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

Randomized Parallel Control Study on the Effect of Xuefu Zhuyu Decoction(血府逐瘀汤) combined with WANG Leting,s(王乐亭) “Piwei Laoshizhen/脾胃老十针” and Midication for Post-stroke Depression

[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（P0.01） while acupuncture combined with medicine group was better than combined of traditional and western medicine group（P0.01）. 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（P0.01）, and combined of traditional and western medicine group and acupuncture combined with medicine group were better than the control group（P0.01 or P0.05） while acupuncture combined with medicine group was better than combined of traditional and western medicine group（P0.05）. [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.