吴志敏　　胡万华　　赵娜

[摘要] 目的 觀察解郁1号方联合八段锦干预脑卒中后抑郁（PSD）的临床疗效及作用机制。方法 研究对象为2019年1—12月在温州市中医院神经内科住院的80例PSD患者，随机分成试验组和对照组，每组40例。对照组予盐酸舍曲林治疗，试验组予解郁1号方联合八段锦治疗，治疗后观察两组临床疗效并进行比较。分别采用汉密尔顿抑郁量表（HAMD）、症状自评量表（SCL-90）对PSD患者抑郁情况及相关心理状况进行评价，两组患者治疗前、治疗4周后分别评价1次;治疗前、治疗4周后检测患者血清中5-羟色胺（5-HT）、脑源性神经营养因子（BDNF）水平。 结果 治疗4周后，试验组患者的HAMD、SCL-90躯体化、抑郁、其他（饮食睡眠）因子均低于对照组，差异均有统计学意义（P<0.05）;两组患者5-HT和BDNF水平均比治疗前明显提高，差异均有统计学意义（P<0.05），且试验组治疗后5-HT和BDNF数值均高于对照组（P<0.05）;两组不良反应和脱落发生率比较，差异无统计学意义（P>0.05）。 结论 解郁1号方联合八段锦治疗PSD的临床疗效显著，可能与提高患者5-HT、BDNF的表达有关。

[关键词] 八段锦;解郁1号方;脑卒中后抑郁;临床观察

[中图分类号] R749.4;R743.3          [文献标识码] B          [文章编号] 1673-9701（2021）11-0134-04

Clinical observation of JieYu No.1 Recipe combined with Baduanjin in treatment of post-stroke depression

WU Zhimin   HU Wanhua   ZHAO Na

Department of Neurology， Wenzhou Hospital of Traditional Chinese Medicine in Zhejiang Province， Wenzhou   325000， China

[Abstract] Objective To observe the clinical efficacy and mechanism of Jieyu No.1 Recipe combined with Baduanjin in intervention of post-stroke depression（PSD）. Methods A total of 80 patients with PSD who were hospitalized in the Department of Neurology， Wenzhou Hospital of Traditional Chinese Medicine from January to December 2019 were selected as the study objects. They were randomly divided into the experimental group and the control group， with 40 cases in each group. The control group was treated with sertraline hydrochloride， and the experimental group was treated with Jieyu No.1 Recipe combined with Baduanjin treatment. After treatment， the clinical efficacy of the two groups was observed and compared. The Hamilton Depression Scale（HAMD） and Self-Rating Symptom Scale（SCL-90） were used to evaluate the depression and related psychological conditions of PSD patients. The two groups were evaluated once before treatment and four weeks after treatment. The serum levels of 5-hydroxytryptamine（5-HT） and brain-derived neurotrophic factor（BDNF） were detected before treatment and after four weeks of treatment. Results After four weeks of treatment， the HAMD， SCL-90 somatization， depression， and other（diet and sleep） factors of the experimental group were lower than those of the control group， and the differences were statistically significant（P<0.05）. The levels of 5-HT and BDNF of the two groups were significantly higher than before treatment， and the differences were statistically significant（P<0.05）. After treatment， the values of 5-HT and BDNF in the experimental group were higher than those in the control group（P<0.05）; There was no statistically significant difference in the incidence of adverse reactions and shedding（P>0.05）. Conclusion Jieyu No.1 Recipe combined with Baduanjin has a significant clinical effect in the treatment of PSD， which may be related to increasing the expression of 5-HT and BDNF in patients.

[Key words] Baduanjin; JieYu No.1 Recipe; Post-stroke depression; Clinical observation

卒中后抑郁（Post-stroke depression，PSD）是脑卒中后最常见的神经、精神症状之一，而且发病率逐年增加[1]，在卒中发生后最初3个月内抑郁的患病率约为27.3%[2]。PSD严重影响卒中患者的神经功能恢复，降低生存质量，延长住院时间及增加家庭和社会的负担，甚至增加致残率及死亡率[3]。大多数脑卒中患者存在一定程度抑郁障碍，同时也伴有焦虑、躯体化症状、恐怖情绪和睡眠障碍等心理障碍问题，严重影响了患者及其家属的生活和工作。因此，本研究采用随机对照研究方法，以常规西药治疗为对照组，观察解郁1号方联合八段锦对脑卒中后抑郁患者相关心理问题的干预效果。……