本文選題：解郁1號(hào)方 + 失眠　； 參考：《安徽中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:隨著城市化的進(jìn)程,越來(lái)越多的人進(jìn)入了更加快節(jié)奏的生活,伴隨帶來(lái)的是生活和精神上的壓力,抑郁癥在此前提下更加頻繁的侵襲著現(xiàn)代人。抑郁癥是一種以抑郁發(fā)作為特征的心境障礙,是一組臨床綜合征,抑郁發(fā)作的主要臨床癥狀包括心境低落、興趣和愉快感喪失、失眠、思維遲緩、意志活動(dòng)減退和軀體不適等。據(jù)世界衛(wèi)生組織(WHO)預(yù)測(cè),到2020年,抑郁癥將成為僅次于首位缺血性心臟病的第2位致殘疾病。一項(xiàng)流行病學(xué)調(diào)查研究表明西方國(guó)家和我國(guó)抑郁癥的終生患病率分別為13.23%和5.3%,其中患病的女性至少是男性的1.5倍,在我國(guó)近年來(lái)大量的文獻(xiàn)報(bào)告顯示這一比例正在不斷增高。在抑郁狀態(tài)的患者中,有不少患者失眠癥狀表現(xiàn)的尤為突出,長(zhǎng)期的失眠使患者的心理負(fù)擔(dān)更加嚴(yán)重,使抑郁狀態(tài)的其他臨床癥狀加重和增多,其他癥狀的加重與增多反過(guò)來(lái)又進(jìn)一步影響患者入睡,最終形成一種惡性循環(huán)。目的:(1)觀察自擬解郁1號(hào)方聯(lián)合帕羅西汀治療以失眠為主癥的抑郁狀態(tài)的臨床效果;(2)評(píng)價(jià)中藥辨證施治聯(lián)合西藥抗抑郁藥治療以失眠為主癥的抑郁狀態(tài)的可行性,并為中西醫(yī)聯(lián)合治療抑郁癥提供依據(jù)。方法:1.分組:采用隨機(jī)分組法,納入以失眠為主癥的抑郁狀態(tài)患者60例,分為治療組30例,對(duì)照組30例。研究組予以自擬解郁1號(hào)方聯(lián)合帕羅西汀治療,對(duì)照組予以單藥帕羅西汀治療。2.指標(biāo)與療效:治療周期為8周,檢測(cè)治療前和治療后4周、8周兩組患者中醫(yī)癥候積分、漢密爾頓抑郁量表(HAMD)評(píng)分、匹茲堡睡眠質(zhì)量指數(shù)(PSQI)評(píng)分及觀察治療前后安全指標(biāo)的變化。結(jié)果:(1)同期治療前后比較,治療組與對(duì)照組患者治療后4周、8周的中醫(yī)癥候積分、HAMD評(píng)分和PSQI評(píng)分均不同程度的較治療前減低,與治療前相比具有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01)。(2)同期兩組比較,中醫(yī)癥候積分、HAMD評(píng)分和PSQI評(píng)分,與治療前相比無(wú)明顯差異(P㧐0.05);同期兩組比較,治療后4周中醫(yī)癥候積分治療組較對(duì)照組減分更明顯,兩組之間比較具有統(tǒng)計(jì)學(xué)意義(P0.05),HAMD評(píng)分和PSQI評(píng)分治療組較對(duì)照組減分不明顯,比較無(wú)統(tǒng)計(jì)學(xué)意義(P㧐0.05);同期兩組比較,治療后8周,中醫(yī)癥候積分、HAMD評(píng)分和PSQI評(píng)分,治療組均較對(duì)照組減分更明顯,兩組間比較具有明顯差異(P0.05)。(3)同期治療前后比較,中醫(yī)癥候積分、HAMD評(píng)分和PSQI評(píng)分各因子分治療前后比較均有不同程度改善,在治療后8周兩組絕大部分因子分與治療前相比具有統(tǒng)計(jì)學(xué)意義(P0.05或P0.01),治療后4周部分因子分與治療前相比具有統(tǒng)計(jì)學(xué)意義(P0.05),總體而言治療組較對(duì)照組改善更明顯。(4)兩組患者用藥后不良反應(yīng)發(fā)生率治療組較對(duì)照組更低,治療組安全性更高。結(jié)論:對(duì)以失眠為主癥的抑郁狀態(tài)患者的治療,臨床上應(yīng)用SSRI類抗抑郁藥聯(lián)合自擬解郁1號(hào)方治療其臨床療效較單用SSRI類抗抑郁藥更佳且副作用發(fā)生率降低。
[Abstract]:Background: with the process of urbanization, more and more people have entered a more rapid pace of life, accompanied by life and mental pressure, depression in this premise more frequent invasion of modern people. Depression is a kind of mood disorder characterized by depression, which is a group of clinical syndrome. The main clinical symptoms of depression include depression, loss of interest and pleasure, insomnia, mental retardation, decreased mental activity and physical discomfort. According to the World Health Organization (WHO), depression will become the second most disabled disease by 2020, second only to ischemic heart disease. An epidemiological study shows that the lifetime prevalence of depression in western countries and China is 13.23% and 5.3% respectively, in which women are at least 1.5 times as sick as men. In recent years, a large number of literature reports in China show that the proportion of depression is increasing. Among the patients with depressive state, many of them have especially prominent symptoms of insomnia. Long-term insomnia makes the psychological burden of the patients more serious, and other clinical symptoms of the state of depression are aggravated and increased. The exacerbation and increase of other symptoms, in turn, further affect the patient's sleep, and ultimately form a vicious circle. Objective to observe the clinical effect of Jieyu No. 1 prescription combined with paroxetine in the treatment of depressive state with insomnia. And provides the basis for the treatment of depression by the combination of traditional Chinese and western medicine. Method 1: 1. Group: 60 depressive patients with insomnia were randomly divided into treatment group (n = 30) and control group (n = 30). The study group was treated with Jieyu No. 1 prescription combined with paroxetine, while the control group was treated with paroxetine alone. Indexes and efficacy: the treatment cycle was 8 weeks. The scores of TCM symptoms, Hamilton Depression scale (Hamd), Pittsburgh Sleep quality Index (PSQI), and the changes of safety indexes before and after treatment were measured. Results compared with control group before and after treatment, the scores of TCM symptom scores, Hamd and PSQI in the treatment group and the control group were decreased in different degrees after 4 weeks and 8 weeks of treatment. There was no significant difference in TCM symptom score and PSQI score between the two groups in the same period compared with before treatment (P0.05 or P0.01U. 2) compared with before treatment, there was no significant difference between the two groups in the same period, and in the same period, there was no significant difference between the two groups. Four weeks after treatment, the score of TCM symptom score in the treatment group was significantly higher than that in the control group, and there was no significant difference between the two groups in P0.05 Hamd score and PSQI score, but there was no significant difference between the two groups. At 8 weeks after treatment, the scores of Hamd and PSQI of TCM symptoms were significantly lower in the treatment group than in the control group, and there was a significant difference between the two groups before and after treatment. The scores of TCM symptom scores and scores of Hamd and PSQI were improved to some extent before and after treatment. At 8 weeks after treatment, most of the factor scores in the two groups were statistically significant compared with those before treatment (P0.05 or P0.01), and at the 4th week after treatment, part of the factor scores were statistically significant compared with those before treatment. Overall, the improvement of the treatment group was more obvious than that of the control group. The incidence of adverse reactions in the treatment group was lower than that in the control group. The safety of the treatment group was higher. Conclusion: the clinical effect of SSRI combined with Jieyu No. 1 is better than that of SSRI antidepressant alone and the incidence of side effects is lower than that of SSRI antidepressant alone.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R749.4

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