卒中单元中西医结合治疗对脑卒中患者抑郁及认知功能的影响

A clinical study of the effects of a stroke unit using integrated traditional Chinese and western approaches on post-stroke depression and cognitive impairment

目的观察卒中单元中西医结合治疗对脑卒中患者抑郁及认知功能的影响。方法选取脑卒中后抑郁（PSD）患者105例，按照随机数字表法将其分为对照组、常规治疗组、联合治疗组，每组35例。3组均给予卒中单元常规治疗（包括药物治疗、肢体康复训练、语言训练、心理治疗、健康教育等），常规治疗组在上述基础上加用舍曲林（商品名：左洛复）药物治疗，联合治疗组则在卒中单元常规治疗及服用舍曲林基础上，根据中医辨证分型加用中草药方剂。治疗前及治疗第8，24周时采用汉密尔顿抑郁量表（HAMD）对患者的抑郁程度进行评定，利用简易精神状况检查（MMSE）和蒙特利尔认知评估量表（MoCA）评定患者的认知功能。结果治疗前，3组患者HAMD、MMSE、MoCA评分组间比较，差异均无统计学意义（P〉0．05）；治疗第8周，常规治疗组和联合治疗组HAMD评分[（14．28±0．64）分、（13．32±0．91）分]与治疗前比较，差异有统计学意义（P〈0．05）；治疗第24周，常规治疗组HAMD、MMSE、MoCA评分[（12．65±0．75）分、（23．24±0．89）分、（23．36±0．88）分]与治疗前比较，差异均有统计学意义（P〈0．05）；联合治疗组治疗第24周HAMD、MMSE、MoCA评分[（10．15毒0．67）分、（25．21±0．92）分、（25．44±0．85）分]与治疗前比较，差异亦有统计学意义（P〈0．05）；常规治疗组和联合治疗组HAMD、MMSE、MoCA评分与对照组同时间点比较，差异均有统计学意义（P〈0．05），且联合治疗组各指标评分均优于常规治疗组（P〈0．05）。结论卒中单元中西医结合治疗可显著改善PSD患者的抑郁程度，提高其认知功能，值得临床进一步应用、推广。

Objective To observe the effects of the integrated traditional and western treatments on post- stroke depression and cognitive impairment in a stroke unit. Methods A total of 105 patients with post-stoke de- pression （PSD） admitted to the authors＇ stroke unit were enrolled and randomized into a control group （n = 35 ） , a conventional treatment group （n = 35 ） and an integrated treatment group （n = 35 ）. All the patients were treated with routine interventions including medications, rehabilitation training, psychological counseling and health education. Meanwhile, the patients in the conventional treatment group were also treated with anti-depressant seItraline, while those in the integrated treatment group were treated with sertraline and Chinese medicine as addition. The rating scales such as Hamilton depression （HAMD） , mini-mental state examination （MMSE） , the Montreal cognitive as- sessment （MOCA） were used to evaluate all patients after 8 weeks and 24 weeks of treatment. Results Before treatment, there was no significant difference among the 3 groups with regard to assessment scores of HAMD, MMSE and MoCA （P 〉 0.05）. After 8 weeks of treatment, the conventional treatment group and the integrated treatment group were significantly improved in terms of HAMD [ （ 14.28 ± 0.64 ） and （ 13.32 ± 0.91 ） respectively ] （ P 〈 0.05）. The scores of HAMD, MMSE and MOCA of the conventional treatment group and the integrated treatment group were significantly improved after 24 weeks of treatment （P 〈 0.05 ） , and the integrated treatment group im- proved to a significantly greater extent when compared with the conventional treatment group Conclusion Integrated traditional and western treatment used in the authors＇ stroke unit can effectively improve post-stroke depression and cognitive impairment.