加味补阳还五汤联合经颅磁刺激治疗卒中后抑郁临床疗效及安全性分析  

Clinical Efficacy and Safety Analysis of Modified Buyang Huanwu Decoction Combined with Transcranial Magnetic Stimulation for Patients with Post-stroke Depression

作　　者：卞伟煜 韩俊萍 单永琳[3] 马凌云[3] 孔彦 BIAN Weiyu;HAN Junping;SHAN Yonglin(The outpatient department1,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou Hebei 061001,China;Intervention Center,Fuwai Hospital Attached to Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Neurology,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine,Cangzhou Hebei 061001,China)

机构地区：[1]河北省沧州中西医结合医院门诊部,河北沧州061001 [2]中国医学科学院阜外医院介入中心,北京100037 [3]河北省沧州中西医结合医院神经内科,河北沧州061001 [4]沧州市中心医院检验科,河北沧州061001

出　　处：《四川中医》2022年第6期124-128,共5页Journal of Sichuan of Traditional Chinese Medicine

基　　金：2020年度河北省中医药科研计划项目(项目编号:2020466)

摘　　要：目的:探讨加味补阳还五汤联合经颅磁刺激在卒中后抑郁(PSD)患者中的应用价值。方法:选择2019年6月~2020年6月间河北省沧州中西医结合医院收治的PSD患者80例,根据随机数字表法均分为观察组与对照组。对照组单纯经颅磁刺激治疗,观察组采用加味补阳还五汤联合经颅磁刺激治疗,两组均观察6周,分析两组治疗效果,比较两组治疗前、后的汉密尔顿抑郁量表(HAMD)、Barthel指数、美国国立卫生院神经功能缺损评估量表(NIHSS)评分。此外,在治疗前、后分别采血检测两组血清单胺类递质水平[去甲肾上腺素(NE)、5-羟吲哚乙酸(5-HIAA)、5-羟色胺硫酸肌酐(5-HT)、多巴胺(DA)]以及炎症因子水平[白介素-1β(IL-1β)、白介素-2(IL-2)、白介素-6(IL-6)、白介素-23(IL-23)、肿瘤坏死因子-α(TNF-α)],记录两组观察期间不良反应发生率。结果:观察组治疗总有效率为92.50%,高于对照组的75.00%(P<0.05)。两组治疗后HAMA、NIHSS评分均较治疗前明显降低,其中观察组低于对照组,而Barthel指数评分较治疗前明显增高,且观察组高于对照组(P<0.05)。两组治疗后血清NE、5-HIAA、5-HT、DA较治疗前均增高,且观察组较对照组明显增高(P<0.05)。两组治疗后血清IL-1β、IL-2、IL-6、IL-23、TNF-α较治疗前明显降低,且观察组较对照组明显降低(P<0.05)。两组不良反应率比较无差异(P>0.05)。结论:PSD患者经加味补阳还五汤联合经颅磁刺激治疗,能进一步缓解抑郁症状与神经功能缺损情况,提升日常生活能力,改善血清单胺类递质水平,减轻炎症,安全性高,总体疗效可靠。Objective:To explore the application value of Modified Buyang Huanwu Decoction combined with transcranial magnetic stimulation for patients with post stroke depression(PSD).Methods:80 cases of PSD patients admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from June 2019 to June 2020 were included.According to the random number table method,they were divided into an observation group and a controlled group with 40 cases each.The controlled group was treated with transcranial magnetic stimulation alone,and the observation group was treated with Modified Buyang Huanwu Decoction combined with transcranial magnetic stimulation.Both groups were observed for 6 weeks.The treatment effects of the two groups were analyzed,and the Hamilton depression scale(HAMD),Barthel Index,and National institutes of health stroke scale(NIHSS)of the two groups were compared before and after treatment.In addition,blood was collected before and after treatment to detect serum norepinephrine(NE)and 5-hydroxyindole acetic acid(5-HIAA),5-hydrotryptamine(5-HT),dopamine(DA)and interleukins-1β(IL-1β),interleukin-2(IL-2),interleukin-6(IL-6),interleukin-23(IL-23),tumor necrosis factor-α(TNF-α).Results:The total effective rate of the observation group was 92.50%,which was higher than 75.00%of the controlled group(P<0.05).The HAMA and NIHSS scores of the two groups after treatment were significantly lower than those before the treatment.The observation group was lower than the controlled group,while the Barthel index score was significantly higher than that before the treatment,and the observation group was higher than the controlled group(P<0.05).Serum NE,5-HIAA,5-HT,DA after treatment in the two groups were all higher than before treatment,and the observation group was significantly higher than the controlled group(P<0.05).Serum IL-1β,IL-2,IL-6,IL-23,TNF-αafter treatment in the two groups were significantly lower than before treatment,and the observation group was significantly lower than the controlled grou

关 键 词：卒中后抑郁 颅磁刺激 加味补阳还五汤 单胺类递质 不良反应 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]