乌灵胶囊联合草酸艾司西酞普兰治疗卒中后睡眠障碍的临床研究

发布时间：2018-05-29 14:48

本文选题：卒中后睡眠障碍 + 生活质量　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的比较缺血性脑卒中睡眠障碍与非睡眠障碍患者焦虑、抑郁、疲劳水平及生活质量的差异,分析卒中后睡眠障碍(Post-Stroke Sleep Disorder,PSSD)患者睡眠质量与生存质量的相关性;观察乌灵胶囊联合草酸艾司西酞普兰治疗卒中后睡眠障碍的疗效及两药联用对患者生活质量的改善情况。方法1.选取2016年6月-2017年2月在解放军武汉总医院神经内科住院治疗的103例急性缺血性脑卒中(2周内)患者为研究对象,对所有患者进行匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)测评,根据PSQI量表结果将患者分为两组,PSQI评分≥7的患者作为睡眠障碍组,PSQI评分7的患者作为非睡眠障碍组。收集所有患者的人口统计学资料及临床资料,分别对两组患者行美国国立卫生研究院卒中量表(Nation Institutes of Health Stroke Scales,NHISS)、汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)、汉密顿抑郁量表(Hamilton Depression Scale,HAMD)、疲劳严重度量表(Fatigue Severity Scale,FSS)及卒中专门生存质量量表(Stroke-Specific Quality of Life Scale,SS-QOL)测评。比较缺血性脑卒中睡眠障碍患者与非睡眠障碍患者焦虑、抑郁情绪、疲劳水平及生活质量的差异;运用多元逐步回归分析法对卒中后睡眠障碍患者睡眠质量与生活质量的相关性进行分析。2.64例卒中后睡眠障碍患者随机分为两组,其中对照组31例,研究组33例,所有患者均给予急性缺血性脑卒中常规药物治疗,在此基础上对照组给与草酸艾司西酞普兰(口服10mg 1次/日),研究组给与乌灵胶囊(口服0.99g 3次/日)联合草酸艾司西酞普兰(口服10mg 1次/日)。分别于治疗前及治疗后2周、4周对两组患者进行PSQI、HAMA量表、HAMD量表、FSS量表及SS-QOF量表评定,比较两组患者治疗前及治疗后各时间段各项量表评分的差异,观察两组药物治疗卒中后睡眠障碍的疗效及生活质量的改善情况,同时记录患者服用药物的不良反应。结果1.103例缺血性脑卒中患者分为两组,其中睡眠障碍组64例,非睡眠障碍组39例,睡眠障碍组患者的PSQI量表评分、NHISS评分、HAMA量表评分、HAMD量表评分、FSS量表评分及SS-QOF量表评分与非睡眠障碍组患者相比差异具有统计学意义(P0.05)。64例卒中后睡眠障碍患者中,轻度睡眠障碍5例,中度睡眠障碍50例,重度睡眠障碍9例;对卒中后睡眠障碍患者睡眠质量与生存质量的多元逐步回归分析结果显示睡眠效率及睡眠时间与生活质量呈正相关,睡眠时间对卒中患者生活质量的影响更为显著。2.64例卒中后睡眠障碍患者随机分为2组,对照组31例,研究组33例,两组患者的年龄、男女构成、PSQI评分、NHISS评分相比较无统计学差异(P0.05),具有可比性。(1)匹兹堡睡眠质量指数(PSQI)评分:两组患者治疗后2周、4周的PSQI评分与治疗前相比均有显著性差异(P0.01);研究组治疗后2周、4周的PSQI量表评分与对照组相比较差异具有统计学意义(P0.05)。(2)汉密顿焦虑量表(HAMA)评分、汉密顿抑郁量表(HAMD)评分:两组患者治疗后2周、4周的HAMA量表和HAMD量表评分与治疗前相比均有显著性差异(P0.01);研究组治疗后2周、4周的HAMA量表和HAMD量表评分与对照组相比较差异具有统计学意义(P0.05)。(3)疲劳严重度量表(FSS)评分:研究组治疗后2周、4周的FSS量表评分与治疗前相比较有显著性差异(P0.01);对照组的FSS量表评分治疗前与治疗后各时间段相比较无显著性差异(P0.05);治疗2周后两组患者的FSS量表评分无显著性差异(P0.05),治疗4周研究组FSS量表评分低于对照组(P0.05)。(4)卒中专门生存质量量表(SS-QOF)评分:两组患者治疗后2周、4周的SS-QOF量表评分与治疗前相比较有显著性差异(P0.01);研究组治疗后2周、4周的SS-QOF量表评分与对照组相比差异具有统计学意义(P0.05)。结论1.缺血性脑卒中睡眠障碍患者的神经功能缺损程度重于与非睡眠障碍患者,卒中后睡眠障碍患者相较于非睡眠障碍患者其焦虑、抑郁负性情绪严重,疲劳水平高,生活质量差。对卒中患者进行积极的药物治疗和肢体康复训练的同时还应关注卒中患者的睡眠质量,预防卒中后睡眠障碍的发生。对卒中后睡眠障碍患者应积极干预,对其负性情绪进行药物治疗和心理疏导,提高卒中患者的生活质量。2.乌灵胶囊联合草酸艾司西酞普兰和单用草酸艾司西酞普兰均能改善卒中患者的睡眠障碍,乌灵胶囊联合草酸艾司西酞普兰治疗卒中后睡眠障碍的疗效优于单用草酸艾司西酞普兰。乌灵胶囊能改善卒中患者的睡眠情况、缓解疲劳,草酸艾司西酞普兰治疗焦虑、抑郁,两药联用较单用草酸艾司西酞普兰能在短期内改善卒中患者的生活质量。
[Abstract]:Objective to compare the differences of anxiety, depression, fatigue and quality of life in patients with apoplexy and non sleep disorders, and to analyze the correlation between sleep quality and quality of life in patients with Post-Stroke Sleep Disorder (PSSD), and to observe the combination of Wuling capsule combined with oxalic acid Ai Sciplan in the treatment of post stroke sleep disorder. The curative effect and the improvement of the quality of life of the patients combined with the combined use of two drugs. Method 1. 103 cases of acute ischemic stroke (2 weeks) hospitalized in the Department of Neurology, Wuhan general hospital, Wuhan General Hospital of the Liberation Army in June 2016, were selected as the subjects. The Pittsburgh sleep quality index scale (Pittsburgh Sleep Quality Index) was carried out for all patients. PSQI) assessment, according to the results of the PSQI scale, the patients were divided into two groups, the patients with PSQI score more than 7 were used as sleep disorder group, and the patients with PSQI score 7 were used as non sleep disorder group. The demographic data and clinical data of all patients were collected, and the National Health Institute Stroke Scale (Nation Institutes of Health Str) was performed on the two groups of patients. Oke Scales, NHISS), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA), the Hamilton Depression Scale (Hamilton Depression Scale, HAMD), the severity of the fatigue measurement, and the assessment of the apoplexy specific quality of life scale. The difference of anxiety, depression, fatigue, and quality of life in the patients with non sleep disorders, and the correlation of sleep quality and quality of life in patients with sleep disorders after stroke were analyzed by multiple stepwise regression analysis (.2.64), two groups were randomly divided into two groups, 31 in the control group and 33 in the study group. On the basis of the conventional drug treatment for acute ischemic stroke, the control group gave oxalitalopram (oral 10mg 1 times per day). The study group gave Wuling capsule (oral 0.99g 3 times / day) combined with oxalic acid Ai Sciplan (oral 10mg 1 times / day). Before and 2 weeks after treatment and 4 weeks, two groups were given PSQI, HA The MA scale, the HAMD scale, the FSS scale and the SS-QOF scale were evaluated to compare the difference of the scale scores between the two groups before and after the treatment. The curative effect and the improvement of the quality of life were observed in the two groups of drugs in the treatment of sleep disorders after stroke, and the adverse reactions of the patients were recorded. The results of 1.103 patients with ischemic stroke were observed. There were two groups, including 64 sleep disorders, 39 non sleep disorders, PSQI scale score, NHISS score, HAMA scale score, HAMD scale score, FSS scale score, SS-QOF scale score and non sleep disorder group with statistical significance (P0.05).64 case after stroke sleep disorder patients were mild. 5 cases of sleep disorders, 50 cases of moderate sleep disorder and 9 cases of severe sleep disorder. Multiple stepwise regression analysis of sleep quality and quality of life after stroke patients showed that sleep efficiency and sleep time were positively related to the quality of life. The effect of sleep time on the living quality of stroke patients was more significant.2.64 after stroke sleep. The patients were randomly divided into 2 groups, the control group 31 cases, the study group 33 cases, the age of the two groups, the PSQI score, the NHISS score and the comparable (P0.05). (1) the Pittsburgh sleep quality index (PSQI) score: two groups of patients after 2 weeks, 4 weeks of PSQI score compared with before treatment have significant difference (P0.01) 2 weeks after treatment, 2 weeks after treatment, 4 weeks of PSQI scale score compared with the control group had a statistically significant difference (P0.05). (2) Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score: two groups of patients after 2 weeks of treatment, 4 weeks of HAMA scale and HAMD scale scores compared with before treatment were significantly different (P0.01); the study group treatment After 2 weeks, the 4 week HAMA scale and the HAMD scale score compared with the control group was statistically significant (P0.05). (3) the fatigue severity scale (FSS) score: the FSS scale of the study group was significantly different from that before the treatment (P0.01) at the 4 week after treatment (P0.01); the FSS scale of the group was compared with the time period of the treatment before and after the treatment. There was no significant difference (P0.05), and there was no significant difference between the two groups after 2 weeks of treatment (P0.05). The score of the FSS scale in the 4 week treatment group was lower than that of the control group (P0.05). (4) the score of specific quality of life (SS-QOF) for stroke (SS-QOF): two groups of patients at 2 weeks after treatment, and 4 weeks' SS-QOF scale scores were significantly different from those before treatment (P0.01). The SS-QOF scale score of the study group after 2 weeks and 4 weeks was statistically significant compared with the control group (P0.05). Conclusion the degree of neural function defect in patients with 1. ischemic stroke sleep disorders is more severe than that of non sleep disorder patients, and the patients with sleep disorders after stroke are more anxious than those with non sleeping disorders, and the negative mood of depression is serious and fatigue. High level of work and poor quality of life. Active drug therapy and limb rehabilitation training for stroke patients should also pay attention to the quality of sleep in stroke patients and prevent the occurrence of sleep disorders after stroke. Quality of life.2. Wuling capsule combined with essialopram oxalate and single oxalate Ai Sciplan can improve the sleep disturbance in stroke patients. The efficacy of Wuling capsule combined with oxalic acid Ai Sciplan in the treatment of post stroke sleep disorders is better than that of oxalic oxalic citalopram. Fatigue and oxalic acid Ai Sciplan treatment of anxiety and depression, two drugs combined with escitalopram oxalate alone can improve the quality of life of stroke patients in a short time.
【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

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