舒心解郁汤联合生物反馈治疗老年冠心病伴抑郁障碍的临床研究

Clinical Study of Shuxin Jieyu Decoction (舒心解郁汤) Combined with Biofeedback on Elderly Patients with Coronary Heart Disease and Depression

目的:探讨舒心解郁汤联合生物反馈对老年冠心病(CHD)伴抑郁障碍患者自主神经功能、心率变异性及抗氧化应激平衡的影响。方法:将300例老年冠心病伴抑郁障碍患者按照随机数字表法分为治疗组和对照组,每组150例。所有患者均给予常规冠心病治疗和舍曲林抗抑郁治疗,对照组给予生物反馈治疗,治疗组给予舒心解郁汤联合生物反馈治疗,比较两组患者自主神经功能、心率变异性及氧化/抗氧化应激指标,评价治疗有效性与安全性。结果:治疗组总有效率高于对照组(P<0.05);治疗后两组患者汉密尔顿抑郁量表(HAMD-17项)评分、抑郁自评量表(SDS)评分、中医证候积分均显著降低(P<0.05),且治疗组患者治疗后各评分显著低于对照组(P<0.05);治疗后两组患者全部窦性心搏RR间期标准差(SDNN)、相邻RR间期差值的均方根(RMSSD)、相邻NN之间>50 ms的个数占总窦性心搏个数的百分比(PNN50)均显著提高(P<0.05),且治疗组患者治疗后各指标均显著高于对照组(P<0.05);治疗后两组患者血清超氧化物歧化酶(SOD)、总氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)显著提高(P<0.05),丙二醛(MDA)显著降低(P<0.05),且治疗组患者治疗后血清SOD、T-AOC、GSH-Px显著高于对照组(P<0.05),MDA显著低于对照组(P<0.05);两组患者治疗2周、4周、8周后不良反应症状量表(TESS)评分比较,差异无统计学意义(P>0.05)。结论:舒心解郁汤联合生物反馈治疗老年冠心病伴抑郁障碍能显著缓解患者抑郁情绪,提高HRV时域指标,改善其自主神经功能状态,促进氧化/抗氧化应激平衡,且安全性高,不良反应小。

Objective: To explore the effects of Shuxin Jieyu decoction combined with biofeedback on autonomic nervous function, heart rate variability and antioxidant stress balance in elderly patients with coronary heart disease(CHD) and depression. Methods: Totally 300 elderly CHD patients with depressive disorder were divided into treatment and control groups according to random number table method, 150 cases in each group. All patients were given routine CHD treatment and traseline antidepressant treatment. Patients were treated by biofeedback treatment in control group and Shuxin Jieyu decoction combined with biofeedback in treatment group.The autonomic nervous function, heart rate variability and oxidative/antioxidative stress indexes were compared between the two groups to evaluate the efficacy and safety of the treatment. Results: The treatment group showed higher total effective rate than control groupe(P<0.05);After treatment, the scores of hamilton depression scalee(HAMD-17), self-rating depression scaleee(SDS) and TCM syndromes decreased in the two groupse(P<0.05),and the treatment group showed lower scores than the control groupe(P<0.05). After treatment, the RR standard deviation, RMSSD and PNN50 of all sinus beats increased significantly in the two groupse(P <0.05), and the treatment group showed higher indexes than the control groupe(P<0.05). After treatment, the serum superoxide dismutasee(SOD), total oxidative capacitye(T-AOC) and glutathione peroxidasee(GSH-Px) increased significantly in the two groups(P<0.05), while malondialdehydee(MDA) decreased significantly in the two groups(P<0.05);the treatment group showed higher serum SOD, T-AOC and GSH-Px than the control groupe(P<0.05), while lower MDA than the control groupe(P <0.05). There was no significant difference in TESS score between the two groups in 2, 4 and 8 weeks of treatmente(P>0.05). Conclusion: Shuxin Jieyu decoction combined with biofeedback in the treatment of elderly CHD patients with depressive disorder can significantly alleviate depressive mood,improve HRV time-domain indicators, improve autonomic nervous function and promote oxidative/antioxidant stress balance, with high safety and less adverse reactions.