柴胡疏肝散治疗中老年女性缺血性脑卒中后抑郁疗效观察

Efficacy of chaihu shugan powder in treatment of depression after ischemic stroke in middle-aged and elderly women

摘要:

目的 探讨柴胡疏肝散对中老年女性卒中后抑郁患者的疗效。方法 纳入上海中医药大学附属市中医医院诊断为卒中后抑郁的中老年女性患者（127例）作为研究对象。其中，西药对照组42例，中药观察组42例，中西医结合观察组43例。西药对照组在常规治疗基础上，每天服用盐酸舍曲林片；中药观察组在常规治疗的基础上，给予柴胡疏肝散治疗；中西医结合观察组在西药对照组的基础上，给予柴胡疏肝散治疗。3组治疗时间均为1个月。比较3组患者治疗前后汉密尔顿抑郁量表（HAMD）和匹兹堡睡眠质量量表（PSQI）评分，以及血清中5-羟色胺（5-HT）和去甲肾上腺素（NE）水平，并评估临床疗效。结果 治疗后3组患者的HAMD、PSQI评分低于治疗前，且中西医结合观察组患者的HAMD和PSQI评分低于西药对照组和中药观察组（P<0.05）。治疗后3组患者血清5-HT和NE水平较治疗前升高，且中西医结合观察组患者的5-HT和NE水平高于西药对照组和中药观察组（P<0.05）。中西医结合观察组临床总有效率高于西药对照组和中药观察组（P<0.05）。结论 柴胡疏肝散联合盐酸舍曲林能够有效改善中老年女性缺血性卒中后抑郁的抑郁情绪和睡眠障碍，作用机制可能与升高血清中的5-HT、NE水平有关。

Abstract:

Objective To investigate the efficacy of chaihu shugan powder in the treatment of middle-aged and elderly women with post-stroke depression.Methods A total of 127 middle-aged and elderly women who were diagnosed with post-stroke depression in the Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine were enrolled as subjects， and they were divided into Western medicine control group with 42 patients， traditional Chinese medicine observation group with 42 patients， and integrated traditional Chinese and Western medicine observation group with 43 patients. The patients in the Western medicine control group were given sertraline hydrochloride tablets in addition to conventional treatment， those in the traditional Chinese medicine observation group were given chaihu shugan powder in addition to conventional treatment， and those in the integrated traditional Chinese and Western medicine observation group were given chaihu shugan powder in addition to the treatment in the Western medicine control group. The course of treatment was 1 month for all three groups. Among the three groups scores of the Hamilton Depression Scale （HAMD） and the Pittsburgh Sleep Quality Index （PSQI）， and the serum levels of serotonin （5-HT） and norepinephrine （NE） were compared before and after treatment. Clinical efficacy and safety were assessed.Results After treatment， all three groups had significant reductions in HAMD and PSQI scores， and the integrated traditional Chinese and Western medicine observation group had significantly lower HAMD and PSQI scores than the Western medicine control group and the traditional Chinese medicine observation group （P<0.05）. After treatment， all three groups had significant increases in the serum levels of 5-HT and NE， and the integrated traditional Chinese and Western medicine observation group had significantly higher levels of 5-HT and NE than the other two groups （P<0.05）. The integrated traditional Chinese and Western medicine observation group had a significantly higher overall response rate than the Western medicine control group and the traditional Chinese medicine observation group （P<0.05）.Conclusions Chaihu shugan powder combined with sertraline can effectively improve depressive mood and sleep disorders in middle-aged and elderly women after ischemic stroke， possibly by increasing the serum levels of 5-HT and NE.