發(fā)布時(shí)間：2018-04-01 21:13

  本文選題：中風(fēng)　切入點(diǎn)：抑郁　出處：《河南中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的中風(fēng)后抑郁(Post-stroke depression,PSD)是中風(fēng)的常見并發(fā)癥之一,嚴(yán)重影響患者的身心恢復(fù)。針對(duì)目前臨床藥物價(jià)格昂貴、起效慢、副作用多等不足,為發(fā)揮中醫(yī)的多靶點(diǎn),個(gè)體化治療具有其獨(dú)特優(yōu)勢(shì)。本課題以臨床觀察的形式,選取導(dǎo)師經(jīng)驗(yàn)方滋腎理肝湯治療PSD,驗(yàn)證滋腎理肝湯對(duì)腎虛肝郁型中風(fēng)后抑郁的療效,同時(shí)對(duì)PSD的發(fā)病機(jī)制進(jìn)行分析和探討,為其臨床應(yīng)用及推廣提供參考。方法本課題共選取2014年3月到2015年4月之間,漯河市第二人民醫(yī)院神經(jīng)內(nèi)科及河南中醫(yī)學(xué)院第一附屬醫(yī)院腦病科住院患者60例。所有患者均經(jīng)頭顱CT或MRI證實(shí)為腦卒中,且病程在2周到6個(gè)月之間。60例患者隨機(jī)分為治療組(30例)和對(duì)照組(30例),所有患者均接受腦卒中常規(guī)治療,在此基礎(chǔ)上,治療組采用自擬滋腎理肝湯口服治療,對(duì)照組給予鹽酸帕羅西汀片口服治療。在兩組患者治療前和治療6周時(shí),記錄其中醫(yī)證候評(píng)分及HAMD評(píng)分,NIHSS評(píng)分,ADL評(píng)分,以HAMD量表評(píng)分差異判定療效,以HAMD量表減分率來統(tǒng)計(jì)有效例數(shù)(減分率≥50%為顯效;減分率在25%-50%之間為有效;減分率≤25%為無效),通過統(tǒng)計(jì)學(xué)處理來評(píng)價(jià)其療效及安全性。結(jié)果對(duì)采集到的各項(xiàng)數(shù)據(jù)進(jìn)行分析,分別將兩組患者的年齡,性別,文化程度及抑郁程度進(jìn)行對(duì)比,發(fā)現(xiàn)兩組間無明顯差異(P05.0),具有可比性。治療組和對(duì)照組在治療后HAMD評(píng)分下降,較治療前差異有統(tǒng)計(jì)學(xué)意義(P05.0),治療組顯效率33.33%,有效率53.33%,總有效率為86.66%;對(duì)照組有效率60.00%,顯效率13.33%,總有效率為73.33%,組間對(duì)比差異明顯。在改善神經(jīng)功能缺損方面,治療組在治療前后NIHSS評(píng)分、中醫(yī)證候評(píng)分及ADL評(píng)分的差異均有統(tǒng)計(jì)學(xué)意義(P05.0),兩組對(duì)比,治療組療效更為突出,提示滋腎理肝湯能有效改善患者的抑郁癥狀,并能促進(jìn)患者缺損神經(jīng)功能的恢復(fù)。結(jié)論運(yùn)用滋腎理肝湯治療中風(fēng)后抑郁,滋水涵木,標(biāo)本兼治,起效迅速,療效顯著,既明顯改善了患者的抑郁情緒,又能有效促進(jìn)受損運(yùn)動(dòng)及感覺神經(jīng)功能的恢復(fù),安全有效。
[Abstract]:Objective Post-stroke depression (PSD) is one of the common complications of stroke.Aiming at the disadvantages of high price, slow effect and many side effects of clinical drugs, individualized therapy has its unique advantages in order to give full play to the multiple targets of traditional Chinese medicine (TCM).In the form of clinical observation, this paper selects the tutor's experience prescription Zishen Ligan decoction to treat PSDs, verifies the curative effect of Zishen Ligan decoction on depression after stroke with kidney deficiency and liver depression, and analyzes and probes into the pathogenesis of PSD.To provide a reference for its clinical application and promotion.Methods between March 2014 and April 2015, 60 inpatients from the Department of Neurology, the second people's Hospital of Luohe City and the Department of Encephalopathy, the first affiliated Hospital of Henan College of traditional Chinese Medicine, were selected.All patients were confirmed as stroke by CT or MRI, and 60 patients were randomly divided into treatment group (n = 30) and control group (n = 30).The treatment group was treated orally with Zishen Ligan decoction and the control group with paroxetine hydrochloride.The reduction rate was between 25% and 50%, and less than 25% was ineffective. The efficacy and safety were evaluated by statistical analysis.Results the age, sex, education level and depression degree of the two groups were compared, and there was no significant difference between the two groups (P05.0).In the aspect of improving nerve function defect, the difference of NIHSS score, TCM syndrome score and ADL score before and after treatment in the treatment group was statistically significant (P05.0), the curative effect of the treatment group was more prominent than that of the control group.The results suggest that Zishen Ligan decoction can effectively improve the depressive symptoms of patients and promote the recovery of defective nerve function.Conclusion the application of Zishen Ligan decoction in the treatment of post-stroke depression, nourishing water and culturing wood, treating both the symptoms and the root causes is rapid and effective. It not only obviously improves the depressed mood of the patients, but also can effectively promote the recovery of damaged motor and sensory nerve function, and is safe and effective.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7

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