基于"双心模式"的疏调汤治疗冠心病合并焦虑抑郁临床研究

Clinical study on Shutiao Decoction based on psycho-cardiacology model in treating coronary heart disease with anxiety and depression

目的评价疏调汤治疗冠心病合并焦虑抑郁患者的临床疗效。方法将符合入选标准的2019年1-12月昆明市中医医院稳定性冠心病合并焦虑抑郁患者60例按随机数字表法分为2组,每组30例。对照组采用冠心病西医常规疗法联合心理干预,治疗组在对照组基础上服用疏调汤。2组均治疗4周。分别于治疗前后进行中医证候评分,采用西雅图心绞痛量表(Seattle Angina Questionnaiire,SAQ)评估患者生活质量及机体功能状态,采用汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)、汉密顿抑郁量表(Hamilton Depression Scale,HAMD)评估患者的焦虑、抑郁状态,评价临床疗效。结果治疗组总有效率为90.0%(27/30)、对照组为73.3%(22/30),2组比较差异有统计学意义(Z=-2.515,P=0.012)。治疗后,治疗组中医证候评分[(9.37±6.47)分比(18.37±6.58)分,t=-5.341]低于对照组(P<0.01);SAQ量表中躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度评分均高于对照组(t值分别为2.294、7.698、4.677、3.215,P<0.05或P<0.01);HAMA[(9.20±5.26)分比(12.17±4.88)分,t=-2.266]、HAMD[(11.27±5.83)分比(15.03±6.16)分,t=-2.433]评分低于对照组(P<0.05)。结论疏调汤结合西医常规疗法及心理干预可有效改善冠心病合并焦虑抑郁患者生活质量及机体功能状态,提高临床疗效,改善心绞痛症状及焦虑、抑郁状态。

Objective To observe the clinical effect of Shutiao Decoction on patients with coronary heart disease and anxiety and depression.Methods Sixty patients with stable coronary artery disease and anxiety and depression from January 2019 to December 2019 in Kunming Municipal Hospital of Traditional Chinese Medicine were selected.They were divided into a treatment group of 30 cases and a control group of 30 cases according to random number table method.The control group recieved Western medicine routine treatment combined with psychological intervention,the treatment group was treated with Shutiao Decoction on the basis of the control group,and the treatment course of both groups was 4 weeks.Before and after treatment,TCM syndrome score,Seattle Angina Scale(SAQ),Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were evaluated.The adverse events were recorded during treatment and clinical efficacy was evaluated.Results After treatment,the total effective rate in the treatment group was 90.0%(27/30),the control group was 73.3%(22/30),where the difference between the two groups was statistically significant(Z=-2.515,P=0.012).After treatment,the TCM syndrome score(9.37±6.47 vs.18.37±6.58;t=-5.341,P<0.01)of the treatment group was significantly lower than that of the control group.Among SAQ domains’scores,the physical activity limitation,and the stable state of angina pectoris,angina attack in the treatment group were significantly higher than those of the control group(t values were 2.294,7.698,4.677,3.215,respectively,P<0.05 or P<0.01).The HAMA score of the treatment group was significantly lower than that of the control group(9.20±5.26 vs.12.17±4.88;t=-2.266,P=0.027).The HAMD score in the treatment group was significantly lower than that of the control group(11.27±5.83 vs.15.03±6.16;t=-2.433,P=0.018).During the treatment period,the incidence of adverse reactions was 3.33%(1/30)in the treatment group and 6.67%(2/30)in the control group.There was no statistically significant difference between the two groups(χ2=0.351,P=0.554).Conclusion Shutiao Decoction combined with western medicine routine treatment can improve patients’TCM syndromes,relief angina pectoris,anxiety and depression.