| Research background:Stroke is common and frequently encountered illness of the nervous system, its survival is 50%-70% and has different levels of sequelae(1). Due to damage in physical functionality and brain, patients are easily depressed, which is “Post-stroke Depression(PSD)”. After stroke, patients easily associate with a kind of emotional disorders that characterized in depression, hypofunction, slow thinking. It often makes patients clinically characterized by silence, lost in interest in everything around, refusing to contact with external, even with self-injury and suicide, which not only brings to the patients with physical and mental pain, which conducive to the nerve defect function rehabilitation, also increased the complexity of the physical treatment, hospitalization period, and mortality. Because of its similarity to depression, traditional western medicine treatment for the disease leans to antidepressant, which brings clinical therapeutic effect, but the single treatment, and the slow drug effect, long course of treatment, side effects, expensive, poor patient compliance limited the exertion of its biggest treatment effect. In the First Affiliated Henan Institute of Traditional Chinese Hospital, I followed professor Zhang Yunke during the study, observing him using Chaihu shugan powder Decoction combined with antidepressant drug for the treatment of Post-stroke Depression. It has obvious advantages and the effect is remarkable. This topic is built on the observation and evaluation of Chaihu shugan powder combined with fluoxetine in the treatment of Post-stroke depression to get benefits, from the perspective of the traditional Chinese medicine to research the disease of medicine etiology and pathogenesis, exploring the new thinking for clinical treatment and providing a new way.Objective:The topic is aimed at evaluating the clinical effect of treating PSD using Chaihu shugan powder combined with fluoxetine, putting clinical basis for the traditional Chinese medicine treatment of PSD.Method:We totally brought 60 patients of First Affiliated Henan Institute of Traditional Chinese Hospital in patient department during 2014.3-2014.12 into the survey. They were divided into treatment group and control group(30 cases in each group). All patients were diagnosed with cerebral infarction by CT or MRI, determination of depression according to the Hamilton Depression Rating Scale for Depression(HAMD). All patients were accepted the routine neurology medical treatment of PSD. On the basis, the patients in the control group received fluoxtine(prozac, Britain lilly) 20 mg, taking daily since morning, a total of one time. Treatment group were given Chaihu shugan powder Decoction therapy in addition(Chen pi 12 g, Chai hu 9g, Chuan qiong 6g, Zhi qiao 6g, Bai shao 12 g, Xiang fu 6g, Yu jin 9g, Zhi gancao 3g, add Dang shen 12 g, Huang zhi 20 g for patients with kidney deficiency, add Hou pu 6g, Fa banxia 6g for patients with more phlegm, add Bai he 30 g, Shu dihuang 12 g for patients with yin deficiency, add Tao ren 9g, Hong hua 6g for patients with slasis of heat, add Ye jiaoteng 15 g for patients with felling ill at ease, made it water decoction, 200 ml at one time, twice a day). We statisticed all patients’ Hamilton Depression Scale(HAMD) scores, National Institutes of Health Stroke Scale(NIHSS) scores, Activities of Daily Living(ADL) scores after they admitted to hospital and on the 2nd, 4th and 8th week after the therapy, which is convenient to evaluate the improvement of symptoms of patients with PSD, the rehabilitation of deficiency of neural function and the improvement of life quality. Record the adverse reactions in the process of treatment, conducted RT, liver renal function and ECG after patients admitted to hospital and at 8th week after therapy for safety assessment.Results:Analysis the data we got, we didn’t find obvious different in ages, sex, culture degreebetween two groups(p<0.05), suggesting that the two groups were comparable patient data. We statisticed all patients’ Hamilton Depression Scale(HADM) scores, National Institutes of Health Stroke Scale(NIHSS) scores, Activities of Daily Living(ADL) scores after they admitted to hospital and on the 2nd, 4th, 8th week. At first, 2nd, 4th, 8th week three scale scores in treatment group were less than the control group. There is statistically significant difference(p<0.05); we use HADM score decrement rate to evaluate the efficacy of depression symptoms, from the observing, we can see the scores of treatment group and contrast group on the 2nd, 4th,8th week are both decreased obviously, there is no statistically significant difference, suggesting both two have the same effect. From the Hamilton Depression Scale(HADM) reduction rate stasitced(significant effect, decrement rate>60%; normal effect, decrement rate between 30% and 60%; invaild, decrement rate<30%) to evaluate the efficacy of scores. We observed: the significant effective rate of treatment group was total effective rate was 83%; control group effective rate was 77%, there is no obvious difference. Then we evaluate the effect of improvement of nerve function deficiency according to the difference of the scores of NIHSS and ADL, there is statistically significant on the scores of NIHSS and ADL before and after treatment(p<0.05). The treatment group are obviously improve much more than the contrast group, suggesting the patients with PSD treated by Chaihu shugan powder can improve depression symptoms. Besides that, there was no adverse obvious reactions between two groups, suggesting the method of clinical is safe and effective.Conclusion:Treat PSD by the Chaihu shugan powder Decoction combined with fluoxetine, not only have no adverse reactions, safe and effective, but also can it have obvious advantages to promote the rehabilitation of nerve defect and improve the ability of self-care, deserving further research. |
PDF Full Text Request