【作者】 林孔秦；

【导师】 陈国华；

【作者基本信息】 湖北中医药大学 ， 中医内科学（专业学位）， 2013， 硕士

【摘要】 目的卒中后抑郁（Post-stroke depression，PSD）是发生于脑卒中之后，严重影响卒中神经功能缺损恢复的常见并发症之一，表现类似于抑郁症。现临床上常用5-羟色胺再摄取抑制剂、NE和5-羟色胺再摄取抑制剂等抗抑郁药物治疗本病。但此类药物起效慢，疗程长，多有严重副作用，且价格昂贵，限制了其在临床的使用。在笔者跟随陈国华教授学习期间，发现陈师使用和营解郁汤治疗卒中后抑郁，每有奇效，本课题遂以临床观察的形式，验证和营解郁汤治疗卒中后抑郁患者的临床疗效，探讨PSD的中医病因，病机及中医药治疗评价，为推广其在临床的使用奠定基础。方法本课题共选取2011.6-2012.6之间，武汉市中西医结合医院神经内科住院患者76例。所有患者均为新发脑梗死（脑梗死发病时间距离本次就医时间14天内），且经头颅CT/MRI证实。76例患者随机分为治疗组（40例）和对照组（36例），所有患者均接受脑梗死神经内科常规治疗，在此基础上，治疗组给予和营解郁汤加减辨证治疗（百合30g、白芍15g、知母15g、丹参15g、酸枣仁15g，根据临床辩证需要酌情加减，气滞明显者加柴胡15g、川芎15g、香附6g；痰浊壅盛者加胆南星15g、竹茹15g、半夏15g；血瘀较甚者加桃仁15g、红花10g、当归10g；阴虚较甚者加怀牛膝30g、天冬15g、玄参15g；证见阴阳两虚者，加肉桂15g、制附子6g、熟地30g，水煎服，每次200ml口服，每日2次）；对照组给予盐酸舍曲林（左洛复）100mg/d，口服治疗。两组患者分别于入院时及接受治疗后2、6、10周进行HAMD评分，NIHSS评分，ADL评分，对该方对于抑郁症状改善功能及神经功能缺损改善功能进行评价。记录治疗过程中的不良反应，并分别于入院时及治疗后10周进行血液分析等生化检查及心电图检查，对该方临床使用的安全性进行评价。结果分析采集到的数据，我们分别记录两组中患者的年龄，性别，文化程度及神经功能缺损严重程度并进行对比，未发现两组患者之间有明显差异（P>0.05），提示两组患者资料具有可比性。于治疗前及治疗后2、6、10周对两组患者进行汉密尔顿抑郁量表（HAMD），美国国立卫生研究院卒中量表（NIHSS），日常生活活动能力量表（ADL）评定，记录分数。抑郁症状的疗效以治疗前后HAMD分数差异评定，观察到治疗组开始治疗后2周HAMD分数就明显下降，较治疗前差异有统计学意义（P<0.05），而对照组在治疗开始2周后也观察到HAMD分数下降，较治疗前差异有统计学意义。以HAMD减分率（显效，减分率≥60%；有效，减分率介于30%-60%之间；无效，减分率≤30%）来统计有效例数，观察到治疗组有效率为54%，显效率为34%，总有效率达88%；对照组有效率为57%，显效率为27%，总有效率为84%，两者有效率对比并无明显差异。在神经功能缺损症状改善方面，治疗组在接受治疗前后NIHSS评分及ADL评分的差异均有统计学意义（P<0.05），且相对于对照组而言，卒中症状改善更为明显，提示卒中常规治疗联合和营解郁汤能针对PSD的特征，兼顾改善PSD患者的卒中症状。针对不良反应的观察，也有令人振奋的结果，两组患者均未出现严重不良反应，提示该方运用于临床治疗卒中后抑郁是安全可行的。结论运用和营解郁汤治疗卒中后抑郁，和营法和解郁法并举，疗效确切，不仅能显著改善患者抑郁症状，并且可以促进患者神经功能缺损恢复，提高生活自理能力，且无不良反应，安全有效。更多还原

【Abstract】 ObjectivePost-stroke depression (PSD) is a depressive state secondary to stroke. Its clinical manifestations similar to typical depression，thus low spirits，slow response and reduced verbal activity and motions，it is one of the most common complication ofstroke.During the study following Chen professor,I found use HeYingJieYu decoction to treat PSD was effective. So I conductedthis research，aimed to test and verify the HeYingJieYu decoction’s effect of the treatment of post-stroke depression patients and to investigate the cause and pathogeny of PSD and openup new ideas of the traditional Chinese medicine therapy.Methodswe totally bring76patients of WuHan First Hospital neurology in patient department during2011.6-2012.6into the survey.all patients were newly attacked with cerebral infarction（means get access to hospital after cerebral infarction attacked infourteen days），and all patients were confirmed by head CT/MRI.76patients were randomly divided into treatment group（40cases）and control group（36cases）. Both groups received the routineneurology Medical Treatment of cerebral infarction，and receive d the HeYingJieYu decoction therapy in addition.（Bai he30g，Bai shao15g，Zhi mu15g，Dan shen15g，Suan zao ren15g，and According to the principle of treatment based on syndrome differentiation，we add and subtract the decoction.patients with Qi depression，we add Chai hu15g，Chuan xiong15g，Xiang fu6g；with Phlegm，we add Dan nan xing15g，Zhu ru15g；Ban xia15g；with Blood stasis，we add Tao ren15g，Hong hua10g，Dang gui10g；with Yin deficiency，we add Huai niu xi30g，Tian dong15g，Xuan shen15g；with Yin and Yang deficiency，we add Rou gui15g，Zhi fu zi6g，Shu di30g，we made it water decoction，taking200ml at one time，two times a day.Control group treated with sertraline100mg/d. we statistics patients’ HAMD scores，NIHSS scores，ADL scores after they admitted to hospital and at the2,6,10weeks after therapy. Evaluate the Effect of improvement ofthe symptoms of depression and Nerve function defect. Recordsof adverse reactions in the treatment process.we conduct Bloodbiochemical examination and ECG after patients admitted to hospital and at the10weeks after therapy for safety assessment。ResultsAnalysis the statistical data we got，We did not found obvious different in ages, level of education,sex, degree of nerve function defect between two group. We use HAMD score decrement rate to Evaluate the efficacy of HeYingJieYu decoction（we set three levels：Significant effect，decrement rate>60%；normaleffect，decrement rate between30%-60%；invalid，decrement rate<30%）.we observed effective rate of treatment group was88%,compared with84%of control group,the result did not show significant different. While in the aspect of improvement of nerve f unction defection,treatment group show advantage than controlgroup. There is statistical significance Differences between the treatment group and the control group which measured by NIHSS scale and BI scale,suggested the HeYingJieYu decoction can give consideration to both stroke and depression.and one more exciting results was there was no Adverse reactions happened during the threpy，thus proved its safety in used in clinical.ConclusionsTreat post-stroke depression by the HeYingJieYu decoction，for it gives consideration to both stroke and depression，Not only can it significantly improve patients with depressive symptoms，But also can promote nerve function defect recovery.and the most important，there was no adverse reactions.更多还原