调肝扶脾、化痰通络法针药并用治疗脑卒中后抑郁的临床研究
发布时间：2018-07-25 17:50
【摘要】：卒中后抑郁(post-stroke depression, PSD)是脑卒中常见的并发症以及卒中患者最主要的自杀原因之一,严重影响了患者及其家人的生活质量。因其没有特殊症状,也没有特异的生物学指标,加之有些患者存在语言障碍或智能障碍,抑郁症状不能被检出,易致漏诊。因此,卒中后抑郁的早期发现与早期治疗可以明显改善卒中患者的预后和生活质量。 目前抗抑郁西药治疗存在起效慢、疗程长、副作用大、患者依从性差、价格昂贵等问题,严重影响了治疗的依从性。中医药治疗对本病的治疗和延缓病势发生发展具有明显的优势,因此探究一种有效的中医药治疗方法具有重要意义。 本研究通过查阅文献,以频数分布归纳出卒中后抑郁患者最常见的十个中医症状：情绪低落、兴趣减低、全身疲乏感、睡眠障碍、烦躁、头晕、食欲减退、腰膝酸软、畏寒肢冷、小便清长,依其症状无、轻、中、重的程度不同,分别赋予相应分值,制定卒中后抑郁中医症状评分量表。同时从抑郁、睡眠、神经功能缺损等方面进行量表评定,综合探讨中医药治疗卒中后抑郁的疗效。 [目的]通过中医症状量表及抑郁、睡眠、神经功能缺损等方面的相关量表评定,综合探讨中医药治疗卒中后抑郁的疗效。 [方法]采用随机数字表将2012年9月至2014年1月期间美国洛杉矶地区Eastern Medicine诊所及北京中医药大学东方医院就诊的卒中后抑郁患者随机分为治疗组和对照组,每组各30例患者。两组均给予脑血管病二级预防治疗及根据病情在医师指导下的抗抑郁药物治疗,治疗组患者以调肝扶脾、化痰通络为法,采用针灸+中药治疗,治疗周期为8周。对比2组患者入组时、治疗2周、4周、8周中医症状量表、汉密尔顿抑郁量表、美国国立卫生院卒中量表、日常生活能力量表、匹兹堡睡眠量表、改良的Rankin量表(mRS)评分,结合不同时点的相关量表分值变化及量表分值之间的相关性研究,多层面探讨中医药治疗卒中后抑郁的疗效,为中医药治疗卒中后抑郁提供新思路。 [结果] 1、一般资料 60例患者中,男性27例占45%；女性33例占55%,女性发病率高于男性；吸烟者占48.3%；饮酒者占33.3%；高血压病发病率较高,其次为血脂异常和糖尿病。 患者年龄、性别、文化程度、烟酒史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、评价量表与汉密尔顿抑郁量表(HAMD)的相关性 通过对2组不同时点中医症状量表、NIHSS量表、ADL评分、MRS评分及匹兹堡睡眠量表(PSQI)与HAMD量表分值行秩相关检验,结果提示2组各时点中医症状分值与HAMD分值有相关性(P0.05)；对照组4个时点HAMD分值与NIHSS分值具有相关性(P0.05)；对照组4个时点HAMD分值与ADL分值具有相关性(P0.05)；对照组治疗前后HAMD分值与MRS分值具有相关性(P0.05),；2组各时点PSQI分值与HAMD分值有相关性(P0.05)。该结果一方面说明了中医症状量表及匹兹堡睡眠量表与HAMD量表从抑郁症状评价上的一致性,引发我们多角度出发探究针药并用治疗方法的有效率,同时也提示我们卒中后患者的抑郁程度状与神经功能缺损程度、患者日常生活能力及预后有相关性,引发我们早期积极干预卒中后抑郁的症状,从而加强肢体功能的康复。 3、2组治疗前后各量表分值变化 从抑郁、睡眠、神经功能缺损等方面进行量表评定,综合探讨调肝扶脾、化痰通络法针药并用治疗卒中后抑郁的疗效。研究结果表明治疗组治疗前后中医症状分值、HAMD分值、NIHSS分值、ADL分值、匹兹堡睡眠量表分值有统计学差异(P0.05),且治疗8周与入组时、2周、4周三个时点分值比较有明显差异；治疗组和对照组治疗前后MRS有统计学差异(P0.05)。提示调肝扶脾、化痰通络法针药并用可从抑郁症状的改善、睡眠质量、神经功能缺损、提高患者生活质量及预后等方面起到一定疗效。 4、实验室检查 治疗组和对照组治疗前后总胆固醇、甘油三酯水平有所下降,有统计学差异(P0.05)；对照组治疗前后及治疗8周与治疗组高密度脂蛋白比较有统计学差异(P0.05)；治疗组和对照组治疗前后低密度脂蛋白有所下降,有统计学差异(P0.05)；2组患者入组时与治疗8周空腹血糖水平无差异(P0.05)。一方面考虑患者经脑血管病二级预防后血脂情况有所改善,还初步证实调肝扶脾、化痰通络法针药并用治疗对患者血脂及血糖无负性影响。 5、不良事件 总结针药并用治疗常见的不良事件：胃肠道症状、皮肤过敏、咽喉肿痛、头晕头痛及心慌胸闷,观察发现调肝扶脾、化痰通络法针药并用治疗卒中后抑郁虽少数患者有不良事件,但症状较轻,不影响继续治疗,且未出现危及生命的症状。2组对比无差异(P0.05)。 6、药物加减情况 对比治疗前后患者药物(药量和服药数目)加减情况,卡方检验提示2组有差异(P0.05)。 [结论] 1、卒中后患者的抑郁程度与神经功能缺损程度、患者日常生活能力及预后有相关性,中医症状量表和匹兹堡睡眠量表可以从抑郁常见伴随症状及睡眠方面判定患者的抑郁症状,与HAMD量表评价有相关性。 2、调肝扶脾、化痰通络法针药可改善患者的抑郁症状、睡眠质量、神经功能缺损、患者生活质量及预后,临床应用安全有效。
[Abstract]:Post stroke depression (post-stroke depression, PSD) is one of the common complications of stroke and one of the most important suicidal causes of stroke patients. It seriously affects the quality of life of the patients and their families. There are no special symptoms, no specific biological indicators, and some patients have language disorders or mental disorders, and depression symptoms are not. Early detection and early treatment of post stroke depression can significantly improve the prognosis and quality of life of stroke patients.
At present, antidepressant western medicine has slow onset, long treatment process, large side effects, poor compliance and high price, which seriously affect the compliance of the treatment. Chinese medicine treatment has obvious advantages to the treatment of this disease and the development of the disease. Therefore, it is of great significance to explore an effective treatment method of traditional Chinese medicine.
Through the literature review, this study summed up the ten most common TCM symptoms of post-stroke depression: depression, low interest, fatigue, sleep disorder, irritability, dizziness, anorexia, low back and knee, cold limbs, and the length of urine, according to the symptoms of no, light, medium and heavy, the corresponding score was given, respectively. The scale of TCM symptom score of post stroke depression was set, and the scale of depression, sleep and nerve function defect was evaluated, and the curative effect of traditional Chinese medicine on post-stroke depression was discussed.
[Objective] to evaluate the efficacy of Chinese medicine in the treatment of post-stroke depression by TCM symptom scale, depression, sleep and neurological impairment.
[Methods] a random digital table was used to randomly divide the patients with post stroke depression in the Eastern Medicine clinic in Losangeles and the Eastern Hospital of Beijing University of Chinese Medicine from September 2012 to January 2014. The patients were randomly divided into the treatment group and the control group, with 30 patients in each group. The two groups were given the two stage prevention and treatment of cerebrovascular disease and according to the doctor's condition. The treatment group was treated with antidepressant medicine, the treatment group was treated with the liver and the spleen, the phlegm and the collaterals were used as the method, the treatment cycle was 8 weeks with Acupuncture plus Chinese medicine. Compared with the 2 groups, the symptom scale of traditional Chinese medicine, the Hamilton depression scale, the national health hospital stroke scale, the daily living capacity scale, the Pittsburgh sleep scale, were compared for the 2 groups. The improved Rankin scale (mRS) score, combined with the correlation between the variation of the correlation scale and the scale of the different points, was used to study the curative effect of Chinese medicine in the treatment of post stroke depression, and to provide a new idea for the treatment of post stroke depression.
[results]
1, general information
Among the 60 patients, 27 were male, 33 were women, 55% were women, women were higher than men, smokers accounted for 48.3%, drinkers accounted for 33.3%, hypertension was higher, followed by dyslipidemia and diabetes.
There was no statistical difference in age, sex, education level, history of smoking and drinking and past medical history by chi square test (P0.05).
2, the correlation between the rating scale and the Hamilton Depression Scale (HAMD).
Through 2 groups of different symptoms of TCM symptom scale, NIHSS scale, ADL score, MRS score and Pittsburgh Sleep Scale (PSQI) and HAMD scale line rank correlation test, the results suggested that the scores of TCM symptoms were correlated with HAMD scores at each time point of the 2 groups (P0.05), and the 4 time points in the control group were correlated with the NIHSS score (P0.05), and the control group was 4. There was a correlation between the time point HAMD score and the ADL score (P0.05); the HAMD score and the MRS score of the control group were correlated (P0.05) before and after treatment, and the PSQI score of the 2 groups at each time point was correlated with the HAMD score (P0.05). The results showed the consistency of the TCM symptom scale and the Pittsburgh sleep sleep scale and the HAMD scale on the depressive symptoms evaluation. At the same time, it also suggests that the degree of depression in the patients after stroke is associated with the degree of nerve function defect, the patient's daily life ability and prognosis, which causes us to actively intervene in the symptoms of post stroke depression and strengthen the rehabilitation of limb function.
Changes of the scale of each scale in group 3,2 before and after treatment
According to the scale of depression, sleep and nerve function defect, the effect of regulating liver and helping spleen, removing phlegm and dredging collaterals and treating post stroke depression was synthetically discussed. The results showed that the score of TCM symptoms, HAMD score, NIHSS score, ADL score, and Pittsburgh sleep scale were statistically different (P0.05) before and after treatment (P0.05), and the treatment was treated. There were significant differences between the 8 weeks and the 8 weeks, 2 weeks and 4 Wednesday points. There were statistical differences between the treatment group and the control group before and after treatment (P0.05). It suggested that the treatment of the liver and the spleen, the method of eliminating phlegm and dredging collaterals can improve the depression, the quality of sleep, the nerve function defect, the quality of life and the prognosis of the patients.
4, laboratory examination
In the treatment group and the control group, the total cholesterol and triglyceride levels decreased before and after the treatment (P0.05), and the high density lipoprotein (HDL) in the control group and the treatment group before and after treatment and the treatment 8 weeks were statistically different (P0.05); the low density lipoprotein in the treatment group and the control group decreased, and there were statistical differences (P0.05); the 2 groups were statistically different. There was no difference in the level of fasting blood glucose between the patients and the 8 weeks (P0.05). On the one hand, the improvement of blood lipid in patients with cerebrovascular disease two was considered, and it was also preliminarily confirmed that the liver and the spleen, the method of eliminating phlegm and dredging collaterals and the treatment had no negative effect on blood lipid and blood sugar.
5, adverse events
The common adverse events were summarized as follows: gastrointestinal symptoms, skin allergies, sore throat and sore throat, dizziness and headache and palpitation and chest tightness. It was observed that the liver and the spleen, the method of eliminating phlegm and collaterals were used in the treatment of post stroke depression, although a few patients had adverse events, but the symptoms were light and did not affect the continued treatment, and there was no life threatening symptom.2 group. There is no difference in contrast (P0.05).
6, drug addition and reduction
The drug dosage and dosage were compared before and after treatment. Chi square test showed that there was a difference between the 2 groups (P0.05).
[Conclusion]
1, the degree of depression after stroke was correlated with the degree of nerve function defect, the patient's daily living ability and prognosis. The TCM symptom scale and the Pittsburgh sleep scale could determine the depressive symptoms of the patients from the common concomitant symptoms and sleep of depression, which were related to the HAMD scale evaluation.
2, regulating liver and helping spleen, removing phlegm and dredging collaterals can improve the patient's depressive symptoms, sleep quality, nerve function defect, the quality of life and prognosis of the patients, and the clinical application is safe and effective.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3
本文编号：2144574
[Abstract]:Post stroke depression (post-stroke depression, PSD) is one of the common complications of stroke and one of the most important suicidal causes of stroke patients. It seriously affects the quality of life of the patients and their families. There are no special symptoms, no specific biological indicators, and some patients have language disorders or mental disorders, and depression symptoms are not. Early detection and early treatment of post stroke depression can significantly improve the prognosis and quality of life of stroke patients.
At present, antidepressant western medicine has slow onset, long treatment process, large side effects, poor compliance and high price, which seriously affect the compliance of the treatment. Chinese medicine treatment has obvious advantages to the treatment of this disease and the development of the disease. Therefore, it is of great significance to explore an effective treatment method of traditional Chinese medicine.
Through the literature review, this study summed up the ten most common TCM symptoms of post-stroke depression: depression, low interest, fatigue, sleep disorder, irritability, dizziness, anorexia, low back and knee, cold limbs, and the length of urine, according to the symptoms of no, light, medium and heavy, the corresponding score was given, respectively. The scale of TCM symptom score of post stroke depression was set, and the scale of depression, sleep and nerve function defect was evaluated, and the curative effect of traditional Chinese medicine on post-stroke depression was discussed.
[Objective] to evaluate the efficacy of Chinese medicine in the treatment of post-stroke depression by TCM symptom scale, depression, sleep and neurological impairment.
[Methods] a random digital table was used to randomly divide the patients with post stroke depression in the Eastern Medicine clinic in Losangeles and the Eastern Hospital of Beijing University of Chinese Medicine from September 2012 to January 2014. The patients were randomly divided into the treatment group and the control group, with 30 patients in each group. The two groups were given the two stage prevention and treatment of cerebrovascular disease and according to the doctor's condition. The treatment group was treated with antidepressant medicine, the treatment group was treated with the liver and the spleen, the phlegm and the collaterals were used as the method, the treatment cycle was 8 weeks with Acupuncture plus Chinese medicine. Compared with the 2 groups, the symptom scale of traditional Chinese medicine, the Hamilton depression scale, the national health hospital stroke scale, the daily living capacity scale, the Pittsburgh sleep scale, were compared for the 2 groups. The improved Rankin scale (mRS) score, combined with the correlation between the variation of the correlation scale and the scale of the different points, was used to study the curative effect of Chinese medicine in the treatment of post stroke depression, and to provide a new idea for the treatment of post stroke depression.
[results]
1, general information
Among the 60 patients, 27 were male, 33 were women, 55% were women, women were higher than men, smokers accounted for 48.3%, drinkers accounted for 33.3%, hypertension was higher, followed by dyslipidemia and diabetes.
There was no statistical difference in age, sex, education level, history of smoking and drinking and past medical history by chi square test (P0.05).
2, the correlation between the rating scale and the Hamilton Depression Scale (HAMD).
Through 2 groups of different symptoms of TCM symptom scale, NIHSS scale, ADL score, MRS score and Pittsburgh Sleep Scale (PSQI) and HAMD scale line rank correlation test, the results suggested that the scores of TCM symptoms were correlated with HAMD scores at each time point of the 2 groups (P0.05), and the 4 time points in the control group were correlated with the NIHSS score (P0.05), and the control group was 4. There was a correlation between the time point HAMD score and the ADL score (P0.05); the HAMD score and the MRS score of the control group were correlated (P0.05) before and after treatment, and the PSQI score of the 2 groups at each time point was correlated with the HAMD score (P0.05). The results showed the consistency of the TCM symptom scale and the Pittsburgh sleep sleep scale and the HAMD scale on the depressive symptoms evaluation. At the same time, it also suggests that the degree of depression in the patients after stroke is associated with the degree of nerve function defect, the patient's daily life ability and prognosis, which causes us to actively intervene in the symptoms of post stroke depression and strengthen the rehabilitation of limb function.
Changes of the scale of each scale in group 3,2 before and after treatment
According to the scale of depression, sleep and nerve function defect, the effect of regulating liver and helping spleen, removing phlegm and dredging collaterals and treating post stroke depression was synthetically discussed. The results showed that the score of TCM symptoms, HAMD score, NIHSS score, ADL score, and Pittsburgh sleep scale were statistically different (P0.05) before and after treatment (P0.05), and the treatment was treated. There were significant differences between the 8 weeks and the 8 weeks, 2 weeks and 4 Wednesday points. There were statistical differences between the treatment group and the control group before and after treatment (P0.05). It suggested that the treatment of the liver and the spleen, the method of eliminating phlegm and dredging collaterals can improve the depression, the quality of sleep, the nerve function defect, the quality of life and the prognosis of the patients.
4, laboratory examination
In the treatment group and the control group, the total cholesterol and triglyceride levels decreased before and after the treatment (P0.05), and the high density lipoprotein (HDL) in the control group and the treatment group before and after treatment and the treatment 8 weeks were statistically different (P0.05); the low density lipoprotein in the treatment group and the control group decreased, and there were statistical differences (P0.05); the 2 groups were statistically different. There was no difference in the level of fasting blood glucose between the patients and the 8 weeks (P0.05). On the one hand, the improvement of blood lipid in patients with cerebrovascular disease two was considered, and it was also preliminarily confirmed that the liver and the spleen, the method of eliminating phlegm and dredging collaterals and the treatment had no negative effect on blood lipid and blood sugar.
5, adverse events
The common adverse events were summarized as follows: gastrointestinal symptoms, skin allergies, sore throat and sore throat, dizziness and headache and palpitation and chest tightness. It was observed that the liver and the spleen, the method of eliminating phlegm and collaterals were used in the treatment of post stroke depression, although a few patients had adverse events, but the symptoms were light and did not affect the continued treatment, and there was no life threatening symptom.2 group. There is no difference in contrast (P0.05).
6, drug addition and reduction
The drug dosage and dosage were compared before and after treatment. Chi square test showed that there was a difference between the 2 groups (P0.05).
[Conclusion]
1, the degree of depression after stroke was correlated with the degree of nerve function defect, the patient's daily living ability and prognosis. The TCM symptom scale and the Pittsburgh sleep scale could determine the depressive symptoms of the patients from the common concomitant symptoms and sleep of depression, which were related to the HAMD scale evaluation.
2, regulating liver and helping spleen, removing phlegm and dredging collaterals can improve the patient's depressive symptoms, sleep quality, nerve function defect, the quality of life and prognosis of the patients, and the clinical application is safe and effective.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3
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