中西医结合治疗中风后抑郁临床研究

目的:观察自拟疏肝益肾通络汤治疗脑卒中后抑郁的临床疗效。方法:将76例脑卒中后抑郁患者按随机数字表法分成观察组和对照组,每组38例。对照组采用常规西药盐酸氟西汀胶囊治疗,每次20 mg,每天1次,早餐后口服,连续用药4周。观察组在对照组治疗的基础上加用中药自拟疏肝益肾通络方治疗,药物组成:黄芪30 g,柴胡、枳壳、石菖蒲、白术、郁金、茯苓各15 g,当归、炒枣仁各20 g,甘草6 g。辨证加减用药:嗳气频繁发、脘闷者加法半夏15 g;胁肋胀痛者加青皮10 g;失眠者加龙骨、牡蛎各10 g;郁火烦躁者加牡丹皮15 g。水煎服,首煎加水500 m L,取药汁150 m L;二煎加水300 m L,取150 m L药汁,相混合,早、晚两次服用,每天1剂,连续服用4周。治疗后采用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、日常生活能力评定量表(activity of daily living scale,ADL)评测两组治疗效果。结果:治疗前观察组HAMD评分为(28.21±1.36)分,对照组HAMD评分为(28.30±1.53)分,治疗4周后两组患者的HAMD评分均得到改善,观察组HAMD评分为(12.15±1.28)分,明显低于对照组的(17.28±1.37)分,可见观察组优于对照组,差异有统计意义(P0.05);治疗前观察组ADL评分为(50.91±10.16)分,对照组ADL评分为(65.73±8.46)分,治疗后观察组ADL评分为(77.15±8.08)分,明显高于对照组的(65.73±8.46)分,差异有统计意义(P0.05);观察组临床有效率为94.7%,显著高于对照组的84.2%,差异有统计意义(P0.05);对照组不良反应发生率高于观察组,差异有统计意义(P0.05)。结论:对脑卒中后抑郁患者采用疏肝益肾通络汤治疗疗效显著,且无明显不良反应。

Clinical Study on Treatment of Depression After Stroke with Combination of Chinese and Western Medicine

Objective:To observe the clinical effect of self-made Shugan Yishen Tongluo decoction in the treatment of post-stroke depression.Methods:76 patients with post-stroke depression were randomly divided into the observation group and the control group,38 cases in each group.The control groupwas given conventional western medicine,Fluoxetine Hydrochloride capsules,20 mg each time,1 time a day,after breakfast orally for 4 weeks.The observation group was treated with self-made Shugan Yishen Tongluo decoction,composition:Huangqi (Astragalus Membranaceus) 30 g,Chaihu (Radix Bupleuri) 15 g,Zhike (Fructus Auran tii) 15 g,Shichangpu (Acorus Gramineus) 15 g,Baizhu (Rhizoma Atractylodis M acrocephalae) 15 g,Yujin (Radix Curcumae) 15 g,Fuling (Poria Cocos) 15 g,Danggui (Angelica Sinensis) 20 g,Chaosuanzaoren (Semen Ziziphi Spinosae) 20 g,Gancao (Liquo rice) 6 g.Frequent belching,fullness,with Fabanxia(Rhizoma Pinellinae Praeparata) 15 g,distending pain in hypochondrium,with Qingpi(Pericarpium Citri Reticulatae Viride) 10 g,insomnia with Longgu(Fossil Fragments) 10 g and Muli (Concha Ostreae) 10 g,suffering from the fidgets,with Mudanpi (Moutan Bark)15 g.Water decoction,taking 4 consecutive weeks.After treatment,Hamilton depression scale (HAMD) and activity of daily living scale (ADL) were used to evaluate the effect of the two groups.Results:Before treatment,the observation group HAMD score was (28.21 ± 1.36) points,control group HAMD score was (28.30 ± 1.53) points,after 4 weeks of treatment,HAMD scores of two groups were improved,the observation group HAMD score was (12.15 ± 1.28) points,significantly lower than the control group (17.28 ± 1.37) points,and the observation group better than the control group,the difference was statistically significant (P ＜ 0.05);before treatment,the observation group ADL score was (50.91 ± 10.16)points,control group ADL score was (65.73 ± 8.46)points,after treatment,the observation group ADL score was (77.15 ± 8.08)points,significantly higher than the control group (65.73 ± 8.46)points,the difference was statistically significant (P ＜ 0.05);the clinical effective rate of observation group was 94.7％,significantly higher than 84.2％ in the control group (P ＜ 0.05);the adverse reaction rate of control group was higher than that of the observation group (P ＜ 0.05).Conclusion:Shugan Yishen Tongluo decoction treatment of patients with depression after stroke has significant effect,and no obvious adverse reactions.