177例脑卒中后抑郁病例中医证候分布特点

Distribution and Characteristics of 177 Cases with Post-stroke Depression Syndromes

目的观察脑卒中后抑郁样病例的中医证型的分布及中医证候特点。方法采用临床流行病学调查方法对177例脑卒中后抑郁患者的症状、体征、舌象四诊资料进行调查,并应用聚类分析等方法对调查的结果进行数据统计分析。结果 PSD患者症状、体征和舌脉象主要有26个,症状、体征出现的频率前6项为情绪不宁(96.04%)、胁肋胀满(95.48%)、纳差(64.97%)、悲忧善哭(59.88%)、胸部闷塞(57.06%)、喜怒无常(38.41%)等。舌脉象以舌质红(57.62%)、舌质淡(55.36%)、薄白(58.19%)、苔薄腻(48.58%)、脉弦(62.14%)、弦数(58.19%)多见。177例中患者中气滞血瘀证76例,肝郁脾虚证42例,心脾两虚证26例,肾虚肝郁证18例,脾肾阴虚证9例,痰火扰心证6例。脑卒中后抑郁主要症状构成中,气滞血瘀和心脾两虚证以情绪不宁为主;肝郁脾虚证和肾虚肝郁证胁肋胀满、胸部闷塞和悲忧善哭为主;痰火扰心主要以喜怒无常、失眠健忘为多;而脾肾阴虚以情绪不宁、喜怒无常为多。结论脑卒中后抑郁的基本中医证型为气滞血瘀证、痰瘀互阻证、肾精不足证、脾胃虚弱证、痰火扰心证、肝郁血虚证、肝郁血瘀证、心脾两虚证,以气滞血瘀证最多。

Objective： TCM syndromes of post-stroke depression with their distribution features will help im- prove the understanding of post-stroke depression cases and achieve accurate diagnosis and treatment. Methods： investigate symptoms ,signs ,tongue diagnostic information of 177 cases with post-stroke depression by using clini- cal epidemiology method and apply statistical methods such as cluster analysis to analyze the results of the survey. Results： There are mainly 26 symptoms, signs ,tongue and pulse condition. The most frequent onset of first 6 are restless mood （96.04%）,lateral thorax fullness （95.48%）, anorexia （64.97%）, sudden weep （59.88%）, chest chok- ing（57.06% ）,moody （38.41%） and so on. Tongue and pulse condition included red tongue （57.62%）,pale （55.36%） ,thin white （58.19%） ,thin greasy moss （48.58%） ,pulse string （62.14%） ,and strings （58.19%）. There were blood stasis type （76 cases）,liver and spleen deficiency type （42 cases）,heart and spleen deficiency type （26 cases）, liver stagnation and kidney depression type （ 18 cases ）, spleen and kidney yin deficiency （nine cases）, phlegm-fire disturbing heart type （6 cases）. Restless mood was the main expression of Qi stagnation and blood stasis type and heart and spleen deficiency type. Lateral thorax fullness, chest choking and sudden weep represent liver depression and spleen deficiency type and kidney deficiency and liver depression type. Moody temper,in- somnia and forgetfulness were the token of phlegm fire disturbing heart type. And restless mood represents spleen and kidney yin deficiency type. Conclusion： The basic post-stroke depression syndromes include Qi stagnation and blood stasis type, phlegm and blood stasis type, kidney essence deficiency type, spleen and stomach deficiency type, phlegm-fire disturbing heart type,liver stagnation and blood deficiency type,liver stagnation and blood stasis type ,and heart and spleen deficiency type,among which Qi stagnation and blood stasis type is mostly seen. Vari- ous syndromes have their own characteristics treating post- stroke depression.