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

Clinical Study of TCM Liqi Huoxue Jieyu Therapy Compared with Western Medicine Cap Prozac in Treatment of Geriatric Post-Stroke Depression

目的：观察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疗效。方法：本课题共选取2011年7月—2013年7月期间的患者共120例病例,随机分为治疗组及对照组各60人,所有患者均接受脑梗死神经内科常规治疗。在此基础上,治疗组给予中医理气活血解郁法（理气活血解郁方加减辨证治疗合心理认知疗法）,对照组给予百忧解片20 mg/d口服治疗。两组患者分别于入院时及接受治疗后第10、30、60 d记录汉密尔顿抑郁量表（HAMD）评分、中医证候表现评分、临床血液流变学常用检测指标。结果：1从汉密尔顿抑郁量表（HAMD）评分统计数据,可以看出,治疗组及对照组接收治疗后第10 d均有明显下降,较治疗前差异有统计学意义（P〈0.05）,但组间比较并无显著差异（P〉0.05）;2从中医整体症候评分统计数据,可以看出,治疗开始10 d后,治疗组有明显下降,与治疗前相比,差异有统计学意义（P〈0.05）,与对照组相比,治疗组评分改善更为明显（P〈0.05）,提示理气活血解郁方合认知疗法在缓解老年PSD患者中医临床伴随症状方面,更优于百忧解片;3以HAMD减分率统计数据,治疗组有效率为50%,显效率为18.3%,总有效率达68.3%;对照组有效率为48.3%,显效率为16.7%,总有效率为65.0%,两者有效率对比并无明显差异,提示理气活血解郁方合认知疗法在治疗老年PSD患者抑郁症状方面,与百忧解片效果相当。4入组时两组的血液流变学指标均高于正常,全血黏度（120 s-1、70 s-1和30 s-1）、全血还原黏度（高切、中切）、红细胞聚集指数、红细胞刚性指数与汉密尔顿抑郁量表（HAMD）呈显著正相关（P〈0.05~0.01）;5治疗组全血黏度（120 s-1、70 s-1和30 s-1）、全血还原黏度（高切、中切）、红细胞聚集指数、红细胞刚性指数等指标经中医药治疗第10 d的变化值与HAMD抑郁量表的减分值呈显著正相关（P〈0.05~0.01）。结论：运用理气活血解郁法治疗老年脑卒中后抑郁,疗效确切,不仅能显著改善患者抑郁症状,并且还可以明显缓解患者血液的高黏滞状态,且无不良反应,安全有效。

Objective ： To observe the clinical effect of TCM Liqi Huoxue Jieyu therapy compared with Western medicine Cap Prozac in geriatric poststroke depression. Method：We totally brought 120 patients of Zhejiang Geriatric Care Hospital during 2011.7-2013.7 into the survey. They were randomly divided into treatment group and control group （60 cases in each group）. All patients received the routine neurology medical treatment of cerebral infarction. And the patients in treatment group received Liqi Huoxue Jieyu therapy（ Liqi Huoxue Jieyu Decoction combine with cognitive behavior therapy）in addition. Control group was treated with Cap Prozac 20 mg/d. We analyzed all patients＇ Hamilton Depression Scale （HAMD） scores,TCM syndrome chart scores, clinical Hemorheology detection after they admitted to hospital and on the 10th ,30th and 60thday after therapy. Results ： （1）The Hamilton Depression Scale （HAMD） scores of treatment group and contrast group on 10th day after treatment were both significantly decreased and there was statistically significantdifference （P 〈 0.05 ） compared with those before treatment, but no significant difference （ P 〉 0.05 ） between two groups. （2）The TCM syndrome chart scores of treatment group on 10th day after therapy were significantly decreased and there was statistically significant difference （P 〈 0.05） compared with those before treatment. The treatment group＇s score was obviously improved than that of contrast group （ P 〈 0.05 ）. It is suggested that the therapeutic effect in alleviating the elderly PSD patients＇TCM clinical symptoms of Liqi Huoxue Jieyu therapy is better than Cap Prozac. （3）According to the Hamilton Depression Scale （HAMD） reduction rate, the significant effective rate of treatment group was 50% and the normal effective rate was 18.3%. The total effective rate was 68.3%. And the significant effective rate of contrast group was 48.3% and the normal effective rate was 16.7%. The total effective rate was 65.0%. There was no significant difference between two groups effective rate comparison. It is suggested that the therapeutic effect of Liqi Huoxue Jieyu decoction combined with cognitive therapy is the same as Prozac in alleviating the elderly PSD patients＇depressive symptoms. （4）All blood rheology indicators of two groups were higher than those before treatment. There was a positive correlation between whole blood viscosity （ 120 s^-1,70 s^-1 and 30s^-1 ）, whole blood viscosity （high cut,reduction in low shear） , erythrocyte aggregation index, erythrocyte rigidity index and the Hamilton Depression Scale （ HAMD ） （ P 〈 0.05, P 〈 0. 01 ）. There was a positive correlation between whole blood viscosity （ 120 s^-1 ,70 s^-1 and 30s^-1） ,whole blood viscosity （high cut,reduction in low shear） ,erythrocyte aggregation index, erythrocyte rigidity index and the Hamilton Depression Scale （HAMD） reduced scores on 10th days after TCM therapy （P 〈 0.05,P 〈 0.01 ）. Conclusions：Treating geriatric post -stroke depression by Liqi Huoxue Jieyu therapy not only can significantly improve patients with depressive symptoms,but also can relieve the blood hyperviscosity. And the most important,there is no adverse reaction. It is safe and effective.