逍遥神欢散治疗肝郁脾虚型脑卒中后抑郁疗效研究

发布时间：2018-12-11 22:51

【摘要】：1、目的:本文通过对逍遥神欢散加帕罗西汀治疗肝郁脾虚型脑卒中后抑郁(poststroke depression,PSD)的汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD),美国国立卫生研究院卒中量表(The National Institutes of Health Stroke Scale,NIHSS),肝郁脾虚型中医证候积分量表的对比观察,评价其有效及安全性,明确疏肝解郁,健脾安神法在肝郁脾虚型脑卒中后抑郁治疗中的作用,探寻中医药辨证治疗脑卒中后抑郁的方法。为临床运用中医辨证以及中医药治疗脑卒中后抑郁提供依据和方法。2、方法:选取60例PSD患者作为研究对象(2014年1月至2015年8月均来自阜阳市第六人民医院神经内科的住院患者及门诊患者),采用数字表法随机分为两组,中药治疗组及对照组各30例,由于部分研究病例研究期间出现脱落,最终治疗组28例、对照组28例。两组分别予以脑卒中基础治疗,治疗组予逍遥神欢散联合帕罗西汀(中药一日一剂,分早、中、晚三次口服,帕罗西汀,20mg早);对照组口服帕罗西汀治疗。分别于治疗前、2周、4周及8周对两组进行中医证候量表积分、HAMD及NIHSS积分进行疗效评定,临床实验期间进行常规安全性检查,评价逍遥神欢散治疗脑卒中后抑郁的临床治疗效果及用药安全性。3、结果:2、4、8周后,组内比较,两组HAMD、中医证候量表、NIHSS总积分较疗前降低明显(P0.05);组间比较,三种检测指标积分较对照组下降有统计学意义(P0.05)。HAMD总积分减分率比较:两组治疗2、4、8周,均无差异(P0.05),疗效大体相当,逍遥神欢散联合帕罗西汀有效率高于对照组;中医证候总积分减分率疗效评价比较:治疗2、4、8周,中医证候的积分变化较大,明显优于对照组(P0.05)。中医证候积分治疗组2、4、8周后总有效率为75%、89.29%及92.86%。4、结论:逍遥神欢散联合帕罗西汀与单用帕罗西汀在脑卒中后抑郁治疗疗效上无明显差异,两种治疗方法疗效基本相当,但有效率高于单用帕罗西汀;在改善中医证候、抑郁症状、受损神经系统功能的恢复上明显优于单用帕罗西汀;且在治疗脑卒中后抑郁远期疗效较为突出,并能减少帕罗西汀的不良反应。总之,逍遥神欢散联合帕罗西汀在改善PSD近、远期中医证候、抑郁症状、促进受损神经系统功能恢复等方面值得肯定,疏肝解郁,健脾安神法治疗PSD患者的方法及思路值得推广。
[Abstract]:1. Objective: to study the effects of Xiaoyaoshenhuan San plus paroxetine on post-stroke depression (poststroke depression,PSD) in patients with liver depression and spleen deficiency (poststroke depression,PSD). The National Institutes of Health Stroke scale (The National Institutes of Health Stroke Scale,NIHSS) and the TCM Syndromes integral scale of liver stagnation and spleen deficiency type were compared and observed to evaluate their effectiveness and safety. The effect of the method of invigorating the spleen and soothing the mind in the treatment of post-stroke depression with liver stagnation and spleen deficiency, and exploring the method of treating post-stroke depression with traditional Chinese medicine syndrome differentiation. For clinical use of TCM syndrome differentiation and Chinese medicine treatment of post-stroke depression to provide the basis and methods. 2, Methods: sixty patients with PSD were randomly divided into two groups, including inpatients and outpatients from Department of Neurology, sixth people's Hospital of Fuyang City from January 2014 to August 2015. There were 30 cases in the treatment group and 30 cases in the control group, 28 cases in the treatment group and 28 cases in the control group because of the abscission of some cases during the study. The two groups were given basic treatment of stroke, the treatment group was treated with Xiaoyaoshenhuan powder combined with paroxetine (one dose of traditional Chinese medicine, three times a day, paroxetine, 20mg early), and the control group was treated with paroxetine. Before, 2 weeks, 4 weeks and 8 weeks after treatment, the TCM syndromes scale scores, HAMD and NIHSS scores were evaluated, and routine safety tests were performed during the clinical trials. To evaluate the clinical efficacy and safety of Xiaoyaoshenhuan Powder in the treatment of post-stroke depression. 3. Results: after 8 weeks, the HAMD, syndromes scale and total NIHSS score in the two groups were significantly lower than those before treatment (P0.05). Compared with the control group, the scores of the three indexes were significantly decreased (P0.05). HAMD total score reduction rate comparison: the two groups treated with 2 weeks of 4 weeks, there was no difference (P0.05), the curative effect was about the same, all of the two groups had no difference (P0.05), the curative effect was about the same as that of the control group. The effective rate of Xiaoyao Shenhuan San combined with paroxetine was higher than that of control group. Comparison of the curative effect evaluation of the total score reduction rate of TCM syndromes: after 8 weeks of treatment, the scores of TCM syndromes changed significantly, which was significantly better than that of the control group (P0.05). The total effective rate of TCM syndrome integral group after 8 weeks was 75% and 92.86% respectively. Conclusion: there is no significant difference between Xiaoyaoshenhuan powder and paroxetine alone in the treatment of post-stroke depression. The efficacy of the two methods was similar, but the effective rate was higher than that of paroxetine alone. It is superior to paroxetine alone in improving TCM syndromes, depressive symptoms and the recovery of damaged nervous system function, and is more effective in the treatment of post-stroke depression, and can reduce the adverse reactions of paroxetine. In a word, the combination of Xiaoyao Shenhuan San and paroxetine is worthy of recognition in improving the short-term and long-term TCM syndromes of PSD, depressive symptoms, promoting the recovery of damaged nervous system function, and soothing the liver and relieving depression. The method and thought of invigorating spleen and soothing mind in treating PSD patients is worth popularizing.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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