發(fā)布時間：2018-03-07 13:55

  本文選題：抑郁發(fā)作　切入點(diǎn)：脾胃論　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討從《脾胃論》結(jié)合六經(jīng)辨證理論指導(dǎo)下的中醫(yī)藥治療抑郁發(fā)作的療效,以明確通過該角度治療抑郁發(fā)作的可行性以及中醫(yī)優(yōu)勢。方法：本研究所有對象均為2015年1月至2015年12月于廣東省中醫(yī)院、廣州醫(yī)學(xué)院第一附屬醫(yī)院、南方醫(yī)科大學(xué)就診符合納入標(biāo)準(zhǔn)的輕中度抑郁發(fā)作的患者,總病例數(shù)為61例,中藥組38例,西藥組23例。中藥組予補(bǔ)中益氣湯合半夏瀉心湯／小柴胡湯／當(dāng)歸四逆湯／溫氏奔豚湯治療,西藥組予左洛復(fù)治療,療程4周。在治療前后及過程中不同時點(diǎn)分別進(jìn)行HAMD-17、SDS、SAS、PSQI、WHOQOL-BREF進(jìn)行療效評估。成果：1.主要療效指標(biāo)(1) HAMD-17有效率比較：治療2周后,中、西藥組有效率分別為68.4%、47.8%,兩組間有效率比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；治療4周后,中、西藥組有效率分別為68.5%、82.6%,兩組間有效率比較,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。(2)按病情嚴(yán)重程度分層后,HAMD-17總分比較：中藥組輕、中度抑郁患者治療前后HAMD-17總分比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；輕度抑郁患者中、西藥組治療前HAMD-17平均分分別為11.50、12.38,治療2周后,兩組HAMD-17平均分分別為7.33、10.38,兩組間比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。2.次要療效指標(biāo)(1)SDS總分比較：兩組SDS總分在治療2周、4周后與同組基線比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。治療2周、4周后兩組SDS總分進(jìn)行組間比較,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。(2)SAS總分比較：兩組SAS總分在治療2周、4周后與同組基線比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。治療2周、4周后兩組SAS總分進(jìn)行組間比較,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。(3) PSQI總分比較：中藥組在治療4周后PSQI總分與同組基線比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05),而在治療2周后差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)；西藥組在治療2周、4周后PSQI總分與同組基線比較,差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。(4)生存質(zhì)量比較：兩組生存質(zhì)量總分在治療4周后與同組基線比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05),而在治療2周后差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。同一時點(diǎn)兩組間比較,差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。中藥組生理、心理領(lǐng)域得分在2周、4周后分別與同組基線比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。西藥組生理領(lǐng)域得分在治療4周后與同組基線比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。兩組社會領(lǐng)域和環(huán)境領(lǐng)域在治療2周、4周后與同組基線比較,差異均無統(tǒng)計(jì)學(xué)意義。3.研究人群基本特征(1)人群特征：本研究抑郁發(fā)作患者中,女性36人,男性25人,女男比例為1.44：1；平均年齡為31.11歲；文化程度多為高中及以上,約占78.69%。(2)中藥組中醫(yī)證型分布特點(diǎn)：太陰組17人,少陽組12人,厥陰組6人,少陰組3人。太陰組和少陽組占76.31%。太陰組和少陽組治療2周、4周后HAMD-17總分分別與同組基線比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論：1.《脾胃論》結(jié)合六經(jīng)辨證理論指導(dǎo)下的中藥能明顯改善抑郁發(fā)作患者的抑郁情緒,與西藥左洛復(fù)相比,其起效更早而遠(yuǎn)期療效相當(dāng),因此在一定程度上,可以替代西藥左洛復(fù)進(jìn)行治療。2.該理論指導(dǎo)下的中藥治療輕度抑郁發(fā)作,其療效優(yōu)于西藥左洛復(fù),因此對輕度抑郁發(fā)作患者,可以單純采用中藥進(jìn)行干預(yù)。3.該理論指導(dǎo)下的中藥能改善抑郁發(fā)作患者睡眠質(zhì)量,而西藥左洛復(fù)對睡眠的改善不明顯,因此對輕、中度抑郁發(fā)作伴有睡眠障礙的患者,可以采用中藥替代西藥左洛復(fù)進(jìn)行治療。4.該理論指導(dǎo)下的中藥與西藥左洛復(fù)均能改善抑郁發(fā)作患者主觀抑郁、焦慮情緒,且兩者改善程度相當(dāng)。5.該理論指導(dǎo)下的中藥與西藥左洛復(fù)均能提高抑郁發(fā)作患者生存質(zhì)量,但中藥對于生存質(zhì)量中生理、心理領(lǐng)域的改善比西藥左洛復(fù)更為顯著。6.針對輕、中度抑郁發(fā)作患者,若無明顯消極觀念或行為,首選中藥治療。7.本課題研究人群以女性、青年、高中以上文化為主,中醫(yī)證候分布以太陰證、少陽證為主。
[Abstract]:Objective: To investigate the curative effect of combined stomach on the < > depression treatment guidelines under the theory of TCM syndrome differentiation of the six meridians to clear the attack, attack through the angle the feasibility and advantages of Chinese medicine treatment of depression. Methods: in this study, all the subjects were from January 2015 to December 2015 in Guangdong Province Traditional Chinese Medical Hospital and the First Affiliated Hospital of Guangzhou Medical College, Southern Medical University hospital with mild to moderate depression criteria the episodes, the total number of cases was 61 cases, 38 cases of Chinese medicine group, western medicine group of 23 cases. The Chinese medicine group were treated with Buzhong Yiqi Decoction Banxiaxiexin decoction and Xiaochaihu Decoction and Angelica four inverse soup / Wen bentun soup treatment, the treatment group were treated with sertraline, 4 weeks before and after treatment. And in the process at different time points were HAMD-17, SDS, SAS, PSQI, WHOQOL-BREF were evaluated. Results: 1. main indicators of efficacy (1) HAMD-17 efficiency comparison: after 2 weeks of treatment, the western medicine group The efficiency were 68.4%, 47.8%, two groups of efficiency comparison, the difference was statistically significant (P < 0.05); after 4 weeks of treatment, western medicine group was respectively 68.5%, 82.6%, two groups had efficiency comparison, no statistically significant difference (P > 0.05) (2) according to the illness. The severity of the stratification, HAMD-17 scores: the traditional Chinese medicine group, comparison of the HAMD-17 score before and after treatment in patients with moderate to severe depression, the difference was statistically significant (P < 0.05); the patients with mild depression, the western medicine group before treatment the average HAMD-17 scores were 11.50,12.38, 2 weeks after treatment, two groups of average HAMD-17 scores were 7.33,10.38, comparison between the two groups, the difference was statistically significant (P < 0.05).2. secondary index (1) SDS scores: two groups of SDS score in the treatment of 2 weeks, 4 weeks compared with baseline group, the difference was statistically significant (P < 0.05). The treatment of 2 weeks, two groups of SDS score between groups comparison of 4 weeks, 宸紓鏃犵粺璁″鎰忎箟(P錛，

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