疗前及治疗第24周后用多导睡眠图(PSG)评估中西医结合治疗组及西医治疗组患者的睡眠状况。结果(1)治疗前,四组患者HAMD、PSQI、NIHSS、Barthel评分比较,各组间差异无统计学意义(P0.05);(2)治疗第8周后,中西医结合治疗组、中医治疗组、西医治疗组和对照组HAMD、PSQI、NIHSS、Barthel评分与各组内治疗前比较,差异均有统计学意义(均P0.05);治疗第24周后,中西医结合治疗组、中医治疗组、西医治疗组和对照组HAMD、PSQI、NIHSS、Barthel评分与各组内治疗第8周后、治疗前比较,差异均有统计学意义(均P0.05);(3)治疗第8周后中西医结合治疗组、中医治疗组和西医治疗组HAMD、PSQI、NIHSS、Barthel评分与对照组比较,差异均有统计学意义(均P0.05);治疗第8周后中西医结合治疗组HAMD、PSQI、NIHSS、Barthel评分与中医治疗组、西医治疗组比较,差异均有统计学意义(均P0.05);治疗第8周后中医治疗组HAMD、PSQI、NIHSS、Barthel评分与西医治疗组比较,差异有统计学意义(P0.05)。(4)治疗第24周后中西医结合治疗组、中医治疗组和西医治疗组HAMD、PSQI、NIHSS、Barthel评分与对照组比较,差异均有统计学意义(均P0.05);治疗第24周后中西医结合治疗组HAMD、PSQI、NIHSS、Barthel评分与中医治疗组、西医治疗组比较,差异均有统计学意义(均P0.05);治疗第24周后中医治疗组HAMD、PSQI、NIHSS、Barthel评分与西医治疗组比较,差异有统计学意义(P0.05)。(5)在治疗前,中西医结合治疗组和西医治疗组患者入睡潜伏期(SL)、总睡眠时间(TST)、觉醒次数(NW)、睡眠效率(SE)、深睡眠(S3+S4%)、REM睡眠潜伏期(RL)、REM睡眠时间(RT)比较,组间差异无统计学意义(P0.05);(6)治疗第24周后,中西医结合治疗组和西医治疗组患者入睡潜伏期(SL)时间缩短、总睡眠时间(TST)增加、觉醒次数(NW)减少、睡眠效率(SE)提高、深睡眠(S3+S4%)时间增加、REM睡眠潜伏期(RL)时间缩短、REM睡眠时间(RT)增加,其中两组患者的上述指标与治疗前各组内比较,差异均有统计学意义(均P0.05);中西医结合治疗组的上述指标与西医治疗组比较,差异有统计学意义(均P0.05)。结论卒中单元中西医结合治疗对卒中后抑郁合并睡眠障碍患者的抑郁症状及睡眠质量有显著改善,有助于卒中患者神经功能及日常生活能力的恢复,值得临床推广应用。
[Abstract]:Objective to compare the Chinese and Western medicine stroke unit combined treatment with traditional Chinese medicine or western medicine treatment on single clinical efficacy in patients with depression with sleep disorder after stroke, to understand whether the combination treatment is equal to or better than single treatment effect, explore the best for post-stroke depression in patients with stroke unit of traditional Chinese medicine and Western medicine combined treatment of sleep disorders, and provide a new basis for its clinical promotion. Methods the 180 cases of post-stroke depression (PSD) patients with sleep disorders using completely randomized design into the combination of traditional Chinese and Western medicine treatment group, Chinese medicine treatment group, western medicine treatment group and control group, 45 cases in each group. Four groups of patients were given routine treatment of stroke unit (including drug therapy in treatment of stroke unit language, and rehabilitation therapy, supportive therapy, health education etc.), Chinese medicine treatment group treated with Anshen mixture, western medicine treatment group were treated with antidepressants Ai Sciplan therapy combined with antidepressant drug and Ai Sciplan Anshen mixture treatment group with combination of TCM and Western medicine. Before treatment and 24 weeks after treatment, eighth patients with depressive symptoms were assessed (Hamilton Depression Scale (HAMD)), in patients with sleep state (Pittsburgh sleep quality index scale (PSQI), neurological function) in patients with post stroke (National Institutes of Health Stroke Scale (NIHSS)), stroke patients life ability (Barthel index). At the same time before and after twenty-fourth weeks treatment by polysomnography (PSG) sleep medicine combined with western medicine treatment group and Western medicine group (results in the assessment of patients with. 1) before treatment, four groups of HAMD, PSQI, NIHSS, Barthel score comparison, no statistically significant difference between the groups (P0.05); (2) after eighth weeks of treatment, the treatment group combined with traditional Chinese medicine and Western medicine, Chinese medicine treatment group, western medicine treatment group and control group HAMD, PSQI, NI HSS, with the Barthel score in each group before treatment, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment, the treatment group combined with traditional Chinese medicine and Western medicine, Chinese medicine treatment group, western medicine treatment group and control group HAMD, PSQI, NIHSS, and Barthel score in each group after eighth weeks of treatment, compared with before treatment, the differences were statistical significance (P0.05); (3) after eighth weeks of treatment with combination of TCM and Western medicine treatment group, TCM treatment group and Western medicine group HAMD, PSQI, NIHSS, Barthel score compared with the control group, the differences were statistically significant (P0.05); after eighth weeks of treatment, combination therapy group HAMD, PSQI, NIHSS. The Barthel score and the Chinese medicine treatment group, compared with the western medicine treatment group, the differences were statistically significant (P0.05); after eighth weeks of treatment, Chinese medicine treatment group HAMD, PSQI, NIHSS, Barthel scores were compared with western medicine treatment group, the difference was statistically significant (P0.05). (4) after twenty-fourth weeks of treatment with combination of TCM and Western medicine treatment The treatment group, TCM treatment group and Western medicine group HAMD, PSQI, NIHSS, Barthel score compared with the control group, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment with combination of TCM and Western medicine treatment group HAMD, PSQI, NIHSS, Barthel score and TCM treatment group, compared with the Western medicine treatment group, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment, Chinese medicine treatment group HAMD, PSQI, NIHSS, Barthel scores were compared with western medicine treatment group, the difference was statistically significant (P0.05). (5) before treatment, the patients in the treatment group were sleep latency group and Western medicine treatment combining traditional Chinese and Western Medicine (SL), total sleep time (TST), awakening the number (NW), sleep efficiency (SE), deep sleep (S3+S4%), REM sleep latency (RL), REM sleep time (RT), no significant difference between the groups (P0.05); (6) after twenty-fourth weeks of treatment, the patients in the treatment group were sleep latency group and Western medicine treatment combining traditional Chinese and Western Medicine (SL shorten the time, total sleep) Time (TST) increased the number of awakening (NW) reduced sleep efficiency (SE) increased deep sleep time increased (S3+S4%), REM (RL) shorten the sleep latency time, REM sleep time (RT) increased, the index and the two groups of patients before treatment were compared, the differences were statistically significant (all P0.05); these indicators compared with western medicine treatment group in the treatment group of traditional Chinese and Western medicine, the difference was statistically significant (P0.05). Conclusion the stroke unit of Integrated Chinese and Western medicine treatment can significantly improve the depressive symptoms and quality of sleep in patients with depression with sleep disorder after stroke, helps apoplexy nerve function and daily life ability recovery, worthy of clinical application.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R749.4

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