本文選題：缺血性中風　切入點：焦慮抑郁共病　出處：《河南中醫(yī)學院》2014年碩士論文

【摘要】：目的：本研究是在甜夢口服液既往臨床應用和研究的基礎上，通過觀察患者漢密爾頓焦慮量表(14項HAMAl4)、漢密爾頓抑郁量表(17項HAMDl7）、神經(jīng)功能缺損評分（NIHSS)、中醫(yī)癥候評分等指標的變化，來全面客觀地評價甜夢口服液聯(lián)合帕羅西汀治療缺血性中風后焦慮抑郁共�。I虛證）的臨床療效，為甜夢口服液在臨床中進一步擴大應用奠定基礎。 方法：采取隨機對照的設計方法，選取符合缺血性中風后焦慮抑郁共病（腎虛證）診斷標準，并且發(fā)病后無意識障礙、嚴重失語、構音障礙等影響臨床評價的60例患者，采用隨機數(shù)字表的方法隨機分配為治療組和對照組各30例，各組患者均在按2010版《中國腦血管病防治指南》給予標準二級預防基礎上，治療組給予甜夢口服液聯(lián)合帕羅西汀，對照組給予帕羅西汀，療程4周，甜夢口服液（每日2次，20ml/次），帕羅西汀（每日1次，，20mg/次）。在治療前、治療后分別對受試者進行漢密爾頓焦慮量表(14項HAMAl4)、漢密爾頓抑郁量表(17項HAMDl7)、神經(jīng)功能缺損量表（NIHSS)評估以及中醫(yī)癥候評分,試驗前、試驗結束時分別檢測ALT、AST、BUN、Cr，觀察患者不良反應并及時進行記錄。數(shù)據(jù)采用Spss17.0進行統(tǒng)計分析。 結果：兩組病人在性別、年齡、民族、文化程度、病程、伴隨疾病等基線方面具備可比性（P0.05）。4個方面療效指標結果如下： 1HAMA和HAMD量表積分：①治療前兩組HAMA和HAMD量表評分情況比較，統(tǒng)計學處理無顯著性差異（P0.05）；②兩組治療前后組內(nèi)比較，統(tǒng)計學處理（P0.05），有顯著性差異，提示兩組均能改善HAMA和HAMD量表積分；③治療后兩組組間比較，統(tǒng)計學處理有顯著性差異（P0.05）提示甜夢口服液聯(lián)合帕羅西汀能夠更有效的改善HAMA和HAMD量表積分。 2中醫(yī)癥候積分：①治療前兩組中醫(yī)癥候積分組間比較，統(tǒng)計學處理無顯著性差異（P0.05）；②治療組治療前后組內(nèi)比較（P0.05），對照組治療前后組內(nèi)比較（P0.05）；③治療后兩組組間比較，統(tǒng)計學處理有顯著性差異（P0.05），提示甜夢口服液能夠有效的改善中醫(yī)癥候。 3神經(jīng)功能缺損積分：①治療前兩組NIHSS量表積分比較，無顯著性差異（P0.05)；②兩組治療前后組內(nèi)比較，統(tǒng)計學處理（P0.05），有顯著性差異，提示兩組均能促進神經(jīng)功能康復；③治療后兩組組間比較，統(tǒng)計學處理有顯著性差異(P0.05)，提示甜夢口服液聯(lián)合帕羅西汀能夠更有效促進患者神經(jīng)功能康復。 4治療期間治療組和對照組未見嚴重不良反應。 結論：甜夢口服液聯(lián)合帕羅西汀能夠更有效的改善缺血性中風后焦慮抑郁共病患者的臨床癥狀和中醫(yī)腎虛證癥候，促進神經(jīng)功能的康復，臨床用之安全有效。
[Abstract]:Objective: on the basis of previous clinical application and study of Tianmeng Oral liquid, the changes of 14 items of Hamilton anxiety scale (Hamilton anxiety scale), 17 items of Hamilton Depression scale (Hamilton Depression scale), 17 items of HAMDL 7s, neurological impairment score (NIH) and TCM symptom score (TCM) were observed. Objective to evaluate the clinical efficacy of Tianmeng oral liquid combined with paroxetine in the treatment of post-ischemic apoplectic anxiety and depression syndromes (kidney deficiency syndrome), and lay a foundation for the further application of Tianmeng oral liquid in clinical practice. Methods: a randomized controlled design was used to select 60 patients who met the diagnostic criteria of post-ischemic anxiety and depression syndromes (kidney deficiency syndrome), and who were affected by the clinical evaluation, such as unconscious disorder, severe aphasia, dysarthria and so on. The patients in each group were randomly assigned into treatment group (n = 30) and control group (n = 30). All patients in each group were treated with Tianmeng oral liquid combined with paroxetine on the basis of standard secondary prevention and treatment according to the 2010 edition of China guidelines for the Prevention and treatment of Cerebrovascular Disease. The control group was given paroxetine for 4 weeks, sweet dream oral liquid (20 ml / d) and paroxetine (20 mg / d). After treatment, 14 items of Hamilton anxiety scale (Hamilton anxiety scale), 17 items of Hamilton Depression scale (Hamd), 17 items of Hamilton Depression scale (Hamilton Depression scale) and NIHSSs were evaluated, and the scores of TCM symptoms were evaluated. At the end of the trial, the patients were detected for alt ASTX bun Cr3, and the adverse reactions were observed and recorded in time. The data were analyzed by Spss17.0. Results: the baseline of sex, age, nationality, education, course of disease and concomitant disease were comparable between the two groups (P < 0.05). The results were as follows:. Before the treatment of 1HAMA and HAMD, there was no significant difference in the scores of HAMA and HAMD between the two groups. There was no significant difference between the two groups before and after treatment, and there was a significant difference between the two groups before and after treatment, and there was significant difference between the two groups before and after treatment, and there was a significant difference between the two groups before and after treatment. It was suggested that both groups could improve the scores of HAMA and HAMD after treatment with HAMA and HAMD. There was a significant difference between the two groups (P 0.05). It suggested that Tianmeng Oral liquid combined with paroxetine could improve the scores of HAMA and HAMD more effectively. (2) there was no significant difference between the two groups before and after the treatment of TCM symptom integral. There was no significant difference between the two groups before and after treatment, and there was no significant difference between the two groups before and after treatment in the control group, and there was no significant difference between the two groups before and after treatment in the control group, and there was no significant difference between the two groups before and after treatment in the control group, and there was no significant difference between the two groups before and after treatment. Statistical analysis showed significant difference (P 0.05), suggesting that Tianmeng Oral liquid could effectively improve the symptoms of traditional Chinese Medicine (TCM). 3 there was no significant difference in the scores of NIHSS scale between the two groups before and after the treatment of neurologic impairment score: there was no significant difference. There was significant difference between the two groups before and after treatment, and there was a significant difference between the two groups before and after treatment (P 0.05), and there was a significant difference between the two groups before and after treatment. It was suggested that the two groups could promote the rehabilitation of nerve function. There was a significant difference between the two groups after treatment. It suggested that the combination of Tianmeng oral liquid and paroxetine could promote the recovery of nerve function of the patients more effectively. 4 there were no serious adverse reactions in the treatment group and the control group during the treatment period. Conclusion: the combination of Tianmeng oral liquid and paroxetine can effectively improve the clinical symptoms and kidney deficiency syndrome of patients with post-ischemic apoplectic anxiety and depression syndromes, promote the recovery of nerve function, and be safe and effective in clinical use.
【學位授予單位】：河南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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