黄连温胆汤加味治疗卒中后抑郁症的临床研究
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摘要
目的分析黄连温胆汤加味对卒中后抑郁症(post-stroke depression, PSD)患者抑郁状态、认知功能障碍、神经功能及血液流变学指标的影响。方法回顾性收集本院诊治的PSD患者88例,分为对照组和观察组各44例。对照组予以常规神经内科治疗,配合心理疏导,观察组在对照组基础上予以黄连温胆汤加味治疗,观察比较2组抑郁状态、认知功能障碍、神经功能及血液流变学指标等。结果 2组患者在治疗2周及4周后, HAMD评分、NIHSS评分均低于治疗前,且观察组明显低于对照组(P<0.05);而两组MMSE评分均比治疗前升高(P<0.05),且观察组明显高于对照组(P<0.05);经1个月治疗后,2组全血黏度、红细胞沉降等指标均比治疗前降低(P<0.05),且观察组降低程度比对照组明显(P<0.05)。疗效上观察组总有效率为86.37%,明显高于对照组的69.18%(P<0.05)。结论对PSD患者实施神经内科常规治疗、心理疏导,联合黄连温胆汤加味有助于降低其认知功能障碍、改善患者情绪、稳定血液流变学指标、促进神经功能恢复,疗效确切,值得临床开展应用。
Objective To analyze the effects of modified Huanglian Wendan Decoction on depression, cognitive dysfunction, neurological function, and hemorheological indices in patients with post-stroke depression. Methods Eighty-eight patients with post-stroke depression who were diagnosed and treated in our hospital were retrospectively enrolled and equally divided into control group and observation group. Both groups received conventional neurological treatment combined with psychological counseling. The observation group received additional treatment with modified Huanglian Wendan Decoction.Depression, cognitive dysfunction, neurological function, and hemorheological indices were compared between the two groups.Results After 2 and 4 weeks of treatment, the scores for the Hamilton Depression Rating Scale and National Institutes of Health Stroke Scale were reduced in both groups and were significantly lower in the observation group than in the control group(P<0.05);the Mini-Mental State Examination score was significantly elevated in both groups(P<0.05) and was significantly higher in the observation group than in the control group(P <0.05). After one month of treatment, the whole blood viscosity and erythrocyte sedimentation rate were significantly reduced in both groups(P<0.05); the observation group had significant greater reductions in the above indices than the control group(P<0.05). The overall response rate was significantly higher in the observation group than in the control group(86.37% vs 69.18%, P<0.05). Conclusion Conventional neurological treatment and psychological counseling combined with modified Huanglian Wendan Decoction can improve cognitive function and emotion, stabilize hemorheological indices, and promote the recovery of neurological function in the treatment of patients with post-stroke depression, which holds promise for clinical application.
Objective To analyze the effects of modified Huanglian Wendan Decoction on depression, cognitive dysfunction, neurological function, and hemorheological indices in patients with post-stroke depression. Methods Eighty-eight patients with post-stroke depression who were diagnosed and treated in our hospital were retrospectively enrolled and equally divided into control group and observation group. Both groups received conventional neurological treatment combined with psychological counseling. The observation group received additional treatment with modified Huanglian Wendan Decoction.Depression, cognitive dysfunction, neurological function, and hemorheological indices were compared between the two groups.Results After 2 and 4 weeks of treatment, the scores for the Hamilton Depression Rating Scale and National Institutes of Health Stroke Scale were reduced in both groups and were significantly lower in the observation group than in the control group(P<0.05);the Mini-Mental State Examination score was significantly elevated in both groups(P<0.05) and was significantly higher in the observation group than in the control group(P <0.05). After one month of treatment, the whole blood viscosity and erythrocyte sedimentation rate were significantly reduced in both groups(P<0.05); the observation group had significant greater reductions in the above indices than the control group(P<0.05). The overall response rate was significantly higher in the observation group than in the control group(86.37% vs 69.18%, P<0.05). Conclusion Conventional neurological treatment and psychological counseling combined with modified Huanglian Wendan Decoction can improve cognitive function and emotion, stabilize hemorheological indices, and promote the recovery of neurological function in the treatment of patients with post-stroke depression, which holds promise for clinical application.
引文
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[9] RIIKKA PIHLAJA, JENNI UIMONEN, SATU MUSTANOJA, et al. Post-stroke fatigue is associated with impaired processing speed and memory functions in first-ever stroke patients[J]. J Psychosom Res, 2014,77(5):380-384.
[10]董斌,刘绪银,张宏伟,等.国医大师张学文辨治脑萎缩经验[J].湖南中医药大学学报,2017,37(7):697-699.
[11]赵亚伟,张彦利,傅天.中医药治疗卒中后抑郁的研究进展[J].现代中西医结合杂志,2017,26(8):909-912.
[12]吴正国.加减逍遥散治疗卒中后抑郁(肝郁脾虚型)的临床观察[D].武汉:湖北中医药大学,2016.
[13]杨翠荣.郁金药理及中医临床应用略述[J].光明中医,2014,29(8):1772-1773.
[14]贾春霞,徐清照,杜月光,等.中医理气活血解郁法对比西医百忧解片治疗老年脑卒中后抑郁的临床研究[J].中华中医药学刊,2014,32(11):2585-2588.
[15]李知莲,吴慧芳.艾地苯醌治疗对缺血性脑卒中后抑郁患者血清学指标的影响[J].海南医学院学报,2015,21(2):262-264.
[2]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志,2001,34(3):184-188.
[3]张利娜,王厹东,庄国芳,等.文拉法辛治疗卒中后抑郁的汉密尔顿抑郁量表与事件相关电位评估[J].脑与神经疾病杂志,2014,22(6):432-436.
[4]李贵琴,任春晖.卒中后抑郁患病率与NIHSS、BI和MMSE评分关系的研究[J].现代中西医结合杂志,2014,23(30):3339-3341.
[5]李婉仪,陈仰昆,李伟,等.脑卒中后抑郁的临床神经心理学及影像学相关因素研究[J].中国实用神经疾病杂志,2014,17(11):1-4.
[6]曹旸,徐凡叶,金亚娟,等.针刺联合黄连温胆汤治疗脑卒中后轻度认知功能障碍的临床疗效研究[J].现代生物医学进展,2017,17(27):5327-5330.
[7] BRAJESH K. LAL, MOIRA C. DUX, SIDDHARTHA SIKDAR, et al. Asymptomatic carotid stenosis is associated with cognitive impairment[J]. J Vasc Surg, 2017,2(33):1023-1217.
[8]胡建芳,陈朝俊,毕小丽,等.疏肝活血汤合针灸早期干预对卒中后抑郁患者预后的影响[J].中国中药杂志,2013,38(14):2403-2405.
[9] RIIKKA PIHLAJA, JENNI UIMONEN, SATU MUSTANOJA, et al. Post-stroke fatigue is associated with impaired processing speed and memory functions in first-ever stroke patients[J]. J Psychosom Res, 2014,77(5):380-384.
[10]董斌,刘绪银,张宏伟,等.国医大师张学文辨治脑萎缩经验[J].湖南中医药大学学报,2017,37(7):697-699.
[11]赵亚伟,张彦利,傅天.中医药治疗卒中后抑郁的研究进展[J].现代中西医结合杂志,2017,26(8):909-912.
[12]吴正国.加减逍遥散治疗卒中后抑郁(肝郁脾虚型)的临床观察[D].武汉:湖北中医药大学,2016.
[13]杨翠荣.郁金药理及中医临床应用略述[J].光明中医,2014,29(8):1772-1773.
[14]贾春霞,徐清照,杜月光,等.中医理气活血解郁法对比西医百忧解片治疗老年脑卒中后抑郁的临床研究[J].中华中医药学刊,2014,32(11):2585-2588.
[15]李知莲,吴慧芳.艾地苯醌治疗对缺血性脑卒中后抑郁患者血清学指标的影响[J].海南医学院学报,2015,21(2):262-264.