調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幉⒂弥委熌X卒中后抑郁的臨床研究
發(fā)布時間：2018-07-25 17:50
【摘要】：卒中后抑郁(post-stroke depression, PSD)是腦卒中常見的并發(fā)癥以及卒中患者最主要的自殺原因之一,嚴重影響了患者及其家人的生活質(zhì)量。因其沒有特殊癥狀,也沒有特異的生物學(xué)指標(biāo),加之有些患者存在語言障礙或智能障礙,抑郁癥狀不能被檢出,易致漏診。因此,卒中后抑郁的早期發(fā)現(xiàn)與早期治療可以明顯改善卒中患者的預(yù)后和生活質(zhì)量。 目前抗抑郁西藥治療存在起效慢、療程長、副作用大、患者依從性差、價格昂貴等問題,嚴重影響了治療的依從性。中醫(yī)藥治療對本病的治療和延緩病勢發(fā)生發(fā)展具有明顯的優(yōu)勢,因此探究一種有效的中醫(yī)藥治療方法具有重要意義。 本研究通過查閱文獻,以頻數(shù)分布歸納出卒中后抑郁患者最常見的十個中醫(yī)癥狀：情緒低落、興趣減低、全身疲乏感、睡眠障礙、煩躁、頭暈、食欲減退、腰膝酸軟、畏寒肢冷、小便清長,依其癥狀無、輕、中、重的程度不同,分別賦予相應(yīng)分值,制定卒中后抑郁中醫(yī)癥狀評分量表。同時從抑郁、睡眠、神經(jīng)功能缺損等方面進行量表評定,綜合探討中醫(yī)藥治療卒中后抑郁的療效。 [目的]通過中醫(yī)癥狀量表及抑郁、睡眠、神經(jīng)功能缺損等方面的相關(guān)量表評定,綜合探討中醫(yī)藥治療卒中后抑郁的療效。 [方法]采用隨機數(shù)字表將2012年9月至2014年1月期間美國洛杉磯地區(qū)Eastern Medicine診所及北京中醫(yī)藥大學(xué)東方醫(yī)院就診的卒中后抑郁患者隨機分為治療組和對照組,每組各30例患者。兩組均給予腦血管病二級預(yù)防治療及根據(jù)病情在醫(yī)師指導(dǎo)下的抗抑郁藥物治療,治療組患者以調(diào)肝扶脾、化痰通絡(luò)為法,采用針灸+中藥治療,治療周期為8周。對比2組患者入組時、治療2周、4周、8周中醫(yī)癥狀量表、漢密爾頓抑郁量表、美國國立衛(wèi)生院卒中量表、日常生活能力量表、匹茲堡睡眠量表、改良的Rankin量表(mRS)評分,結(jié)合不同時點的相關(guān)量表分值變化及量表分值之間的相關(guān)性研究,多層面探討中醫(yī)藥治療卒中后抑郁的療效,為中醫(yī)藥治療卒中后抑郁提供新思路。 [結(jié)果] 1、一般資料 60例患者中,男性27例占45%；女性33例占55%,女性發(fā)病率高于男性；吸煙者占48.3%；飲酒者占33.3%；高血壓病發(fā)病率較高,其次為血脂異常和糖尿病。 患者年齡、性別、文化程度、煙酒史及既往病史經(jīng)卡方檢驗提示無統(tǒng)計學(xué)差異(P0.05),具有可比性。 2、評價量表與漢密爾頓抑郁量表(HAMD)的相關(guān)性 通過對2組不同時點中醫(yī)癥狀量表、NIHSS量表、ADL評分、MRS評分及匹茲堡睡眠量表(PSQI)與HAMD量表分值行秩相關(guān)檢驗,結(jié)果提示2組各時點中醫(yī)癥狀分值與HAMD分值有相關(guān)性(P0.05)；對照組4個時點HAMD分值與NIHSS分值具有相關(guān)性(P0.05)；對照組4個時點HAMD分值與ADL分值具有相關(guān)性(P0.05)；對照組治療前后HAMD分值與MRS分值具有相關(guān)性(P0.05),；2組各時點PSQI分值與HAMD分值有相關(guān)性(P0.05)。該結(jié)果一方面說明了中醫(yī)癥狀量表及匹茲堡睡眠量表與HAMD量表從抑郁癥狀評價上的一致性,引發(fā)我們多角度出發(fā)探究針?biāo)幉⒂弥委煼椒ǖ挠行?同時也提示我們卒中后患者的抑郁程度狀與神經(jīng)功能缺損程度、患者日常生活能力及預(yù)后有相關(guān)性,引發(fā)我們早期積極干預(yù)卒中后抑郁的癥狀,從而加強肢體功能的康復(fù)。 3、2組治療前后各量表分值變化 從抑郁、睡眠、神經(jīng)功能缺損等方面進行量表評定,綜合探討調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幉⒂弥委熥渲泻笠钟舻寞熜�。研究結(jié)果表明治療組治療前后中醫(yī)癥狀分值、HAMD分值、NIHSS分值、ADL分值、匹茲堡睡眠量表分值有統(tǒng)計學(xué)差異(P0.05),且治療8周與入組時、2周、4周三個時點分值比較有明顯差異；治療組和對照組治療前后MRS有統(tǒng)計學(xué)差異(P0.05)。提示調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幉⒂每蓮囊钟舭Y狀的改善、睡眠質(zhì)量、神經(jīng)功能缺損、提高患者生活質(zhì)量及預(yù)后等方面起到一定療效。 4、實驗室檢查 治療組和對照組治療前后總膽固醇、甘油三酯水平有所下降,有統(tǒng)計學(xué)差異(P0.05)；對照組治療前后及治療8周與治療組高密度脂蛋白比較有統(tǒng)計學(xué)差異(P0.05)；治療組和對照組治療前后低密度脂蛋白有所下降,有統(tǒng)計學(xué)差異(P0.05)；2組患者入組時與治療8周空腹血糖水平無差異(P0.05)。一方面考慮患者經(jīng)腦血管病二級預(yù)防后血脂情況有所改善,還初步證實調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幉⒂弥委煂颊哐把菬o負性影響。 5、不良事件 總結(jié)針?biāo)幉⒂弥委煶Ｒ姷牟涣际录何改c道癥狀、皮膚過敏、咽喉腫痛、頭暈頭痛及心慌胸悶,觀察發(fā)現(xiàn)調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幉⒂弥委熥渲泻笠钟綦m少數(shù)患者有不良事件,但癥狀較輕,不影響繼續(xù)治療,且未出現(xiàn)危及生命的癥狀。2組對比無差異(P0.05)。 6、藥物加減情況 對比治療前后患者藥物(藥量和服藥數(shù)目)加減情況,卡方檢驗提示2組有差異(P0.05)。 [結(jié)論] 1、卒中后患者的抑郁程度與神經(jīng)功能缺損程度、患者日常生活能力及預(yù)后有相關(guān)性,中醫(yī)癥狀量表和匹茲堡睡眠量表可以從抑郁常見伴隨癥狀及睡眠方面判定患者的抑郁癥狀,與HAMD量表評價有相關(guān)性。 2、調(diào)肝扶脾、化痰通絡(luò)法針?biāo)幙筛纳苹颊叩囊钟舭Y狀、睡眠質(zhì)量、神經(jīng)功能缺損、患者生活質(zhì)量及預(yù)后,臨床應(yīng)用安全有效。
[Abstract]:Post stroke depression (post-stroke depression, PSD) is one of the common complications of stroke and one of the most important suicidal causes of stroke patients. It seriously affects the quality of life of the patients and their families. There are no special symptoms, no specific biological indicators, and some patients have language disorders or mental disorders, and depression symptoms are not. Early detection and early treatment of post stroke depression can significantly improve the prognosis and quality of life of stroke patients.
At present, antidepressant western medicine has slow onset, long treatment process, large side effects, poor compliance and high price, which seriously affect the compliance of the treatment. Chinese medicine treatment has obvious advantages to the treatment of this disease and the development of the disease. Therefore, it is of great significance to explore an effective treatment method of traditional Chinese medicine.
Through the literature review, this study summed up the ten most common TCM symptoms of post-stroke depression: depression, low interest, fatigue, sleep disorder, irritability, dizziness, anorexia, low back and knee, cold limbs, and the length of urine, according to the symptoms of no, light, medium and heavy, the corresponding score was given, respectively. The scale of TCM symptom score of post stroke depression was set, and the scale of depression, sleep and nerve function defect was evaluated, and the curative effect of traditional Chinese medicine on post-stroke depression was discussed.
[Objective] to evaluate the efficacy of Chinese medicine in the treatment of post-stroke depression by TCM symptom scale, depression, sleep and neurological impairment.
[Methods] a random digital table was used to randomly divide the patients with post stroke depression in the Eastern Medicine clinic in Losangeles and the Eastern Hospital of Beijing University of Chinese Medicine from September 2012 to January 2014. The patients were randomly divided into the treatment group and the control group, with 30 patients in each group. The two groups were given the two stage prevention and treatment of cerebrovascular disease and according to the doctor's condition. The treatment group was treated with antidepressant medicine, the treatment group was treated with the liver and the spleen, the phlegm and the collaterals were used as the method, the treatment cycle was 8 weeks with Acupuncture plus Chinese medicine. Compared with the 2 groups, the symptom scale of traditional Chinese medicine, the Hamilton depression scale, the national health hospital stroke scale, the daily living capacity scale, the Pittsburgh sleep scale, were compared for the 2 groups. The improved Rankin scale (mRS) score, combined with the correlation between the variation of the correlation scale and the scale of the different points, was used to study the curative effect of Chinese medicine in the treatment of post stroke depression, and to provide a new idea for the treatment of post stroke depression.
[results]
1, general information
Among the 60 patients, 27 were male, 33 were women, 55% were women, women were higher than men, smokers accounted for 48.3%, drinkers accounted for 33.3%, hypertension was higher, followed by dyslipidemia and diabetes.
There was no statistical difference in age, sex, education level, history of smoking and drinking and past medical history by chi square test (P0.05).
2, the correlation between the rating scale and the Hamilton Depression Scale (HAMD).
Through 2 groups of different symptoms of TCM symptom scale, NIHSS scale, ADL score, MRS score and Pittsburgh Sleep Scale (PSQI) and HAMD scale line rank correlation test, the results suggested that the scores of TCM symptoms were correlated with HAMD scores at each time point of the 2 groups (P0.05), and the 4 time points in the control group were correlated with the NIHSS score (P0.05), and the control group was 4. There was a correlation between the time point HAMD score and the ADL score (P0.05); the HAMD score and the MRS score of the control group were correlated (P0.05) before and after treatment, and the PSQI score of the 2 groups at each time point was correlated with the HAMD score (P0.05). The results showed the consistency of the TCM symptom scale and the Pittsburgh sleep sleep scale and the HAMD scale on the depressive symptoms evaluation. At the same time, it also suggests that the degree of depression in the patients after stroke is associated with the degree of nerve function defect, the patient's daily life ability and prognosis, which causes us to actively intervene in the symptoms of post stroke depression and strengthen the rehabilitation of limb function.
Changes of the scale of each scale in group 3,2 before and after treatment
According to the scale of depression, sleep and nerve function defect, the effect of regulating liver and helping spleen, removing phlegm and dredging collaterals and treating post stroke depression was synthetically discussed. The results showed that the score of TCM symptoms, HAMD score, NIHSS score, ADL score, and Pittsburgh sleep scale were statistically different (P0.05) before and after treatment (P0.05), and the treatment was treated. There were significant differences between the 8 weeks and the 8 weeks, 2 weeks and 4 Wednesday points. There were statistical differences between the treatment group and the control group before and after treatment (P0.05). It suggested that the treatment of the liver and the spleen, the method of eliminating phlegm and dredging collaterals can improve the depression, the quality of sleep, the nerve function defect, the quality of life and the prognosis of the patients.
4, laboratory examination
In the treatment group and the control group, the total cholesterol and triglyceride levels decreased before and after the treatment (P0.05), and the high density lipoprotein (HDL) in the control group and the treatment group before and after treatment and the treatment 8 weeks were statistically different (P0.05); the low density lipoprotein in the treatment group and the control group decreased, and there were statistical differences (P0.05); the 2 groups were statistically different. There was no difference in the level of fasting blood glucose between the patients and the 8 weeks (P0.05). On the one hand, the improvement of blood lipid in patients with cerebrovascular disease two was considered, and it was also preliminarily confirmed that the liver and the spleen, the method of eliminating phlegm and dredging collaterals and the treatment had no negative effect on blood lipid and blood sugar.
5, adverse events
The common adverse events were summarized as follows: gastrointestinal symptoms, skin allergies, sore throat and sore throat, dizziness and headache and palpitation and chest tightness. It was observed that the liver and the spleen, the method of eliminating phlegm and collaterals were used in the treatment of post stroke depression, although a few patients had adverse events, but the symptoms were light and did not affect the continued treatment, and there was no life threatening symptom.2 group. There is no difference in contrast (P0.05).
6, drug addition and reduction
The drug dosage and dosage were compared before and after treatment. Chi square test showed that there was a difference between the 2 groups (P0.05).
[Conclusion]
1, the degree of depression after stroke was correlated with the degree of nerve function defect, the patient's daily living ability and prognosis. The TCM symptom scale and the Pittsburgh sleep scale could determine the depressive symptoms of the patients from the common concomitant symptoms and sleep of depression, which were related to the HAMD scale evaluation.
2, regulating liver and helping spleen, removing phlegm and dredging collaterals can improve the patient's depressive symptoms, sleep quality, nerve function defect, the quality of life and prognosis of the patients, and the clinical application is safe and effective.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R743.3
本文編號：2144574
[Abstract]:Post stroke depression (post-stroke depression, PSD) is one of the common complications of stroke and one of the most important suicidal causes of stroke patients. It seriously affects the quality of life of the patients and their families. There are no special symptoms, no specific biological indicators, and some patients have language disorders or mental disorders, and depression symptoms are not. Early detection and early treatment of post stroke depression can significantly improve the prognosis and quality of life of stroke patients.
At present, antidepressant western medicine has slow onset, long treatment process, large side effects, poor compliance and high price, which seriously affect the compliance of the treatment. Chinese medicine treatment has obvious advantages to the treatment of this disease and the development of the disease. Therefore, it is of great significance to explore an effective treatment method of traditional Chinese medicine.
Through the literature review, this study summed up the ten most common TCM symptoms of post-stroke depression: depression, low interest, fatigue, sleep disorder, irritability, dizziness, anorexia, low back and knee, cold limbs, and the length of urine, according to the symptoms of no, light, medium and heavy, the corresponding score was given, respectively. The scale of TCM symptom score of post stroke depression was set, and the scale of depression, sleep and nerve function defect was evaluated, and the curative effect of traditional Chinese medicine on post-stroke depression was discussed.
[Objective] to evaluate the efficacy of Chinese medicine in the treatment of post-stroke depression by TCM symptom scale, depression, sleep and neurological impairment.
[Methods] a random digital table was used to randomly divide the patients with post stroke depression in the Eastern Medicine clinic in Losangeles and the Eastern Hospital of Beijing University of Chinese Medicine from September 2012 to January 2014. The patients were randomly divided into the treatment group and the control group, with 30 patients in each group. The two groups were given the two stage prevention and treatment of cerebrovascular disease and according to the doctor's condition. The treatment group was treated with antidepressant medicine, the treatment group was treated with the liver and the spleen, the phlegm and the collaterals were used as the method, the treatment cycle was 8 weeks with Acupuncture plus Chinese medicine. Compared with the 2 groups, the symptom scale of traditional Chinese medicine, the Hamilton depression scale, the national health hospital stroke scale, the daily living capacity scale, the Pittsburgh sleep scale, were compared for the 2 groups. The improved Rankin scale (mRS) score, combined with the correlation between the variation of the correlation scale and the scale of the different points, was used to study the curative effect of Chinese medicine in the treatment of post stroke depression, and to provide a new idea for the treatment of post stroke depression.
[results]
1, general information
Among the 60 patients, 27 were male, 33 were women, 55% were women, women were higher than men, smokers accounted for 48.3%, drinkers accounted for 33.3%, hypertension was higher, followed by dyslipidemia and diabetes.
There was no statistical difference in age, sex, education level, history of smoking and drinking and past medical history by chi square test (P0.05).
2, the correlation between the rating scale and the Hamilton Depression Scale (HAMD).
Through 2 groups of different symptoms of TCM symptom scale, NIHSS scale, ADL score, MRS score and Pittsburgh Sleep Scale (PSQI) and HAMD scale line rank correlation test, the results suggested that the scores of TCM symptoms were correlated with HAMD scores at each time point of the 2 groups (P0.05), and the 4 time points in the control group were correlated with the NIHSS score (P0.05), and the control group was 4. There was a correlation between the time point HAMD score and the ADL score (P0.05); the HAMD score and the MRS score of the control group were correlated (P0.05) before and after treatment, and the PSQI score of the 2 groups at each time point was correlated with the HAMD score (P0.05). The results showed the consistency of the TCM symptom scale and the Pittsburgh sleep sleep scale and the HAMD scale on the depressive symptoms evaluation. At the same time, it also suggests that the degree of depression in the patients after stroke is associated with the degree of nerve function defect, the patient's daily life ability and prognosis, which causes us to actively intervene in the symptoms of post stroke depression and strengthen the rehabilitation of limb function.
Changes of the scale of each scale in group 3,2 before and after treatment
According to the scale of depression, sleep and nerve function defect, the effect of regulating liver and helping spleen, removing phlegm and dredging collaterals and treating post stroke depression was synthetically discussed. The results showed that the score of TCM symptoms, HAMD score, NIHSS score, ADL score, and Pittsburgh sleep scale were statistically different (P0.05) before and after treatment (P0.05), and the treatment was treated. There were significant differences between the 8 weeks and the 8 weeks, 2 weeks and 4 Wednesday points. There were statistical differences between the treatment group and the control group before and after treatment (P0.05). It suggested that the treatment of the liver and the spleen, the method of eliminating phlegm and dredging collaterals can improve the depression, the quality of sleep, the nerve function defect, the quality of life and the prognosis of the patients.
4, laboratory examination
In the treatment group and the control group, the total cholesterol and triglyceride levels decreased before and after the treatment (P0.05), and the high density lipoprotein (HDL) in the control group and the treatment group before and after treatment and the treatment 8 weeks were statistically different (P0.05); the low density lipoprotein in the treatment group and the control group decreased, and there were statistical differences (P0.05); the 2 groups were statistically different. There was no difference in the level of fasting blood glucose between the patients and the 8 weeks (P0.05). On the one hand, the improvement of blood lipid in patients with cerebrovascular disease two was considered, and it was also preliminarily confirmed that the liver and the spleen, the method of eliminating phlegm and dredging collaterals and the treatment had no negative effect on blood lipid and blood sugar.
5, adverse events
The common adverse events were summarized as follows: gastrointestinal symptoms, skin allergies, sore throat and sore throat, dizziness and headache and palpitation and chest tightness. It was observed that the liver and the spleen, the method of eliminating phlegm and collaterals were used in the treatment of post stroke depression, although a few patients had adverse events, but the symptoms were light and did not affect the continued treatment, and there was no life threatening symptom.2 group. There is no difference in contrast (P0.05).
6, drug addition and reduction
The drug dosage and dosage were compared before and after treatment. Chi square test showed that there was a difference between the 2 groups (P0.05).
[Conclusion]
1, the degree of depression after stroke was correlated with the degree of nerve function defect, the patient's daily living ability and prognosis. The TCM symptom scale and the Pittsburgh sleep scale could determine the depressive symptoms of the patients from the common concomitant symptoms and sleep of depression, which were related to the HAMD scale evaluation.
2, regulating liver and helping spleen, removing phlegm and dredging collaterals can improve the patient's depressive symptoms, sleep quality, nerve function defect, the quality of life and prognosis of the patients, and the clinical application is safe and effective.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R743.3
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