發(fā)布時間：2018-05-12 06:19

  本文選題：帕金森病 + 焦慮抑郁�。� 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 帕金森�。≒D）伴焦慮抑郁狀態(tài)是神經(jīng)內(nèi)科門診一類常見的心身疾病，發(fā)病率高達(dá)40%至50%。是PD患者近年來逐漸受到關(guān)注的的非運(yùn)動性癥狀之一。過去人們將認(rèn)識和治療PD的焦點(diǎn)都集中到了靜止性震顫、肌強(qiáng)直、運(yùn)動遲緩、姿勢步態(tài)異常等運(yùn)動功能損害上，忽略了PD伴焦慮抑郁狀態(tài)的存在。事實(shí)上，焦慮抑郁等情緒障礙使PD患者生活及生存質(zhì)量嚴(yán)重下降。近年來隨著醫(yī)學(xué)模式的轉(zhuǎn)變，國內(nèi)外許多醫(yī)生及學(xué)者開始研究PD患者的情緒障礙，取得了豐碩的成果。研究發(fā)現(xiàn)PD伴焦慮抑郁狀態(tài)的患者是受遺傳、環(huán)境及社會因素多重作用的結(jié)果；發(fā)病機(jī)制與神經(jīng)系統(tǒng)退化、神經(jīng)內(nèi)分泌紊亂、免疫應(yīng)答機(jī)制、神經(jīng)毒物損害、社會心理反應(yīng)等有關(guān)，具體的發(fā)病機(jī)制仍不清楚。診斷上主要依靠于患者的臨床癥狀表現(xiàn)及醫(yī)生的經(jīng)驗(yàn)水平，尚無特征性的客觀指標(biāo)可以明確支持診斷。治療上主要運(yùn)用抗焦慮抑郁藥物治療，兼顧抗帕金森病治療，主要藥物有多巴胺替代療法、多巴胺受體激動劑、新型抗抑郁藥氟西汀、米氮平等，治療效果尚可，但同時也存在一定程度的副作用及停藥反跳現(xiàn)象。中醫(yī)學(xué)認(rèn)為該病是“顫證”和“郁證”的共病，其中的因果關(guān)系尚不明確。主要病變部位在肝、腎，與心、脾有關(guān)，主要病理因素為肝風(fēng)內(nèi)動。治療上多遵循補(bǔ)腎填精、活血養(yǎng)肝、柔肝熄風(fēng)等治法，療效顯著。雖然近年來國內(nèi)外有關(guān)PD伴焦慮抑郁狀態(tài)的研究報道有所增多，但仍然相對缺乏，不足以有效指導(dǎo)臨床工作。本研究采用自擬健脾益腎活血方聯(lián)合鹽酸帕羅西汀來治療PD伴焦慮抑郁狀態(tài)（脾腎兩虛證）患者，并對治療的效果進(jìn)行研究和闡述，探討本病治療的新途徑。 方法： 本研究對2012年9月至2013年12月間就診于河北省中醫(yī)院的70名PD伴焦慮抑郁狀態(tài)（脾腎兩虛證）的患者進(jìn)行隨機(jī)對照臨床試驗(yàn)，采用隨機(jī)數(shù)字表法將患者隨機(jī)分組，分為研究組和對照組各35例。兩組均給予抗帕金森基礎(chǔ)藥物進(jìn)行治療，兩組患者性別、年齡、病情嚴(yán)重程度、抑郁程度等具有可比性。研究組加服健脾益腎活血方（可隨癥加減），每日一劑，分兩次服和鹽酸帕羅西汀片，20mg早飯后頓服，1/日；對照組只加服鹽酸帕羅西汀片，20mg早飯后頓服，1/日。規(guī)定8周為一個療程。使用三大量表進(jìn)行評分，即運(yùn)用帕金森病癥狀嚴(yán)重程度評定量表（UPDRS）、漢密爾頓抑郁量表(HAMD)及漢密爾頓焦慮量表(HAMA)對患者在治療前、4周末、8周末的病情分別進(jìn)行評分，通過減分率計算治療的有效率，觀察患者UPDRS、 HAMD、 HAMA評分變化、有效率及副作用發(fā)生率情況。 結(jié)果： 1研究觀察結(jié)果顯示研究組和對照組的帕金森病癥狀嚴(yán)重程度評定量表（UPDRS）評分、漢密爾頓抑郁量表(HAMD)評分和漢密爾頓焦慮量表(HAMA)評分均較前有所下降，差異有統(tǒng)計學(xué)意義（P0.05）； 2研究組按照UPDRS量表、HAMD量表和HAMA量表評分減分率計算所得的有效率（評分減分率30%）高于對照組的有效率，差異有統(tǒng)計學(xué)意義（P0.05）； 3研究組和對照組所用的不同治法在治療后的不同時間點(diǎn)間存在交互作用，差異有統(tǒng)計學(xué)意義（P0.05）；即研究組與對照組在治療后4周、8周UPDRS評分、HAMD評分和HAMA評分下降幅度不同，中西藥組各量表評分結(jié)果的改善幅度顯著優(yōu)于單純西藥組。 4治療組4周后的各量表評分下降幅度與對照組8周后的下降幅度接近，，沒有統(tǒng)計學(xué)意義（P0.05）。提示中西藥治療PD伴發(fā)焦慮抑郁起效較西藥組治療快。 5兩組患者治療前后常規(guī)檢查（血尿常規(guī)、生化常規(guī)、心電圖等）均無明顯異常。在本次研究中，研究組不良反應(yīng)未出現(xiàn)，而對照組出現(xiàn)頭暈、惡心，食欲減退、失眠及興奮的患者有6例(17.1%)。 結(jié)論： 運(yùn)用自擬的健脾益腎活血方聯(lián)合鹽酸帕羅西汀治療PD伴焦慮抑郁狀態(tài)患者（脾腎兩虛證）有效，尤其在改善PD患者焦慮抑郁情緒、提高生活質(zhì)量及減少藥物副作用方面作用明顯，可降低患者抗帕金森藥物的用量，起效快，作用持久且安全。
[Abstract]:Objective:
Parkinson's disease (PD) with anxiety and depression is one of the most common psychosomatic diseases in the outpatient department of Neurology. The incidence of up to 40% to 50%. is one of the non motor symptoms of attention in the PD patients in recent years. In the past, the focus of understanding and treatment of PD was concentrated on static tremor, myotonic, slow motion, and abnormal gait. The impairment of dynamic function neglects the existence of PD with anxiety and depression. In fact, anxiety and depression and other emotional disorders have caused serious decline in the quality of life and life of PD patients. In recent years, many doctors and scholars at home and abroad have begun to study the emotional disorders of PD patients with the change of medical models. The study found that PD accompanied with anxiety. The patients with depression are the result of multiple effects of genetic, environmental and social factors. The pathogenesis is related to the degeneration of the nervous system, the neuroendocrine disorder, the immune response mechanism, the neurotoxic damage, the social psychological reaction and so on. The specific pathogenesis is still unclear. The diagnosis depends mainly on the clinical symptoms of the patients and the doctor's Classics. The main use of antidepressant therapy and anti Parkinson disease treatment, dopamine replacement therapy, dopamine receptor agonist, new antidepressant fluoxetine, Mi Danping, and so on, can be used in the treatment. Traditional Chinese medicine thinks that the disease is a common disease of "tremor syndrome" and "qi stagnation". The causality of the disease is not clear. The main lesions are related to the liver, kidney, heart and spleen, and the main pathological factors are the internal movement of the liver. The treatment is mostly followed by the treatment of Tonifying the kidney, activating blood and liver, suppressing the liver and extinguishing the wind, although the curative effect is remarkable in recent years. Although the curative effect is remarkable, although the curative effect is remarkable in recent years, the curative effect is remarkable although the curative effect is remarkable. Although the curative effect is remarkable in recent years. Although the curative effect is remarkable, although the curative effect is remarkable in recent years The research reports on the state of PD with anxiety and depression at home and abroad have increased, but still relatively lack, not enough to effectively guide the clinical work. This study used self-made invigorating spleen and kidney activating blood recipe combined with Pa Rossi Dean hydrochloric acid to treat PD with anxiety and depression (spleen and kidney two deficiency syndrome), and the effect of treatment was discussed and discussed. A new approach to treatment of disease.
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本文編號：1877470