从《脾胃论》结合六经辨证治疗抑郁发作的临床方案验证

发布时间：2018-03-07 13:55

  本文选题：抑郁发作　切入点：脾胃论　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨从《脾胃论》结合六经辨证理论指导下的中医药治疗抑郁发作的疗效,以明确通过该角度治疗抑郁发作的可行性以及中医优势。方法：本研究所有对象均为2015年1月至2015年12月于广东省中医院、广州医学院第一附属医院、南方医科大学就诊符合纳入标准的轻中度抑郁发作的患者,总病例数为61例,中药组38例,西药组23例。中药组予补中益气汤合半夏泻心汤／小柴胡汤／当归四逆汤／温氏奔豚汤治疗,西药组予左洛复治疗,疗程4周。在治疗前后及过程中不同时点分别进行HAMD-17、SDS、SAS、PSQI、WHOQOL-BREF进行疗效评估。成果：1.主要疗效指标(1) HAMD-17有效率比较：治疗2周后,中、西药组有效率分别为68.4%、47.8%,两组间有效率比较,差异具有统计学意义(P＜0.05)；治疗4周后,中、西药组有效率分别为68.5%、82.6%,两组间有效率比较,差异无统计学意义(P＞0.05)。(2)按病情严重程度分层后,HAMD-17总分比较：中药组轻、中度抑郁患者治疗前后HAMD-17总分比较,差异具有统计学意义(P＜0.05)；轻度抑郁患者中、西药组治疗前HAMD-17平均分分别为11.50、12.38,治疗2周后,两组HAMD-17平均分分别为7.33、10.38,两组间比较,差异具有统计学意义(P＜0.05)。2.次要疗效指标(1)SDS总分比较：两组SDS总分在治疗2周、4周后与同组基线比较,差异具有统计学意义(P＜0.05)。治疗2周、4周后两组SDS总分进行组间比较,差异无统计学意义(P＞0.05)。(2)SAS总分比较：两组SAS总分在治疗2周、4周后与同组基线比较,差异具有统计学意义(P＜0.05)。治疗2周、4周后两组SAS总分进行组间比较,差异无统计学意义(P＞0.05)。(3) PSQI总分比较：中药组在治疗4周后PSQI总分与同组基线比较,差异具有统计学意义(P＜0.05),而在治疗2周后差异无统计学意义(P＞0.05)；西药组在治疗2周、4周后PSQI总分与同组基线比较,差异均无统计学意义(P＞0.05)。(4)生存质量比较：两组生存质量总分在治疗4周后与同组基线比较,差异有统计学意义(P＜0.05),而在治疗2周后差异无统计学意义(P＞0.05)。同一时点两组间比较,差异无统计学意义(P＞0.05)。中药组生理、心理领域得分在2周、4周后分别与同组基线比较,差异有统计学意义(P＜0.05)。西药组生理领域得分在治疗4周后与同组基线比较,差异有统计学意义(P＜0.05)。两组社会领域和环境领域在治疗2周、4周后与同组基线比较,差异均无统计学意义。3.研究人群基本特征(1)人群特征：本研究抑郁发作患者中,女性36人,男性25人,女男比例为1.44：1；平均年龄为31.11岁；文化程度多为高中及以上,约占78.69%。(2)中药组中医证型分布特点：太阴组17人,少阳组12人,厥阴组6人,少阴组3人。太阴组和少阳组占76.31%。太阴组和少阳组治疗2周、4周后HAMD-17总分分别与同组基线比较,差异有统计学意义(P＜0.05)。结论：1.《脾胃论》结合六经辨证理论指导下的中药能明显改善抑郁发作患者的抑郁情绪,与西药左洛复相比,其起效更早而远期疗效相当,因此在一定程度上,可以替代西药左洛复进行治疗。2.该理论指导下的中药治疗轻度抑郁发作,其疗效优于西药左洛复,因此对轻度抑郁发作患者,可以单纯采用中药进行干预。3.该理论指导下的中药能改善抑郁发作患者睡眠质量,而西药左洛复对睡眠的改善不明显,因此对轻、中度抑郁发作伴有睡眠障碍的患者,可以采用中药替代西药左洛复进行治疗。4.该理论指导下的中药与西药左洛复均能改善抑郁发作患者主观抑郁、焦虑情绪,且两者改善程度相当。5.该理论指导下的中药与西药左洛复均能提高抑郁发作患者生存质量,但中药对于生存质量中生理、心理领域的改善比西药左洛复更为显著。6.针对轻、中度抑郁发作患者,若无明显消极观念或行为,首选中药治疗。7.本课题研究人群以女性、青年、高中以上文化为主,中医证候分布以太阴证、少阳证为主。
[Abstract]:Objective: To investigate the curative effect of combined stomach on the < > depression treatment guidelines under the theory of TCM syndrome differentiation of the six meridians to clear the attack, attack through the angle the feasibility and advantages of Chinese medicine treatment of depression. Methods: in this study, all the subjects were from January 2015 to December 2015 in Guangdong Province Traditional Chinese Medical Hospital and the First Affiliated Hospital of Guangzhou Medical College, Southern Medical University hospital with mild to moderate depression criteria the episodes, the total number of cases was 61 cases, 38 cases of Chinese medicine group, western medicine group of 23 cases. The Chinese medicine group were treated with Buzhong Yiqi Decoction Banxiaxiexin decoction and Xiaochaihu Decoction and Angelica four inverse soup / Wen bentun soup treatment, the treatment group were treated with sertraline, 4 weeks before and after treatment. And in the process at different time points were HAMD-17, SDS, SAS, PSQI, WHOQOL-BREF were evaluated. Results: 1. main indicators of efficacy (1) HAMD-17 efficiency comparison: after 2 weeks of treatment, the western medicine group The efficiency were 68.4%, 47.8%, two groups of efficiency comparison, the difference was statistically significant (P < 0.05); after 4 weeks of treatment, western medicine group was respectively 68.5%, 82.6%, two groups had efficiency comparison, no statistically significant difference (P > 0.05) (2) according to the illness. The severity of the stratification, HAMD-17 scores: the traditional Chinese medicine group, comparison of the HAMD-17 score before and after treatment in patients with moderate to severe depression, the difference was statistically significant (P < 0.05); the patients with mild depression, the western medicine group before treatment the average HAMD-17 scores were 11.50,12.38, 2 weeks after treatment, two groups of average HAMD-17 scores were 7.33,10.38, comparison between the two groups, the difference was statistically significant (P < 0.05).2. secondary index (1) SDS scores: two groups of SDS score in the treatment of 2 weeks, 4 weeks compared with baseline group, the difference was statistically significant (P < 0.05). The treatment of 2 weeks, two groups of SDS score between groups comparison of 4 weeks, 宸�寮傛棤缁熻�″�︽剰涔�(P锛，

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