针药并用干预社区卒中后抑郁（肝郁脾虚型）的临床疗效观察

发布时间：2019-06-09 17:13

【摘要】：目的:采用定量评价的方法,观察针药并用法治疗社区肝郁脾虚型卒中后抑郁患者的临床疗效,为社区肝郁脾虚型卒中后抑郁患者提供一个安全、有效的治疗方法,以促进中医药在社区的推广应用。方法:将符合入组标准的社区卒中后抑郁(肝郁脾虚型)患者86例,按照随机数字表以1:1的比例分为治疗组和对照组,每组均为43例。两组均给予神经内科常规治疗,对照组:给予盐酸帕罗西汀片20mg/日,清晨顿服;治疗组:在对照组基础上加针药并用法,中药给予逍遥散加味,水煎服,日一剂,分早晚两次温服,针灸采用平补平泻法,留针30 min/次,4次/周;两组各观察8周,分别在治疗0、2、4、8周进行汉密尔顿抑郁量表(HAMD)、卒中专门化生存质量量表(SSQOL)、匹兹堡睡眠质量指数量表(PSQI)评分比较和疗效评定。结果:1.临床疗效评定比较:治疗组和对照组总有效率分别为92.50%、73.17%,总有效率治疗组明显高于对照组,两组疗效经秩和检验有统计学意义(P0.05);2.HAMD评分比较:治疗2、4、8周后,两组HAMD评分均较治疗前明显下降(P0.05);治疗2周后,HAMD评分组间差异无统计学意义(P0.05);治疗4周、8周后,HAMD评分组间差异均有统计学意义(P0.05);3.SSQOL评分比较:治疗2、4、8周后,治疗组与对照组组内比较,SSQOL评分均较治疗前明显提高(P0.05);治疗2周、4周、8周后,SSQOL评分组间差异均有统计学意义(P0.05);4.PSQI评分比较:治疗2、4、8周后,治疗组与对照组组内比较,PSQI评分均较治疗前明显降低(P0.05);治疗2周、4周、8周后,PSQI评分组间差异均无统计学意义(P0.05)。结论:综上所述针药并用综合治疗方案对社区肝郁脾虚型卒中后抑郁有明显的改善作用,是治疗肝郁脾虚型卒中后抑郁的有效方法,满足了基层社区治疗肝郁脾虚型卒中后抑郁的需求,故此方案适合在社区推广。
[Abstract]:Objective: to observe the clinical effect of acupuncture and medicine combined with acupuncture and medicine in the treatment of post-stroke depression patients with liver depression and spleen deficiency type in community, and to provide a safe and effective treatment for patients with post-stroke depression with liver depression and spleen deficiency type in community. In order to promote the promotion and application of traditional Chinese medicine in the community. Methods: 86 patients with post-stroke depression (liver depression and spleen deficiency type) were randomly divided into treatment group (n = 43) and control group (n = 43) according to the proportion of 1:1. Both groups were given routine treatment in neurology department, while the control group was given paroxetine hydrochloric acid tablets 20mg/ for the first day, and the patients in the morning were given paroxetine hydrochloric acid tablets in the morning. Treatment group: on the basis of the control group, acupuncture and medicine were added and used, traditional Chinese medicine was given Xiaoyao Powder to add flavor, water decoction, one dose a day, warming in the morning and evening twice, acupuncture and moxibustion were treated with flat tonifying and purging method, leaving needles for 30 min/ times, 4 times a week; The two groups were observed for 8 weeks, and the Hamilton depression scale (HAMD), stroke specialized quality of life scale (SSQOL), Pittsburgh Sleeping quality Index (PSQI) score was compared and the curative effect was evaluated at 0, 2, 4 and 8 weeks of treatment, respectively. Result: 1. Comparison of clinical efficacy: the total effective rate of the treatment group and the control group was 92.50% and 73.17% respectively. The total effective rate of the treatment group was significantly higher than that of the control group. The curative effect of the two groups was statistically significant by rank sum test (P 0.05). 2.HAMD score comparison: 2, 4, 8 weeks after treatment, the HAMD scores of the two groups were significantly lower than those before treatment (P 0.05), after 2 weeks of treatment, there was no significant difference in Hamd score between the two groups (P 0.05). After 4 weeks and 8 weeks of treatment, the differences among Hamd scores were statistically significant (P 0.05). Comparison of 3.SSQOL scores: 2 weeks, 4 weeks, 8 weeks after treatment, the SSQOL scores in the treatment group and the control group were significantly higher than those before treatment (P 0.05), and the Hamd scores in the treatment group were significantly higher than those in the control group after 8 weeks of treatment (P 0.05). After 2 weeks, 4 weeks and 8 weeks of treatment, the difference of SSQOL score group was statistically significant (P 0.05). 4.PSQI score comparison: after 2, 4, 8 weeks, the PSQI score in the treatment group and the control group was significantly lower than that before treatment (P 0.05). After 2 weeks, 4 weeks and 8 weeks of treatment, there was no significant difference in PSQI score (P 0.05). Conclusion: acupuncture and medicine combined with comprehensive treatment can obviously improve post-stroke depression of liver depression and spleen deficiency type in community, and it is an effective method to treat post-stroke depression of liver depression and spleen deficiency type. It meets the needs of grass-roots community in the treatment of post-stroke depression of liver depression and spleen deficiency, so the scheme is suitable for promotion in the community.
【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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