摘要
[目的]观察王乐亭脾胃老十针+血府逐瘀汤联合西药综合治疗脑卒中后抑郁疗效。[方法]采用随机平行对照方法,将60例住院患者按随机数字表法随机分为三组,对症及二级预防,改善脑循环、营养神经、控制血压、血糖、血脂、抗凝。对照组20例帕罗西汀,20mg/次,1次/d。中西医结合组20例血府逐瘀汤(柴胡、生地、桃仁、红花各10g,枳壳、赤芍各6g、川芎、桔梗各9g,牛膝10g,甘草6g),水煎服,1剂/d,早晚服;帕罗西汀治疗同对照组。针药并用组20例脾胃老十针:上脘、中脘、下脘、气海、内关、天枢、足三里,留针30min,1次/d,5次/周;血府逐瘀汤、帕罗西汀同中西医结合组。连续治疗8周为1疗程。观测汉密尔顿抑郁量表(HAMD)评分、中风生存质量量表(SS-QQL)评分、脾胃症候积分、不良反应。连续治疗8周(1疗程),判定疗效。[结果]针药并用组显效10例,有效10例,无效0例,总有效率100.00%;中西医结合组显效3例,有效17例,无效0例,总有效率100.00%;对照组显效0例,有效13例,无效7例,总有效率65.00%,临床疗效针药并用组、中西医结合组优于对照组(P<0.01);针药并用组显效优于中西医结合组(P<0.01)。HAMD评分三组均有改善(P<0.01),中西医结合组、针药并用组疗效明显优于对照组(P<0.01),针药并用组优于中西医结合组(P<0.01)。SS-QQL评分三组均显著升高(P<0.01);中西医结合组、针药并用组升高明显大于对照组(P<0.01),针药并用组大于中西医结合组(P<0.05)。脾胃症候量表评分三组均显著升高(P<0.01);中西医结合组和针药并用组升高明显大于对照组(P<0.01),针药并用组大于中西医结合组(P<0.05)。[结论]王乐亭脾胃老十针+血府逐瘀汤联合西药综合治疗治疗PSD,疗效满意,无严重不良反应,值得推广。
[Objective] To observe the effect of Xuefu Zhuyu decoction combined with WANG Leting's "Ten acupoints for spleen and stomach: and midication for post-stroke depression(PSD). [Methods] 60 patients with PSD were randomly assigned to three groups, which were all given basal treatment of Second-level prevention,brain circulation improvement,nerve-nurture,controlling blood pressure,blood glucose,blood lipid and anticoagulation agent. 20 mg paroxetine hydrochloride was prescribed orally in 20 patients of the control group, once a day for 8 weeks. Based on the above treatment, Xuefu Zhuyu decoction(10 g for Chaihu,Shendi,Taoren and Honghua, 6 g for Zhike and Chishao, 9 g for Chuanxiong and Jiegeng, 10 g for Niuxi, 6 g for Gancao) was given in the 20 patients of the combined of traditional and western medicine group for 8 weeks, once a day. Based on the traditional and western medicine group, 30-minute acupuncture of WANG Leting's "Ten acupoints for spleen and stomach" was given in the acupuncture and medicine group for 8 weeks on Shangwan acupoint(RN13),Zhongwan acupoint(RN12),Xiawan acupoint(RN10),Qihai acupoint(CV5),bilateral Neiguan acupoints(PC6)、Tianshu acupoints(ST25),Zusanli acupoints(ST36), 5 times a week. Scores of HAMD、SS-QQL and scores of spleen and stomach syndrome were analysed beforeand after treatment. Moreover, the clinical effect was evaluated and the adverse effect was described. [Results] In the acupuncture combined with medicine group, 10 patients had apparent results, 10 had effective results, 0 had no effects and the total effect rate was 100%; in the combined of traditional and western medicine group, 3 patients had apparent results, 17 had effective results, 0 had no effects and the total effect rate was 100%; in the control group, 0 patients had apparent results, 13 had effective results, 7 had no effects and the total effect rate was 65%. In terms with the clinical effect, combined of traditional and western medicine group and acupuncture combined with medicine group were better than the control group(P<0.01) while acupuncture combined with medicine group was better than combined of traditional and western medicine group(P<0.01). After treatment, scores of HAMD,SS-QQL and scores of spleen and stomach syndrome in the three groups significantly decreased compared with those of before treatment(P<0.01), and combined of traditional and western medicine group and acupuncture combined with medicine group were better than the control group(P<0.01 or P<0.05) while acupuncture combined with medicine group was better than combined of traditional and western medicine group(P<0.05). [Conclusions] Xuefu Zhuyu decoction combined with WANG Leting's "Ten acupoints for spleen and stomach" and Midication has a definite effect and no severe adverse event for PSD. It was worthy of application in clinic.
引文
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