艾灸结合百忧解治疗中风后抑郁症的临床研究

发布时间：2018-03-11 20:25

本文选题：脑卒中后抑郁症　切入点：艾灸疗法　出处：《南京中医药大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：中风后抑郁症(Post Stroke Depression,PSD)系一种继发性抑郁,是脑血管常见的并发症之一。而世界卫生组织(WHO)亦指出,精神性疾病是21世纪人类将要面临的主要疾患。中风后抑郁症(PSD)包括多种精神症状和躯体症状的复杂的情感障碍性疾病。临床上主要表现为情绪低落、睡眠障碍、兴趣减退、易疲劳、思维迟缓、食欲减退、悲观绝望,甚则出现自杀企图和行为异常等症状。临床上如能及时诊断并予以有效的治疗,可降低患者致残率和死亡率,提高其生活质量。目前西药治疗该病主要采用5-HT重摄取抑制剂(SSRI),公认有效,但该药存在着消化神经等系统的副作用,例如：恶心、呕吐、消化不良、嗜睡、性功能障碍等,且价格昂贵,使患者难以接受,依从性差。而中医对本病的治疗和延缓其病势发生发展具备一定优势。因此中医各种治疗手段治疗中风后抑郁的证候及疗效机理相关研究,已引起国内外学者的普遍关注。其中灸法对该病的治疗效果较好,无副作用,而且收效较快,在脑血管疾病的治疗中日益发挥出其优越性。治疗方法：受试对象来源于2010年3月至2011年3月在南京中医药大学附属江苏省中医院神经内科病房或门诊并符合纳入病例标准的中风后抑郁症患者,一共纳入60例分为两组：治疗组与对照组个30例。治疗组以艾灸结合百忧解治疗,对照组以百忧解治疗。治疗组灸法取背俞穴的心俞,肝俞,脾俞,肾俞采用隔姜灸方法。再取神阙进行温和灸加强肝脾肾功能,并减缓百忧解的常见副作用。另外,口服药物：参照药物说明书,给予百忧解维持剂量口服20mg/d,药物于清晨口服。每日一次,15次为1疗程,共进行3疗程。对照组,口服药物：按照药物说明书治疗剂量予患者口服药物百忧解,前15天口服20mg/d,后改为40mg/d,药物均于清晨口服。每日一次,15次为1疗程,共进行3疗程。结果： 1.两组一般资料经过t检验,P0.05,没有显著性差异,具有可比性。 2.汉密尔顿抑郁量表：两组治疗后总有效率经X2检验,虽无显著性差异但治疗组总有效率(83.3%)明显优于对照组(73.33%)。 3.《中风后抑郁症针灸治疗评定量表》：经过治疗,两组患者虽均获得良好疗效,但治疗组的总有效率(86.66%)明显优于对照组(66.67%)。因此得出结论,艾灸结合百忧解治疗PSD效果优于单用百忧解治疗PSD。 4.TESS副反应量表：3疗程结束后,治疗组TESS评分为(3.7±1.5),而对照组TESS评分为(15.8±4.4),分值明显高于治疗组(P值0.05)。因此得出结论,艾灸可以控制并减少百忧解带来的副作用,因此改善患者的生活状态。结论：艾灸结合百忧解与单一使用百忧解治疗PSD均能起到较好的疗效,两者比较之下,艾灸与药物结合治疗PSD的疗效显得更佳,且起效时间来的短而具有持续性及副作用低。因此,艾灸与药物结合治疗PSD优于单一药物疗法,值得在临床上更广泛地应用。
[Abstract]:Objective:. Post Stroke depression (PSD), a secondary form of depression, is one of the most common cerebrovascular complications, and the World Health Organization (WHO) notes that. Mental illness is the main disease that human will face in 21th century. Post-apoplectic depression (PSD) includes a variety of mental and physical symptoms of complex emotional disorders. Clinical manifestations of depression, sleep disorders, decreased interest, Prone to fatigue, slow thinking, loss of appetite, pessimism and despair, and even symptoms such as suicide attempts and abnormal behavior. Clinical diagnosis and effective treatment can reduce the rate of disability and mortality of patients. To improve the quality of life. At present, 5-HT reuptake inhibitor (SSRIN) is widely used in the treatment of the disease, but it has the side effects of digestive nerve system, such as nausea, vomiting, dyspepsia, lethargy, sexual dysfunction and so on. And the price is expensive, make the patient difficult to accept, the compliance is poor. And the Chinese medicine has certain superiority to the treatment of this disease and to delay the occurrence and development of the disease. Therefore, the syndromes and the curative effect mechanism of the treatment of post-apoplectic depression by all kinds of traditional Chinese medicine treatment methods are related research. Moxibustion has attracted the attention of scholars both at home and abroad. Moxibustion has a good effect on the disease, no side effects, and the effect is fast. It has been playing an increasingly important role in the treatment of cerebrovascular diseases. Treatment:. Subjects from March 2010 to March 2011 in the Department of Neurology, Jiangsu Provincial Hospital of traditional Chinese Medicine, Nanjing University of traditional Chinese Medicine, met the criteria for the inclusion of post-stroke depression. A total of 60 cases were divided into two groups: treatment group and control group of 30 cases. The treatment group was treated with moxibustion combined with Prozac solution and the control group with Prozac solution. In the treatment group, the moxibustion method was used to treat Xinshu, Ganshu, spleen, Shenshu and Shenshu, and then the Shenque was taken for mild moxibustion to strengthen the function of liver, spleen and kidney. In addition, oral drugs: according to the drug instructions, the maintenance dose of Prozac was given orally for 20 mg / d, and the drug was taken orally in the morning. 15 times a day as a course of treatment, a total of three courses of treatment were performed in the control group. Oral drugs: according to the dosage of drug instructions, the patients were given oral Prozac, 20 mg / d for the first 15 days, then 40 mg / d for the first 15 days. The drugs were taken orally in the morning. 15 times a day for a course of treatment, a total of three courses. Results:. 1. There was no significant difference in general data between the two groups after t test (P 0.05). 2. Hamilton Depression scale (Hamilton Depression scale): the total effective rate of the two groups after treatment was significantly better than that of the control group (73.33%), although there was no significant difference in the total effective rate between the two groups after X2 test, but the total effective rate of the treatment group was 83.3%. 3. Evaluation scale of Acupuncture and moxibustion treatment for Post-apoplectic Depression: after treatment, both groups obtained good curative effect, but the total effective rate of the treatment group was 86.66), which was significantly better than that of the control group (66.67%). The effect of moxibustion combined with Prozac was better than that of Prozac alone. 4. At the end of the treatment, the TESS score of the treatment group was 3.7 卤1.5g, while the TESS score of the control group was 15.8 卤4.40.The score was significantly higher than that of the treatment group (P = 0.05). Therefore, it was concluded that moxibustion could control and reduce the side effects of Prozac. Therefore, improve the living conditions of patients. Conclusion:. Moxibustion combined with Prozac and Prozac alone can play a better role in the treatment of PSD. Compared with moxibustion and drug therapy, the curative effect of moxibustion combined with drug therapy on PSD is better than that of moxibustion, and the onset time is short, the duration is low and the side effects are low. Moxibustion combined with drug therapy is better than single drug therapy in treating PSD.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R246.6

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