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随机平行对照研究
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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.
[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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[5]张林,钟艳,全淑林,等.针刺联合耳穴贴压治疗脑卒中后抑郁:随机对照研究[J].中国针灸,2017,37(6):581-585.
[6]吴颖,顾自悦.运用疏肝合营法治疗卒中后抑郁的相关性研究[J].世界中医药,2017,12(1):112-115.
[7]陈鹏,刘存志,王桂玲,等.金针王乐亭"老十针"拾遗[J].世界中医药,2012,7(5):430-431.
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[13]Hamilton M.A rating scale for depression.[J].J Neurol Neurosurg Psychiatry,1960,23(1):56-62.
[14]惠建荣,宋毅,刘志丹,等.中风专用生活质量量表的Rasch分析[C]//2011中国针灸学会年会,2011.
[15]聂容荣,黄春华,符文彬.从脾胃论治脑卒中后抑郁症疗效观察[J].中国针灸,2011,31(4):325-328.
[16]周胜红.针刺治疗女性更年期抑郁症60例[J].中国组织工程研究,2007,11(39):7817-7819.
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[18]岳祥海,孙新刚,梁蔚骏,等.卒中后抑郁的流行病学研究进展[J].中华临床医师杂志(电子版),2016,10(12):1790-1794.
[19]Schmid AA,Kroenke K,Hendrie HC,et al.Poststroke depression and treatment effects on functional outcomes[J].Neurology,2011,76(11):1000-1005.
[20]Villain M,Cosin C,Glize B, et al.Affective prosody and depression after stroke:a pilot study[J].Stroke,2016,47(9):2397-2400.
[21]申龙燮,朴莲荀,朴虎男.脑卒中后抑郁患者检测SEP与血浆5-羟色胺的临床意义[J].中风与神经疾病杂志,2016,22(12):1122-1125.
[22]杨燃,张保华,付志新,等.抑郁对缺血性脑卒中病人早期生活质量及认知功能的影响[J].中西医结合心脑血管病杂志,2017,15(17):2190-2192.
[23]江国华,朴泉宇,符昱.养血清脑颗粒联合氟西汀治疗老年脑卒中后抑郁患者的疗效及对神经功能缺损程度的影响[J].中国老年学杂志,2018,38(3):522-524.
[24]单宁.艾灸六神穴配合心理干预治疗脑卒中后抑郁的疗效观察[J].四川中医,2017,35(2):180-182.
[25]范晓禹,张桂玉.认知行为多层次干预护理对卒中后抑郁的效果[J].中国康复理论与实践,2015,21(12):1471-1474.
[26]Fruehwald S,Gatterbauer E,Rehak P,et al.Early fluoxetine treatment of post-stroke depression–a three-month double-blind placebocontrolled study with an open-label long-term follow up[J].J Neurol,2003,250(3):347-351.
[27]Saco RL.Secondary prevention of ischemic stroke:a 1998 US perspective[J].Cerebrovasc Dis,1999,9(S3):37-44.
[28]党翠娇,蔡定芳,俞晓飞.缺血性脑卒中内科二级预防现状[J].中西医结合心脑血管病杂志,2017,15(21):2706-2709.
[29]高尚社.中风后郁证的辨证论治探析[J].中国中医基础医学杂志,2005,11(8):616.
[30]焦雪蕾,李长聪.菖蒲郁金汤合温胆汤治疗脑卒中后抑郁症的临床观察[J].中医药导报,2016,22(8):95-97.
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