發(fā)布時間：2018-03-26 02:46

  本文選題：腦卒中后抑郁　切入點：睡眠障礙　出處：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的比較卒中單元中西醫(yī)結(jié)合治療與中醫(yī)或西醫(yī)單一治療對卒中后抑郁合并睡眠障礙患者的臨床療效,了解聯(lián)合治療是否等于或優(yōu)于單一治療的效果,探索針對卒中后抑郁合并睡眠障礙患者的最佳卒中單元中西醫(yī)結(jié)合治療方案,為其臨床推廣提供新依據(jù)。方法本研究將180例卒中后抑郁(PSD)合并睡眠障礙的患者運用完全隨機對照設(shè)計分為中西醫(yī)結(jié)合治療組、中醫(yī)治療組、西醫(yī)治療組和對照組,每組45例。四組患者均給予卒中單元常規(guī)治療(卒中單元治療包括藥物對癥治療、語言和肢體康復(fù)治療、心理支持治療、健康宣傳教育等),中醫(yī)治療組加用安神合劑治療,西醫(yī)治療組加用抗抑郁藥物艾司西酞普蘭治療,中西醫(yī)結(jié)合治療組同時加用安神合劑及抗抑郁藥物艾司西酞普蘭治療。治療前、治療第8及24周后分別評定患者的抑郁癥狀(漢密爾頓抑郁量表(HAMD))、患者的睡眠狀態(tài)(匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI))、患者卒中后神經(jīng)功能狀況(美國國立衛(wèi)生研究院卒中量表(NIHSS))、卒中患者的生活能力(Barthel指數(shù)量表)。同時在治療前及治療第24周后用多導(dǎo)睡眠圖(PSG)評估中西醫(yī)結(jié)合治療組及西醫(yī)治療組患者的睡眠狀況。結(jié)果(1)治療前,四組患者HAMD、PSQI、NIHSS、Barthel評分比較,各組間差異無統(tǒng)計學(xué)意義(P0.05);(2)治療第8周后,中西醫(yī)結(jié)合治療組、中醫(yī)治療組、西醫(yī)治療組和對照組HAMD、PSQI、NIHSS、Barthel評分與各組內(nèi)治療前比較,差異均有統(tǒng)計學(xué)意義(均P0.05);治療第24周后,中西醫(yī)結(jié)合治療組、中醫(yī)治療組、西醫(yī)治療組和對照組HAMD、PSQI、NIHSS、Barthel評分與各組內(nèi)治療第8周后、治療前比較,差異均有統(tǒng)計學(xué)意義(均P0.05);(3)治療第8周后中西醫(yī)結(jié)合治療組、中醫(yī)治療組和西醫(yī)治療組HAMD、PSQI、NIHSS、Barthel評分與對照組比較,差異均有統(tǒng)計學(xué)意義(均P0.05);治療第8周后中西醫(yī)結(jié)合治療組HAMD、PSQI、NIHSS、Barthel評分與中醫(yī)治療組、西醫(yī)治療組比較,差異均有統(tǒng)計學(xué)意義(均P0.05);治療第8周后中醫(yī)治療組HAMD、PSQI、NIHSS、Barthel評分與西醫(yī)治療組比較,差異有統(tǒng)計學(xué)意義(P0.05)。(4)治療第24周后中西醫(yī)結(jié)合治療組、中醫(yī)治療組和西醫(yī)治療組HAMD、PSQI、NIHSS、Barthel評分與對照組比較,差異均有統(tǒng)計學(xué)意義(均P0.05);治療第24周后中西醫(yī)結(jié)合治療組HAMD、PSQI、NIHSS、Barthel評分與中醫(yī)治療組、西醫(yī)治療組比較,差異均有統(tǒng)計學(xué)意義(均P0.05);治療第24周后中醫(yī)治療組HAMD、PSQI、NIHSS、Barthel評分與西醫(yī)治療組比較,差異有統(tǒng)計學(xué)意義(P0.05)。(5)在治療前,中西醫(yī)結(jié)合治療組和西醫(yī)治療組患者入睡潛伏期(SL)、總睡眠時間(TST)、覺醒次數(shù)(NW)、睡眠效率(SE)、深睡眠(S3+S4%)、REM睡眠潛伏期(RL)、REM睡眠時間(RT)比較,組間差異無統(tǒng)計學(xué)意義(P0.05);(6)治療第24周后,中西醫(yī)結(jié)合治療組和西醫(yī)治療組患者入睡潛伏期(SL)時間縮短、總睡眠時間(TST)增加、覺醒次數(shù)(NW)減少、睡眠效率(SE)提高、深睡眠(S3+S4%)時間增加、REM睡眠潛伏期(RL)時間縮短、REM睡眠時間(RT)增加,其中兩組患者的上述指標(biāo)與治療前各組內(nèi)比較,差異均有統(tǒng)計學(xué)意義(均P0.05);中西醫(yī)結(jié)合治療組的上述指標(biāo)與西醫(yī)治療組比較,差異有統(tǒng)計學(xué)意義(均P0.05)。結(jié)論卒中單元中西醫(yī)結(jié)合治療對卒中后抑郁合并睡眠障礙患者的抑郁癥狀及睡眠質(zhì)量有顯著改善,有助于卒中患者神經(jīng)功能及日常生活能力的恢復(fù),值得臨床推廣應(yīng)用。
[Abstract]:Objective to compare the Chinese and Western medicine stroke unit combined treatment with traditional Chinese medicine or western medicine treatment on single clinical efficacy in patients with depression with sleep disorder after stroke, to understand whether the combination treatment is equal to or better than single treatment effect, explore the best for post-stroke depression in patients with stroke unit of traditional Chinese medicine and Western medicine combined treatment of sleep disorders, and provide a new basis for its clinical promotion. Methods the 180 cases of post-stroke depression (PSD) patients with sleep disorders using completely randomized design into the combination of traditional Chinese and Western medicine treatment group, Chinese medicine treatment group, western medicine treatment group and control group, 45 cases in each group. Four groups of patients were given routine treatment of stroke unit (including drug therapy in treatment of stroke unit language, and rehabilitation therapy, supportive therapy, health education etc.), Chinese medicine treatment group treated with Anshen mixture, western medicine treatment group were treated with antidepressants Ai Sciplan therapy combined with antidepressant drug and Ai Sciplan Anshen mixture treatment group with combination of TCM and Western medicine. Before treatment and 24 weeks after treatment, eighth patients with depressive symptoms were assessed (Hamilton Depression Scale (HAMD)), in patients with sleep state (Pittsburgh sleep quality index scale (PSQI), neurological function) in patients with post stroke (National Institutes of Health Stroke Scale (NIHSS)), stroke patients life ability (Barthel index). At the same time before and after twenty-fourth weeks treatment by polysomnography (PSG) sleep medicine combined with western medicine treatment group and Western medicine group (results in the assessment of patients with. 1) before treatment, four groups of HAMD, PSQI, NIHSS, Barthel score comparison, no statistically significant difference between the groups (P0.05); (2) after eighth weeks of treatment, the treatment group combined with traditional Chinese medicine and Western medicine, Chinese medicine treatment group, western medicine treatment group and control group HAMD, PSQI, NI HSS, with the Barthel score in each group before treatment, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment, the treatment group combined with traditional Chinese medicine and Western medicine, Chinese medicine treatment group, western medicine treatment group and control group HAMD, PSQI, NIHSS, and Barthel score in each group after eighth weeks of treatment, compared with before treatment, the differences were statistical significance (P0.05); (3) after eighth weeks of treatment with combination of TCM and Western medicine treatment group, TCM treatment group and Western medicine group HAMD, PSQI, NIHSS, Barthel score compared with the control group, the differences were statistically significant (P0.05); after eighth weeks of treatment, combination therapy group HAMD, PSQI, NIHSS. The Barthel score and the Chinese medicine treatment group, compared with the western medicine treatment group, the differences were statistically significant (P0.05); after eighth weeks of treatment, Chinese medicine treatment group HAMD, PSQI, NIHSS, Barthel scores were compared with western medicine treatment group, the difference was statistically significant (P0.05). (4) after twenty-fourth weeks of treatment with combination of TCM and Western medicine treatment The treatment group, TCM treatment group and Western medicine group HAMD, PSQI, NIHSS, Barthel score compared with the control group, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment with combination of TCM and Western medicine treatment group HAMD, PSQI, NIHSS, Barthel score and TCM treatment group, compared with the Western medicine treatment group, the differences were statistically significant (P0.05); after twenty-fourth weeks of treatment, Chinese medicine treatment group HAMD, PSQI, NIHSS, Barthel scores were compared with western medicine treatment group, the difference was statistically significant (P0.05). (5) before treatment, the patients in the treatment group were sleep latency group and Western medicine treatment combining traditional Chinese and Western Medicine (SL), total sleep time (TST), awakening the number (NW), sleep efficiency (SE), deep sleep (S3+S4%), REM sleep latency (RL), REM sleep time (RT), no significant difference between the groups (P0.05); (6) after twenty-fourth weeks of treatment, the patients in the treatment group were sleep latency group and Western medicine treatment combining traditional Chinese and Western Medicine (SL shorten the time, total sleep) Time (TST) increased the number of awakening (NW) reduced sleep efficiency (SE) increased deep sleep time increased (S3+S4%), REM (RL) shorten the sleep latency time, REM sleep time (RT) increased, the index and the two groups of patients before treatment were compared, the differences were statistically significant (all P0.05); these indicators compared with western medicine treatment group in the treatment group of traditional Chinese and Western medicine, the difference was statistically significant (P0.05). Conclusion the stroke unit of Integrated Chinese and Western medicine treatment can significantly improve the depressive symptoms and quality of sleep in patients with depression with sleep disorder after stroke, helps apoplexy nerve function and daily life ability recovery, worthy of clinical application.

【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R749.4

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