The Clinical Efficacy Study Of Liqihuoxuejieyu Decoction Combine With Cognitive Behavior Therapy In The Treatment Of Geriatric Post-stroke Depression

Objective Post-stroke depression (Post-stroke depression, PSD) is a common complication after stroke, especially prevalent in elderly patients. Their performance mostly include a lack of interest in anything, emptiness, boredom, apathy, considered meaningless and so alive. Because the occuitence is so subtle, depressive reaction is not easy to be detected. Some patients depressive symptoms can not be detected because of the language barrier. It is always after the accidence when we know it. The clinical west medicine of5-serotonin reuptake inhibitor (SSRI),5-serotonin and norepinephrine reuptake inhibitor (SNRIS) is a better choice for geriatric depression treatment. But these drugs slow onset, long course of treatment, many have serious side effects, and expensive, limiting their use in clinical practice. During the long-term operation, in Zhejiang Geriatric Care Hospital, I found that the clinical efficacy of LiQiHuoXueJieYu Decoction combine with cognitive behavior therapy in geriatric post-stroke depression was wonderful. In this study, we used the way of clinical observations to verify its clinical efficacy investigated the TCM cause and pathogenesis, TCM therapy evaluation in geriatric PSD for more comprehensive, standardized and scientific foundation to promote the use.Method We totally brought120patients of Zhejiang Geriatric Care Hospital in patient department during2011.7-2013.7into the survey. All patients aged75-84years, duration of20months-26months. They were randomly divided into treatment group and control group(60cases in each group). All patients were diagnosed with cerebral infarction by CT or MRI, determination of mild to moderate depression according to the Hamilton Depression Rating Scale for Depression (HAMD), stagnation type according to TCM differentiation in Wang yong-yan "Practical Internal Medicine". All patients received the routine neurology Medical Treatment of cerebral infarction. And the patients in treatment group received LiQiHuoXueJieYu Decoction therapy in addition (Chai hu12g, Fu shou12g, Yu jin12g,Ye Jiao teng9g,dang gui9g, Dan shenlOg Cuan xiongl2g,Chao chi shao12g, Cuan niu xi9g, Ju geng12g. According to the principle of treatment based on syndrome differentiation, we add or subtract the decoction. If the patients sick for a long time with kidney deficiency, we add Zhi shou wu12g, Hu tao18g,Huai shan yao20g,Yi zhi renl8g. If the patients sick with signs of deficiency, we add E jiao12g. If the patients sick for a long time with stasis of heat, we add Sang ye12g,Ju hua12g, Gou teng9g. we made it water decoction, taking200ml at one time, two times a day) combine with cognitive behavior therapy (treatment two times a week, every40minutes, a total of16times). Control group treated with Cap Prozac20mg/d oral treatment. We statisticed all patients’Hamilton Depression Scale (HAMD) scores, TCM syndrome chart scores, clinical Hemorheology detection after they admitted to hospital and on the10th、30th and60th day after therapy. We recorded adverse reactions in the treatment process, conducted Bloodbiochemical examination and ECG after patients admitted to hospital and at60th day after therapy for safety assessment。Results Analysis the statistical data we got, We did not found obvious different in ages, sex, height, weigh betwen two group(P>0.05), suggesting that the two groups were comparable patient data. We statisticed all patients’Hamilton Depression Scale (HAMD) scores, TCM syndrome chart scores, clinical Hemorheology detection after they admitted to hospital and on the10th、30th and60th day after therapy. We use HAMD score decrement rate to evaluate the efficacy of depressive symptoms (Significant effect. decrement rate>60%; normal effect, decrement rate between30%-60%; invalid, decrement rate<30%).we observed:1) From the Hamilton Depression Scale (HAMD) scores statisticed, we can see, the scores of treatment group and contrast group on10th day after treatment are both significantly decreased, there is statistically significant difference (P<0.05)compared with those before treatment, but no significant difference (P>0.05) betwen two groups;2)From the TCM syndrome chart scores statisticed, we can see, the scores of treatment group on10th day after therapy are significantly decreased, there is statistically significant difference (P<0.05)compared with those before treatment, the treatment group are obviously improved much more (P<0.05).It is suggesed that the therapeutic effect in alleviating the elderly PSD patients’ TCM clinical symptoms of Liqi Huoxue Jieyu therapy is better than Cap Prozac.3)From the Hamilton Depression Scale (HAMD) reduction rate statisticed, we observed the Significant effective rate of treatment group was50.0%, the normal effective rate was18.3%, the total effective rate was68.3%; and the Significant effective rate of treatment group was48.3%, the normal effective rate was16.7%, the total effective rate was65.0%. There is no significant difference between two effective rate comparison. It is suggested that the therapeutic effect of LiqiHuoxueJieyu Decoction combined with cognitive therapy is same with Prozac in alleviating the elderly PSD patients’ depressive symptoms.4)A11blood rheology indicators of two groups were higher than normal before treatment. There was a positive correlation between whole blood viscosity (120s-1,70s-1and30s-1), whole blood viscosity (high cut, reduction in low shear), erythrocyte aggregation index, erythrocyte rigidity index and the Hamilton Depression Scale (HAMD)(P<0.05-0.01); There was a positive correlation between whole blood viscosity (120s-1,70s-1and30s-1), whole blood viscosity (high cut, reduction in low shear), erythrocyte aggregation index, erythrocyte rigidity index and the Hamilton Depression Scale (HAMD) reduced scores on10th days after TCM therapy (P<0.05-0.01). There was no adverse reactions happened in two groups patients during the therapy. It is suggested that the therapeutic effect of LiqiHuoxueJieyu Decoction combine with cognitive therapy is safety to be used in clinical.Conclusions Treat geriatric post-stroke depression by the LiQiHuoXueJieYu Decoction combine with cognitive behavior therapy, not only can it significantly improve patients with depressive symptoms, but also can relieve the blood hyperviscosity, and the most important, there was no adverse reactions, safe and effective.