溫陽(yáng)解郁法對(duì)腎虛肝郁型帕金森病抑郁患者的臨床干預(yù)研究
發(fā)布時(shí)間：2018-09-10 07:03
【摘要】：背景:帕金森病(Parkinson's disease,PD)是一種中老年人常見(jiàn)的進(jìn)行性神經(jīng)系統(tǒng)退行性疾病,PD以靜止性震顫、肌肉強(qiáng)直、運(yùn)動(dòng)遲緩及姿勢(shì)異常等為主要運(yùn)動(dòng)癥狀,以抑郁、便秘、眠差、多汗等為主要的非運(yùn)動(dòng)癥狀,非運(yùn)動(dòng)癥狀中以抑郁最多見(jiàn)。據(jù)研究帕金森病抑郁(Parkinson's disease depression,PDD)多見(jiàn)于少動(dòng)型和強(qiáng)直型。PDD與原發(fā)性抑郁有所不同,常見(jiàn)表現(xiàn)有淡漠、反應(yīng)減慢、注意力缺乏、快感減少,而晨起煩躁、失敗感較少出現(xiàn)。PDD目前以西藥治療為主,副反應(yīng)較多,長(zhǎng)期用藥療效減退,根據(jù)既往臨床經(jīng)驗(yàn)我們提出了 PDD "陽(yáng)虛水寒木郁"的發(fā)病機(jī)制,并擬定了溫陽(yáng)解郁治法。據(jù)此運(yùn)用中醫(yī)辨證論治思維和中醫(yī)藥特色治療優(yōu)勢(shì),探索溫陽(yáng)解郁方法方藥對(duì)PDD的治療效果,對(duì)緩解患者的病情,改善其運(yùn)動(dòng)功能,提高其生活質(zhì)量具有重要意義。目的:本研究旨在初步觀察溫陽(yáng)解郁法辨治帕金森病抑郁的臨床療效和安全性,為進(jìn)一步推廣應(yīng)用奠定基礎(chǔ)。方法:選取主要來(lái)自于北京中醫(yī)藥大學(xué)第三附屬醫(yī)院門(mén)診的86例腎虛肝郁型PDD患者,中藥組44例,西藥組42例。中藥組:溫陽(yáng)解郁方,療程12周;西藥組:鹽酸文拉法辛緩釋膠囊,療程12周。整個(gè)試驗(yàn)期間允許合并使用抗帕金森藥物,應(yīng)盡量保持用藥種類(lèi)和劑量不變;整個(gè)研究期間不允許合并使用其它任何抗精神病藥、抗抑郁藥、心境穩(wěn)定劑、鎮(zhèn)靜安眠藥物以及本方案所用中藥以外的其它中藥和中成藥制劑。分別于治療第0周、治療第2周、治療第12周使用生活質(zhì)量量表(shortform 36 questionnaire,SF-36)、漢密爾頓抑郁量表(Hamilton Depression Scale,HAMD)、中醫(yī)證候評(píng)定表(腎虛肝郁證)、帕金森病綜合評(píng)分表(UPDRS Ⅱ、Ⅲ部分)進(jìn)行評(píng)分,觀察分值變化;以副反應(yīng)量表(Treatment Emergent Symptom Scale,TESS)記錄比較其不良反應(yīng)。運(yùn)用SPSS20.0統(tǒng)計(jì)分析軟件進(jìn)行數(shù)據(jù)分析,評(píng)價(jià)其療效。計(jì)量資料以均數(shù)加減標(biāo)準(zhǔn)差(x土s)描述,采用t檢驗(yàn)和秩和檢驗(yàn)等方法,計(jì)數(shù)資料以頻數(shù)、率描述,采用卡方檢驗(yàn)和秩和檢驗(yàn)等方法。P0.05時(shí)差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:組內(nèi)比較:中藥組與西藥組的SF-36、HAMD、中醫(yī)證候評(píng)定表、帕金森病綜合評(píng)分表(UPDRSⅡ、Ⅲ部分)評(píng)分較治療前均有明顯變化(P0.05);組間比較:在第12周時(shí),中藥組的SF-36、中醫(yī)證候評(píng)定表、帕金森病綜合評(píng)分表(UPDRSⅡ、Ⅲ部分)評(píng)分改善程度均大于西藥組(P0.05),HAMD量表評(píng)分變化兩組相當(dāng)(P0.05);在第2周時(shí),兩組各項(xiàng)量表評(píng)分變化相當(dāng)(P0.05)。TESS評(píng)分結(jié)果顯示中藥組副反應(yīng)少于西藥組(P0.05)。結(jié)論:溫陽(yáng)解郁法能夠改善PDD患者的臨床癥狀,改善其生活質(zhì)量。溫陽(yáng)解郁中藥改善PPD患者抑郁狀態(tài)的效果與西藥相同,但不良反應(yīng)相對(duì)較少,值得在臨床中推廣。
[Abstract]:Background: Parkinson's disease (Parkinson's disease,PD) is a common progressive neurodegenerative disease in the elderly. The main symptoms of PD are quiescent tremor, muscular rigidity, motor retardation and abnormal posture. The main symptoms of PD are depression, constipation and poor sleep. Hyperhidrosis was the main non-motor symptom and depression was the most common non-motor symptom. Depression in Parkinson's disease (Parkinson's disease depression,PDD) is more common in oligokinetic type and ankylosis type. PDD is different from primary depression in common symptoms such as apathy, slow response, lack of attention, decreased pleasure, and irritability in the morning. There are few cases of failure. PDD is mainly treated with western medicine at present, with more side effects, and the long-term curative effect is decreased. According to the past clinical experience, we put forward the pathogenesis of "Yang deficiency and water cold wood depression" in PDD, and draw up the treatment method of warming yang depression. On the basis of this, it is of great significance to use the thinking of TCM differentiation and treatment and the advantages of characteristic treatment of Chinese medicine to explore the therapeutic effect of warming yang and relieving depression on PDD, to alleviate the patients' condition, to improve their motor function and to improve their quality of life. Objective: to observe the clinical efficacy and safety of treating Parkinson's disease depression with the method of warming yang and relieving depression, so as to lay a foundation for further application. Methods: 86 cases of PDD with kidney deficiency and liver depression were selected from the outpatient department of the third affiliated Hospital of Beijing University of traditional Chinese Medicine, 44 cases in the Chinese medicine group and 42 cases in the western medicine group. The traditional Chinese medicine group was treated with Wenyang Jieyu recipe for 12 weeks, and the western medicine group with venlafaxine hydrochloride sustained release capsule for 12 weeks. The combination of antiParkinson drugs should be allowed throughout the trial period, and the type and dosage of the drugs should be kept as constant as possible; no combination of any other antipsychotics, antidepressants, and mood stabilizers should be allowed throughout the study period. Sedative sleeping pills and other traditional Chinese medicines and proprietary Chinese medicines used in this scheme. Quality of life scale (shortform 36 questionnaire,SF-36), Hamilton Depression scale (Hamilton Depression Scale,HAMD), TCM Syndromes scale (Kidney deficiency and liver Depression Syndrome) and Parkinson's Disease Synthetical scale (UPDRS 鈪，
本文編號(hào)：2233731
[Abstract]:Background: Parkinson's disease (Parkinson's disease,PD) is a common progressive neurodegenerative disease in the elderly. The main symptoms of PD are quiescent tremor, muscular rigidity, motor retardation and abnormal posture. The main symptoms of PD are depression, constipation and poor sleep. Hyperhidrosis was the main non-motor symptom and depression was the most common non-motor symptom. Depression in Parkinson's disease (Parkinson's disease depression,PDD) is more common in oligokinetic type and ankylosis type. PDD is different from primary depression in common symptoms such as apathy, slow response, lack of attention, decreased pleasure, and irritability in the morning. There are few cases of failure. PDD is mainly treated with western medicine at present, with more side effects, and the long-term curative effect is decreased. According to the past clinical experience, we put forward the pathogenesis of "Yang deficiency and water cold wood depression" in PDD, and draw up the treatment method of warming yang depression. On the basis of this, it is of great significance to use the thinking of TCM differentiation and treatment and the advantages of characteristic treatment of Chinese medicine to explore the therapeutic effect of warming yang and relieving depression on PDD, to alleviate the patients' condition, to improve their motor function and to improve their quality of life. Objective: to observe the clinical efficacy and safety of treating Parkinson's disease depression with the method of warming yang and relieving depression, so as to lay a foundation for further application. Methods: 86 cases of PDD with kidney deficiency and liver depression were selected from the outpatient department of the third affiliated Hospital of Beijing University of traditional Chinese Medicine, 44 cases in the Chinese medicine group and 42 cases in the western medicine group. The traditional Chinese medicine group was treated with Wenyang Jieyu recipe for 12 weeks, and the western medicine group with venlafaxine hydrochloride sustained release capsule for 12 weeks. The combination of antiParkinson drugs should be allowed throughout the trial period, and the type and dosage of the drugs should be kept as constant as possible; no combination of any other antipsychotics, antidepressants, and mood stabilizers should be allowed throughout the study period. Sedative sleeping pills and other traditional Chinese medicines and proprietary Chinese medicines used in this scheme. Quality of life scale (shortform 36 questionnaire,SF-36), Hamilton Depression scale (Hamilton Depression Scale,HAMD), TCM Syndromes scale (Kidney deficiency and liver Depression Syndrome) and Parkinson's Disease Synthetical scale (UPDRS 鈪，
本文編號(hào)：2233731
本文鏈接：http://sikaile.net/zhongyixuelunwen/2233731.html
最近更新
教材專(zhuān)著
