归脾汤加味联合艾司西酞普兰治疗卒中后抑郁伴焦虑的临床观察

Clinical Observation on Modified Guipi Decoction Combined with Escitalopram in the Treatment of Post-stroke Depression with Anxiety

目的探讨归脾汤加味联合艾司西酞普兰治疗卒中后抑郁伴焦虑(PSCAD)的临床疗效,并观察对神经功能及神经递质的影响。方法选取遂宁市中心医院2016年2月—2019年1月收治的PSCAD病人106例,按随机数字表法分为西医组和中西医组,每组53例。西医组给予艾司西酞普兰治疗,每次10~20 mg,1次/日,连续服用8周;中西医组在西医组治疗基础上联合归脾汤加味治疗,每次150 mL,2次/日,4周为1个疗程,服用2个疗程。观察两组治疗前后汉密尔顿抑郁量表(HAMD-24)评分、汉密尔顿焦虑量表(HAMA)评分、神经功能缺损美国国立卫生研究院卒中量表(NIHSS)评分、中医证候评分及血清中去甲肾上腺素(NE)、5-羟色胺(5-HT)、多巴胺(DA)、脑源性神经营养因子(BDNF)水平,评价副反应、中医证候疗效与临床疗效。结果治疗后,中西医组中医证候疗效与临床疗效总有效率分别为90.57%、88.68%,高于西医组的75.47%、71.70%,两组差异均有统计学意义(P<0.05);中西医组HAMD-24、HAMA评分、NIHSS评分和中医证候评分均低于西医组,差异有统计学意义(P<0.05);中西医组血清NE、5-HT、DA、BDNF水平均高于西医组,差异有统计学意义(P<0.05);中西医组副反应总发生率低于西医组,差异有统计学意义(P<0.05)。结论归脾汤加味联合艾司西酞普兰治疗PSCAD可提高神经递质表达,改善抑郁与焦虑症状,促进神经功能恢复,副反应少,临床疗效显著。

Objective To observe the clinical efficacy of Modified Guipi Decoction combined with escitalopram in the treatment of post-stroke depression with Anxiety(PSCAD),and to observe the effects on neurological rehabilitation and neurotransmitters.Methods One hundred and six patients with PSCAD were randomly divided into western medicine group,and Chinese and western medicine group,with 53 cases in each group.The western medicine group was treated with escitalopram 10~20 mg each time,once a day for 8 weeks.The Chinese and western medicine group was treated with Modified Guipi Decoction on the basis of the western medicine group,150 mL per time,twice a day,4 weeks as a course of treatment for two courses.The scores of Hamilton Depression Scale(HAMD-24),Hamilton Anxiety Scale(HAMA),National Institute of Health Stroke Scale(NIHSS),symptoms of Traditional Chinese Medicine,norepinephrine(NE),5-hydroxytryptamine(5-HT),dopamine(DA),brain-derived neurotrophic factor(BDN),adverse reaction,efficacy and clinical efficacy of traditional Chinese medicine were compared between two groups.Results The efficacy and clinical efficacy of traditional Chinese medicine in Chinese and western medicine group were 90.57%and 88.68%,which were higher than those in western medicine group(75.47%and 71.70%,P<0.05).After treatment,the scores of HAMD-24,HAMA,NIHSS and symptoms of traditional Chinese medicine in Chinese and western medicine group were lower than those in western medicine group(P<0.05).The levels of NE,5-HT,DA and BDNF in Chinese and western medicine group were significantly higher than those in western medicine group(P<0.05).The incidence of adverse reaction in the Chinese and western medicine group was lower than that in western medicine group(P<0.05).Conclusion Modified Guipi Decoction combined with escitalopram in the treatment of PSCAD could improve the expression of neurotransmitters,symptoms of depression and anxiety,and promote the recovery of neurological function,with less adverse reaction.