摘要
目的:分析脑卒中后抑郁患者中医证型与神经功能、精神心理学表现的相关性,为辨证施治提供依据。方法:选择2002-04/2005-07在阜新矿业集团公司总医院治疗的脑卒中后抑郁患者177例。①入选对象均在出院前1周内由资深中医师进行辨证诊断,并接受了以下几项评估:神经功能缺损评分(满分45分,分值越高,缺损程度越重)、Fugl-Meyer评分(满分100分,上肢66分,下肢34分,评分越高运动能力越好)、改良的Barthel指数(满分为100分,评分越高日常生活活动能力越好)、临床精神卫生症状自评量表(SCL-90,评估指标包括总分,阳性总分,阳性项目均数和阳性项目均分)、汉密尔顿抑郁和焦虑量表(均为得分越高病情越重)。不同证型患者间进行各量表得分比较。②将患者分为单一证型、2种证型和≥3种证型,并进行组间得分比较。③将患者按虚证、实证和虚实夹杂证型分组,并进行组间得分比较。结果:177例患者均进入结果分析。①177例患者中痰瘀互阻型43例、气滞血瘀型64例、肾精不足型21例、脾胃虚弱型33例、痰火扰心型16例。痰瘀互阻型、气滞血瘀型和肾精不足型患者的Fugl-Meyer评分、改良的Barthel指数得分明显低于总体样本和脾胃虚弱型、痰火扰心型患者,而前3者中多数神经功能缺损评分、汉密尔顿抑郁和焦虑量表得分、SCL-90各项均分都明显高于后3者(P均<0.05～0.01)。②单一证型和2种证型患者的Fugl-Meyer评分、改良的Barthel指数得分明显高于总体样本和≥3种证型患者,而前2者中多数神经功能缺损评分、汉密尔顿抑郁和焦虑量表得分、SCL-90各项均分都明显低于后2者(P均<0.05～0.01)。③虚证、实证、虚实夹杂证证型患者之间多数神经功能和心理学检查评分无明显区别(P均>0.05)。结论:痰瘀互阻、气滞血瘀、肾精不足证型中风后“郁证”及多种证型组合(≥3种)患者的神经功能指标和精神心理学损害较重,进行中医辨证施治有可能改善病情。
AIM： To analvze the correlation of syndrome types in traditional Chinese medicine with neurological function and the.manifestations of mental psychology in patients with post-stroke depression, so as to provide evidence for the treatment based on the syndrome differentiation. METHODS： Totally 177 patients with post-stroke depression were selected from General Hospital of Fuxin Mining Industry Group from April 2002 to July 2005.①All the enrolled subjects were diagnosed based on syndrome differentiation by senior traditional Chinese medicine physicians within 1 week before discharge, and also assessed by neurological deficit scale （NDS, overall scores were 45, higher scores represented more severe deficit degree）, Fugl-Meyer assessment （FMA, overall scores 100 including 66 scores in upper limbs and 34 in lower limbs; higher scores reflected better motor ability）, modified Barthel index （BI, overall scores 100, higher scores reflected better daily life activity）, symptom checklist-90 （SCL-90, including total scores, positive total scores, mean of positive items and mean score of positive item）, Hamilton depression rating scale （HAMD） and Hamihon anxiety rating scale （HAMA, the higher the scores, the more severe the disease）. Comparison in scores of each scale was carried out among the patients with different syndrome types. ②The patients were divided into single syndrome, two types syndromes and more than three types syndromes, and the scores of each group were compared. ③The patients were grouped according to deficiency syndrome, excess syndrome and combination of deficiency and excess syndromes, and the scores of each group were compared. RESULTS： All 177 subjected were involved in the result analysis. ①Of the 177 patients, there were 43 cases with phlegm-blood stasis blocking, 64 with blood stasis due to stagnation of qi, 21 with deficiency of kidneyessence, 33 with deficiency of the spleen-and stomach and 16 with mental disturbance due to phlegm-fire. ②The scores of FMA and BI in the patients with phlegm-blood stasis blocking, blood stasis due to stagnation of qi, and deficiency of kidney-essence were obviously lower than those of the total samples and patients with deficiency of the spleen and stomach and mental disturbance due to phlegm-fire, whereas the total scoies of NDS, HAMD, HAMA, average scores of SCL-90 items in the former three groups were all obviously higher than those in the latter three groups （all P 〈 0.05-0.01）. The scores of FMA and BI among the patients with single and two syndrome types were obviously higher than those of the total samples and the patients with three or more syndrome types, whereas the total scores of NDS, HAMD, HAMA, and average score of SCL-90 items were all obviously lower in the former two than in the latter two （all P 〈 0.05- 0.01）.③There were no obvious differences in the scores of most items of neurological function and psychological tests among the patients of deftciency syndrome, excess syndrome and the deficiency-excess syndrome （all P 〉 0.05）. CONCLUSION： The damages of neurological function and mental psychology are more serious in patients with the syndrome types of phlegmblood stasis blocking, blood stasis due to stagnation of qi, deficiency of kidney-essence, as well as those with several （three or more） syndrome types. The conditions may be improved by the treatment based on syndrome differentiation in traditional Chinese medicine.
出处
《中国临床康复》
CSCD
北大核心
2006年第47期21-24,共4页
Chinese Journal of Clinical Rehabilitation
