温胆汤治疗创伤后应激障碍临床研究

Clinical Study on Wendan Tang for Post-Traumatic Stress Disorder

目的:观察温胆汤治疗创伤后应激障碍(PTSD)的临床疗效。方法:选择PTSD患者120例,按随机数字表法分为中药组、西药组和联合组各40例。中药组采用温胆汤治疗,西药组采用盐酸帕罗西汀片治疗,联合组采用温胆汤联合盐酸帕罗西汀片治疗,治疗3个月。比较3组治疗前后症状评分、创伤后应激障碍检查表—平时版(PCL-C)评分及匹兹堡睡眠质量指数量表(PSQI)评分,检测血清5-羟色胺(5-HT)和多巴胺(DA)水平,评价3组临床疗效,统计治疗期间3组不良反应发生情况。结果:中药组总有效率为82.5%,西药组为70.0%,联合组为92.5%,联合组总有效率高于中药组和西药组(P<0.05)。治疗后,3组各项症状评分及总评分较治疗前降低(P<0.05),且联合组各项症状评分及总评分低于中药组和西药组(P<0.05)。治疗1个月、2个月、3个月后,3组血清5-HT水平较治疗前升高,DA水平较治疗前降低(P<0.05);联合组血清5-HT水平高于同时间点中药组和西药组,DA水平低于同时间点中药组和西药组(P<0.05)。治疗1个月、2个月、3个月后,3组PCL-C评分、PSQI评分较治疗前降低(P<0.05);联合组PCL-C评分、PSQI评分低于同时间点中药组和西药组(P<0.05)。中药组不良反应发生率为17.5%,西药组为75.0%,联合组为47.5%,中药组不良反应发生率低于西药组和联合组(P<0.05),联合组不良反应发生率低于西药组(P<0.05)。结论:温胆汤联合盐酸帕罗西汀治疗PTSD能提高患者血清5-HT含量,降低DA含量和应激障碍水平,改善患者睡眠,临床疗效较好。单独使用温胆汤也可达到和盐酸帕罗西汀片类似的临床效果,且不良反应发生率较低,对于使用西药不良反应比较严重的患者,建议采用温胆汤治疗。

Objective:To observe the clinical effect of Wendan tang for post-traumatic stress disorder(PTSD).Methods:A total of 120 cases of PTSD patients were divided into the Chinese medicine group,the western medicine group and the combination group according to the random number table method,with 40 cases in each group.The Chinese medicine group was treated with Wendan tang,the western medicine group was treated with paroxetine hydrochloride tablets,and the combination group was treated with Wendan tang combined with paroxetine hydrochloride tablets.All groups were treated for three months.Before and after treatment,the scores of symptoms,Posttraumatic Stress Disorder Checklist-Civilian Version(PCL-C)and Pittsburgh Sleep Quality Index(PSQI)in the three groups were compared.The levels of 5-hydroxytryptamine(5-HT)and dopamine(DA)in serum were detected.The clinical effects in the three groups were evaluated.During treatment,the incidence of adverse reactions in the three groups was counted.Results:The total effective rate was 82.5%in the Chinese medicine group,70.0%in the western medicine group and 92.5%in the combination group,and the total effective rate in the combination group was higher than those in the Chinese medicine group and the western medicine group(P<0.05).After treatment,the symptom scores and the total scores in the three groups were decreased when compared with those before treatment(P<0.05),and the symptom scores and the total score in the combination group were lower than those in the Chinese medicine group and the western medicine group(P<0.05).After treatment for one,two and three months respectively,the 5-HT levels in serum in the three groups were increased when compared with those before treatment,and the DA levels were decreased(P<0.05);the 5-HT levels in serum in the combination group were higher than those in the Chinese medicine group and the western medicine group at the same time point,and the DA levels were lower(P<0.05).After treatment for one,two and three months respectively,the scores of PCL-C and PSQI in the three groups were decreased when compared with those before treatment(P<0.05);and the scores of PCL-C and PSQI in the combination group were lower than those in the Chinese medicine group and the western medicine group at the same time point(P<0.05).The incidence of adverse reactions was 17.5%in the Chinese medicine group,75.0%in the western medicine group and47.5%in the combination group.The incidence of adverse reactions in the Chinese medicine group was lower than those in the western medicine group and the combination group(P<0.05),and the incidence of adverse reactions in the combination group was lower than that in the western medicine group(P<0.05).Conclusion:Wendan tang combined with paroxetine hydrochloride tablets for PTSD can improve the 5-HT content in serum and the sleep quality,and reduce the DA content and stress disorder levels with a good clinical effect.Wendan tang alone can also achieve the clinical effect similar to that of paroxetine hydrochloride tablets,with a low incidence of adverse reactions.For patients with serious adverse reactions of western medicine,Wendan tang is recommended.