逐瘀开郁化痰汤治疗缺血性脑卒中后抑郁的临床研究

发布时间：2018-04-30 15:48

本文选题：逐瘀开郁化痰汤 + 舍曲林　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：研究目的:本研究采用逐瘀开郁化痰汤治疗缺血性脑卒中后抑郁(IPSD),通过与西药舍曲林组比较,客观评估逐瘀开郁化痰汤治疗缺血性脑卒中后抑郁(IPSD)的疗效及对改善神经功能的影响程度,为治疗缺血性脑卒中后抑郁(IPSD)积累经验。研究方法:将2016年4月至20l6年12月湖北省中医院花园山院区脑病科住院及门诊,与纳入准则相符的IPSD病人共60例作为研究对象。确诊后随机分治疗组(中药组)与对照组(舍曲林组),每组30例,分别对两组患者治疗前和治疗4周后的中医症候积分、汉密尔顿抑郁量表(HAMD)积分、总有效率及神经功能缺损(CSS)评分的变化进行记录评估,记录的临床数据采用SPSS19.0软件加以统计学分析得出结论。研究结果:治疗前两组病人的年龄、性别、HAMD积分、CSS积分、中医证候积分等进行比较无明显差异,经过4周治疗后抑郁症状较治疗前有明显改善:(1)两组患者抑郁程度疗效比较:治疗4周之后,治疗组总有效率86.77%,对照组的总有效率为76.33%,两组组间比较差异明显(P0.05),说明两组均能对患者的抑郁程度有改善,治疗组疗效高于对照组。(2)治疗4周后,HAMD量表积分、CSS量表积分、中医症候积分对比均较用药之前有下降(P0.01),治疗组改善程度比对照组要高(P0.05),说明两组均可以改善HAMD量表积分、CSS量表积分、中医证候积分,治疗组在改善抑郁症状、神经功能缺损及中医证候程度上优于西药对照组。(3)安全性:在整个临床治疗期间,治疗组都没有出现重大药物不良反应事件。西药对照组在治疗后第3周,2例患者出现轻微的消化不良、口干、失眠等不良反应。治疗前后进行的实验室检验(血、尿、粪常规,心电图,血生化等)均未见明显异常,提示治疗组安全性良好,不良反应机率小,逐瘀开郁化痰汤组更安全。研究结论:逐瘀开郁化痰汤治疗缺血性卒中后抑郁(IPSD)经临床观察疗效显著,不仅使患者卒中后抑郁的症状明显好转,还有助于病人的神经功能的康复,降低致残率,无不良反映及药物依赖性或成瘾性,与西药组治疗比较,能取得更好的临床治疗效果,提示中药在IPSD的治疗上具有较好的优势。
[Abstract]:Objective: to study the effect of Zhuyu Kaiyu Huatan decoction on depression after ischemic stroke and to compare it with sertraline group. Objective to evaluate the efficacy of Zhuyu Kaiyu Huatan decoction in treating depression after ischemic stroke (IPSDs) and its influence on improving neurological function, so as to accumulate experience in the treatment of depression after ischemic stroke. Methods: from April 2016 to December 20l6, 60 cases of IPSD patients in Huayuan Mountain Hospital of Hubei traditional Chinese Medicine Hospital were studied. After diagnosis, they were randomly divided into treatment group (Chinese medicine group) and control group (sertraline group, 30 cases in each group). The scores of TCM symptoms and Hamilton Depression scale (Hamd) were measured before treatment and 4 weeks after treatment, respectively. The changes of total effective rate and neurological impairment score were recorded and evaluated. The clinical data were statistically analyzed by SPSS19.0 software. Results: there was no significant difference in age, sex, Hamd integral and CSS integral, TCM syndrome score between the two groups before treatment. After 4 weeks of treatment, the depressive symptoms were significantly improved in the two groups compared with those before treatment: after 4 weeks of treatment, the depressive degree of the patients in the two groups was better than that before treatment. The total effective rate of the treatment group was 86.77 and the total effective rate of the control group was 76.33. The difference between the two groups was significant (P 0.05), which indicated that both groups could improve the depression degree of the patients, and the curative effect of the treatment group was higher than that of the control group. The comparison of TCM symptom score was lower than that before medication, and the improvement degree of the treatment group was higher than that of the control group, indicating that both groups could improve the HAMD scale integral and CSS-scale integral, TCM syndrome score, and the treatment group was improving the depressive symptoms. Nerve function defect and TCM syndromes were superior to the western medicine control group in safety: there were no significant adverse drug reaction events in the treatment group during the whole clinical treatment period. In the control group, 2 patients had mild adverse reactions such as dyspepsia, dry mouth and insomnia at the 3rd week after treatment. The laboratory tests (blood, urine, stool routine, electrocardiogram, blood biochemistry, etc.) before and after treatment were not obviously abnormal, suggesting that the treatment group was safe, the probability of adverse reactions was small, and the treatment group was more safe. Conclusion: the curative effect of Zhuyu Kaiyu Huatan decoction on depression after ischemic stroke is remarkable. It not only improves the symptoms of depression after stroke, but also helps to rehabilitate the patients' neurological function and reduce the rate of disability. No adverse reactions, drug dependence or addiction, compared with the treatment of western medicine group, can achieve better clinical treatment effect, suggesting that Chinese medicine in the treatment of IPSD has a better advantage.
【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】：R277.7

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