基于“痰郁”探讨葛根石泻汤治疗持续性姿势-感知性头晕的临床研究

Clinical Study of Gegen Shixie Decoction for the Treatment of Persistent Postural-perceptual Dizziness Based on Phlegm Depression

目的:基于“痰郁”探讨葛根石泻汤治疗持续性姿势-感知性头晕(PPPD)的临床疗效及安全性。方法:选取2022年8月—2023年8月就诊于西安市中医医院脑病科门诊、住院部及耳鼻喉科门诊的PPPD(痰浊中阻并肝气郁结型)病人60例,随机分为对照组和治疗组,每组30例。治疗组予以口服葛根石泻汤,对照组予以口服盐酸帕罗西汀,连续治疗4周。观察两组临床疗效及不良反应,比较两组治疗前后相关疗效及安全性评价指标。结果:治疗前,两组汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)、焦虑自评量表(SAS)评分比较差异无统计学意义(P>0.05);治疗后两组HAMD、SDS、SAS评分均降低(P<0.05),组间比较差异无统计学意义(P>0.05)。治疗前,两组眩晕残障量表(DHI)、视觉模拟评分(VAS)、中医证候评分比较差异无统计学意义(P>0.05);治疗后DHI、VAS、中医临床证候评分均较治疗前降低(P<0.05),组间比较差异有统计学意义(P<0.05)。治疗前,两组中医证候量表各单项评分比较差异均无统计学意义(P>0.05);治疗后各单项积分均较治疗前降低(P<0.05),治疗组头晕目眩、头蒙、耳鸣、头痛、神疲乏力、食欲不振、咽干口燥等单项积分均较对照组降低(P<0.05)。治疗组总有效率为79.31%,对照组总有效率为75.00%,差异无统计学意义(P>0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:葛根石泻汤在改善心烦焦虑抑郁等情绪方面与盐酸帕罗西汀等效,而在改善病人头晕目眩、头蒙、食欲不振等症状方面优于盐酸帕罗西汀,且副作用小,安全性好。

Objective:To investigate the clinical efficacy and safety of Gegen Shixie Decoction for the treatment of persistent postural-perceptual dizziness(PPPD)based on the pathogenesis of phlegm-depression.Methods:Sixty patients with PPPD(blocked phlegm with stagnation of liver qi)were selected and randomly divided into treatment group and control group,with 30 cases in each group.The patients in treatment group were given Gegen Shixie Decoction for 4 weeks,and the patients in control group were given paroxetine hydrochloride for 4 weeks.The clinical efficacy and adverse reactions of the two groups were observed,and the relevant observation indexes before and after treatment were compared.Results:Before treatment,there were no significant differences in the scores of Hamilton Depression Scale(HAMD),Self-Rating Depression Scale(SDS),and Self-rating Anxiety Scale(SAS)between the two groups(P>0.05).After treatment,the scores of HAMD,SDS,and SAS in the two groups decreased(P<0.05),and there was no significant difference between the two groups(P>0.05).Before treatment,there were no statistically significant differences in the scores of Vertigo Disability Scale(DHI),Visual Analogue Scale(VAS),and Traditional Chinese Medicine Clinical Syndrome Evaluation Scale between the two groups(P>0.05).After treatment,the scores of DHI,VAS and Traditional Chinese Medicine Clinical Syndrome Evaluation Scale decreased(P<0.05),and there were significant differences between the two groups(P<0.05).There was no significant difference in the scores of each item of the Traditional Chinese Medicine Syndrome Scale between the two groups before treatment(P>0.05).The scores of each item after treatment were lower than those before treatment(P<0.05).The total effective rate of the treatment group was 79.31%,and the total effective rate of the control group was 75.00%,the difference was significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Gegen Shixie Decoction is equivalent to paroxetine hydrochloride in improving emotions such as upset,anxiety,and depression,and it is better than paroxetine hydrochloride in improving symptoms such as vertigo,dizziness,loss of appetite,with less side effects and better safety.