滋肾理肝汤治疗肾虚肝郁型中风后抑郁疗效观察

发布时间：2018-04-01 21:13

本文选题：中风　切入点：抑郁　出处：《河南中医药大学》2016年硕士论文

【摘要】：目的中风后抑郁(Post-stroke depression,PSD)是中风的常见并发症之一,严重影响患者的身心恢复。针对目前临床药物价格昂贵、起效慢、副作用多等不足,为发挥中医的多靶点,个体化治疗具有其独特优势。本课题以临床观察的形式,选取导师经验方滋肾理肝汤治疗PSD,验证滋肾理肝汤对肾虚肝郁型中风后抑郁的疗效,同时对PSD的发病机制进行分析和探讨,为其临床应用及推广提供参考。方法本课题共选取2014年3月到2015年4月之间,漯河市第二人民医院神经内科及河南中医学院第一附属医院脑病科住院患者60例。所有患者均经头颅CT或MRI证实为脑卒中,且病程在2周到6个月之间。60例患者随机分为治疗组(30例)和对照组(30例),所有患者均接受脑卒中常规治疗,在此基础上,治疗组采用自拟滋肾理肝汤口服治疗,对照组给予盐酸帕罗西汀片口服治疗。在两组患者治疗前和治疗6周时,记录其中医证候评分及HAMD评分,NIHSS评分,ADL评分,以HAMD量表评分差异判定疗效,以HAMD量表减分率来统计有效例数(减分率≥50%为显效;减分率在25%-50%之间为有效;减分率≤25%为无效),通过统计学处理来评价其疗效及安全性。结果对采集到的各项数据进行分析,分别将两组患者的年龄,性别,文化程度及抑郁程度进行对比,发现两组间无明显差异(P05.0),具有可比性。治疗组和对照组在治疗后HAMD评分下降,较治疗前差异有统计学意义(P05.0),治疗组显效率33.33%,有效率53.33%,总有效率为86.66%;对照组有效率60.00%,显效率13.33%,总有效率为73.33%,组间对比差异明显。在改善神经功能缺损方面,治疗组在治疗前后NIHSS评分、中医证候评分及ADL评分的差异均有统计学意义(P05.0),两组对比,治疗组疗效更为突出,提示滋肾理肝汤能有效改善患者的抑郁症状,并能促进患者缺损神经功能的恢复。结论运用滋肾理肝汤治疗中风后抑郁,滋水涵木,标本兼治,起效迅速,疗效显著,既明显改善了患者的抑郁情绪,又能有效促进受损运动及感觉神经功能的恢复,安全有效。
[Abstract]:Objective Post-stroke depression (PSD) is one of the common complications of stroke.Aiming at the disadvantages of high price, slow effect and many side effects of clinical drugs, individualized therapy has its unique advantages in order to give full play to the multiple targets of traditional Chinese medicine (TCM).In the form of clinical observation, this paper selects the tutor's experience prescription Zishen Ligan decoction to treat PSDs, verifies the curative effect of Zishen Ligan decoction on depression after stroke with kidney deficiency and liver depression, and analyzes and probes into the pathogenesis of PSD.To provide a reference for its clinical application and promotion.Methods between March 2014 and April 2015, 60 inpatients from the Department of Neurology, the second people's Hospital of Luohe City and the Department of Encephalopathy, the first affiliated Hospital of Henan College of traditional Chinese Medicine, were selected.All patients were confirmed as stroke by CT or MRI, and 60 patients were randomly divided into treatment group (n = 30) and control group (n = 30).The treatment group was treated orally with Zishen Ligan decoction and the control group with paroxetine hydrochloride.The reduction rate was between 25% and 50%, and less than 25% was ineffective. The efficacy and safety were evaluated by statistical analysis.Results the age, sex, education level and depression degree of the two groups were compared, and there was no significant difference between the two groups (P05.0).In the aspect of improving nerve function defect, the difference of NIHSS score, TCM syndrome score and ADL score before and after treatment in the treatment group was statistically significant (P05.0), the curative effect of the treatment group was more prominent than that of the control group.The results suggest that Zishen Ligan decoction can effectively improve the depressive symptoms of patients and promote the recovery of defective nerve function.Conclusion the application of Zishen Ligan decoction in the treatment of post-stroke depression, nourishing water and culturing wood, treating both the symptoms and the root causes is rapid and effective. It not only obviously improves the depressed mood of the patients, but also can effectively promote the recovery of damaged motor and sensory nerve function, and is safe and effective.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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