健脾益肾活血方联合盐酸帕罗西汀治疗帕金森病伴焦虑抑郁状态（脾肾两虚证）的临床研究

发布时间：2018-05-12 06:19

  本文选题：帕金森病 + 焦虑抑郁　； 参考：《河北医科大学》2014年硕士论文

【摘要】：目的： 帕金森病（PD）伴焦虑抑郁状态是神经内科门诊一类常见的心身疾病，发病率高达40%至50%。是PD患者近年来逐渐受到关注的的非运动性症状之一。过去人们将认识和治疗PD的焦点都集中到了静止性震颤、肌强直、运动迟缓、姿势步态异常等运动功能损害上，忽略了PD伴焦虑抑郁状态的存在。事实上，焦虑抑郁等情绪障碍使PD患者生活及生存质量严重下降。近年来随着医学模式的转变，国内外许多医生及学者开始研究PD患者的情绪障碍，取得了丰硕的成果。研究发现PD伴焦虑抑郁状态的患者是受遗传、环境及社会因素多重作用的结果；发病机制与神经系统退化、神经内分泌紊乱、免疫应答机制、神经毒物损害、社会心理反应等有关，具体的发病机制仍不清楚。诊断上主要依靠于患者的临床症状表现及医生的经验水平，尚无特征性的客观指标可以明确支持诊断。治疗上主要运用抗焦虑抑郁药物治疗，兼顾抗帕金森病治疗，主要药物有多巴胺替代疗法、多巴胺受体激动剂、新型抗抑郁药氟西汀、米氮平等，治疗效果尚可，但同时也存在一定程度的副作用及停药反跳现象。中医学认为该病是“颤证”和“郁证”的共病，其中的因果关系尚不明确。主要病变部位在肝、肾，与心、脾有关，主要病理因素为肝风内动。治疗上多遵循补肾填精、活血养肝、柔肝熄风等治法，疗效显著。虽然近年来国内外有关PD伴焦虑抑郁状态的研究报道有所增多，但仍然相对缺乏，不足以有效指导临床工作。本研究采用自拟健脾益肾活血方联合盐酸帕罗西汀来治疗PD伴焦虑抑郁状态（脾肾两虚证）患者，并对治疗的效果进行研究和阐述，探讨本病治疗的新途径。 方法： 本研究对2012年9月至2013年12月间就诊于河北省中医院的70名PD伴焦虑抑郁状态（脾肾两虚证）的患者进行随机对照临床试验，采用随机数字表法将患者随机分组，分为研究组和对照组各35例。两组均给予抗帕金森基础药物进行治疗，两组患者性别、年龄、病情严重程度、抑郁程度等具有可比性。研究组加服健脾益肾活血方（可随症加减），每日一剂，分两次服和盐酸帕罗西汀片，20mg早饭后顿服，1/日；对照组只加服盐酸帕罗西汀片，20mg早饭后顿服，1/日。规定8周为一个疗程。使用三大量表进行评分，即运用帕金森病症状严重程度评定量表（UPDRS）、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)对患者在治疗前、4周末、8周末的病情分别进行评分，通过减分率计算治疗的有效率，观察患者UPDRS、 HAMD、 HAMA评分变化、有效率及副作用发生率情况。 结果： 1研究观察结果显示研究组和对照组的帕金森病症状严重程度评定量表（UPDRS）评分、汉密尔顿抑郁量表(HAMD)评分和汉密尔顿焦虑量表(HAMA)评分均较前有所下降，差异有统计学意义（P0.05）； 2研究组按照UPDRS量表、HAMD量表和HAMA量表评分减分率计算所得的有效率（评分减分率30%）高于对照组的有效率，差异有统计学意义（P0.05）； 3研究组和对照组所用的不同治法在治疗后的不同时间点间存在交互作用，差异有统计学意义（P0.05）；即研究组与对照组在治疗后4周、8周UPDRS评分、HAMD评分和HAMA评分下降幅度不同，中西药组各量表评分结果的改善幅度显著优于单纯西药组。 4治疗组4周后的各量表评分下降幅度与对照组8周后的下降幅度接近，，没有统计学意义（P0.05）。提示中西药治疗PD伴发焦虑抑郁起效较西药组治疗快。 5两组患者治疗前后常规检查（血尿常规、生化常规、心电图等）均无明显异常。在本次研究中，研究组不良反应未出现，而对照组出现头晕、恶心，食欲减退、失眠及兴奋的患者有6例(17.1%)。 结论： 运用自拟的健脾益肾活血方联合盐酸帕罗西汀治疗PD伴焦虑抑郁状态患者（脾肾两虚证）有效，尤其在改善PD患者焦虑抑郁情绪、提高生活质量及减少药物副作用方面作用明显，可降低患者抗帕金森药物的用量，起效快，作用持久且安全。
[Abstract]:Objective:
Parkinson's disease (PD) with anxiety and depression is one of the most common psychosomatic diseases in the outpatient department of Neurology. The incidence of up to 40% to 50%. is one of the non motor symptoms of attention in the PD patients in recent years. In the past, the focus of understanding and treatment of PD was concentrated on static tremor, myotonic, slow motion, and abnormal gait. The impairment of dynamic function neglects the existence of PD with anxiety and depression. In fact, anxiety and depression and other emotional disorders have caused serious decline in the quality of life and life of PD patients. In recent years, many doctors and scholars at home and abroad have begun to study the emotional disorders of PD patients with the change of medical models. The study found that PD accompanied with anxiety. The patients with depression are the result of multiple effects of genetic, environmental and social factors. The pathogenesis is related to the degeneration of the nervous system, the neuroendocrine disorder, the immune response mechanism, the neurotoxic damage, the social psychological reaction and so on. The specific pathogenesis is still unclear. The diagnosis depends mainly on the clinical symptoms of the patients and the doctor's Classics. The main use of antidepressant therapy and anti Parkinson disease treatment, dopamine replacement therapy, dopamine receptor agonist, new antidepressant fluoxetine, Mi Danping, and so on, can be used in the treatment. Traditional Chinese medicine thinks that the disease is a common disease of "tremor syndrome" and "qi stagnation". The causality of the disease is not clear. The main lesions are related to the liver, kidney, heart and spleen, and the main pathological factors are the internal movement of the liver. The treatment is mostly followed by the treatment of Tonifying the kidney, activating blood and liver, suppressing the liver and extinguishing the wind, although the curative effect is remarkable in recent years. Although the curative effect is remarkable, although the curative effect is remarkable in recent years, the curative effect is remarkable although the curative effect is remarkable. Although the curative effect is remarkable in recent years. Although the curative effect is remarkable, although the curative effect is remarkable in recent years The research reports on the state of PD with anxiety and depression at home and abroad have increased, but still relatively lack, not enough to effectively guide the clinical work. This study used self-made invigorating spleen and kidney activating blood recipe combined with Pa Rossi Dean hydrochloric acid to treat PD with anxiety and depression (spleen and kidney two deficiency syndrome), and the effect of treatment was discussed and discussed. A new approach to treatment of disease.
Method锛

本文编号：1877470