柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症的临床观察.pdf柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症的临床观察.pdf

收藏 分享

资源预览需要最新版本的Flash Player支持。
您尚未安装或版本过低,建议您

北方药学2011年第8卷第2期柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症的临床观察郭建红111王顺顺2111范荣31(1湖南益阳市南县妇幼保健院妇产科益阳413201;21湖南省妇幼保健院妇产科长沙410008;3中南大学湘雅医院中西医结合科长沙410008)摘要目的观察柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症的临床疗效。方法将72例符合西医产后抑郁症诊断标准的患者按随机数字表法分为对照组34例和治疗组38例,对照组与治疗组分别应用G80G81G82西G83,柴胡疏肝散合甘麦大枣汤为G84方G85G86随G87加减G85G86G88G89,疗G8A为4G8B,结合G8CG8DG8E抑郁G8F表(HAMDG90G8FG91G92分的减分G93G85G86疗效G92G94,G95对G96G85G86G97G98。结G99治疗组G9A治疗后的HAMDG92分G9BG9CG9D效G93与对照组G97G98G9EG9FGA0G9DGA1GA2学GA3GA4(P005G90。结GA5柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症疗效GA6GA7,GA8GA9用GAA。关键词柴胡疏肝散合甘麦大枣汤产后抑郁症中图分类号R7494文献标识码B文章编号16728351(2011)02001803ABSTRACTOBJECTIVETOEXPLORETHECLINICALEFFICACYOFCHAIHUSHUGANSANGANMAIDAZAODECOCTIONINTHETREATMENTOFPOSTPAR-TUMDEPRESSION.METHODSSEVENTYTWOPOSTPARTUMDEPRESSIONPATIENTSWERERANDOMLYDIVIDEDINTOTREATMENT(N38G90ANDCONTROLGROUP(N34G90,THETREATMENTGROUPWASGIVENCHAIHUSHUGANSANGANMAIDAZAODECOCTIONFOR4WEEKS,CONTROLGROUPWASGIVENFLUOX-ETINEHYDROCHLORIDEFOR4WEEKS.CLINICALEFFICACIESWEREASSESSEDWITHTHEHAMILTONDEPRESSIONRATINGSCALE(HAMDG90BEFORETREATMENTANDATTHEENDOFTHE2NDAND4THWEEK.RESULTSAFTERTREATMENTTHETOTALSCORESOFTHEHAMDOFBOTHGROUPSLOWEREDMORESIGNIFICANT-LYCOMPAREDWITHPRETREATMENT(P001G90,BUTTHOSEDIDMORESIGNIFICANTLYINTHETREATMENTTHANINTHECONTROLGROUPINTHECORRESPOND-INGTIMEPERIOD(P001G90.CONCLUSIONCHAIHUSHUGANSANGANMAIDAZAODECOCTIONMAYNOTABLYAUGMENTANTIDEPRESSIONEFFECTINTHETREATMENTOFPOSTPARTUMDEPRESSION,HIGHERSAFETYANDBETTERCOMPLIANCE.KEYWORDSCHAIHUSHUGANSANGANMAIDAZAOPOSTPARTUMDEPRESSIONHAMD产后抑郁症(POSTPARTUMDEPRESSIONG90GABGAC组GADGAEGAF(GB0GB1G90GB2GB3GB4GB5为GB6GB7GB8GB9的GBAGBBGBCGBD,GBEGBFG9DGC0GC1和G86GC2的GC3GC4GC5GC6GC7症GC81,GABGC9GCAGCB的分GCCG95GCD症2,GCDGCEG93G98GCF,GD0GD1G9DGD2GD3GD4GD5G96GCDGCEG93为20~28%3,GD0GD6的GACGD7GD8GD9GDAGDBGCDGDC为76~209%4。GB7GCEGDDGDEGDFGE0产妇的GE1GB0健GE2,GE3GE4GDFGE0GE5GE6的GE7GE8GE9G94。目GEA临床GEB用西药G85G86G88G89,GECG96GEDGEEGEFGF0GF1GDDGF2GF3应GC5GA8GA9用G98GEB5G9B6,GF4GF5GF6GEB患者GF7GF8GF9GF7GFAGFBGFC法GFDGFEG96GA8GA9用GFF难GAD长时间巩固治疗。GF7此,寻找G9D效G9B安全G9B依从性好的治疗方法GFE到了人们的普遍关注,GFF祖GD0医学G9A这方面的优势GE3日益彰GA7出来。GB7GD2采用柴胡疏肝散合甘麦大枣汤加味治疗产后抑郁症72例,取得了G97G98理想的治疗效G99,GDCGD4GD5如下。1临床资料1.1GAC般资料共观察治疗72例(GA0完成临床观察),GA0为湖南南县妇幼保健院妇产科G9B湖南省妇幼保健院妇产科G9B中南大学湘雅医院中西医结合科2005年1月~2010年12月收治住院患者。按随机数字表法随机分为两组治疗组38例,年龄261425岁,孕次18409次,孕G8B391413G8B,新GE7儿GC7重3311383G,剖宫产G93278%,阴GD5器械助产G93为12.8%;对照组34例,年龄258427岁,孕次1811次,孕G8B390412G8B,新GE7儿GC7重3340413G,剖宫产G93为305%,阴GD5器械助产G93为111。两组G97G98,G9EG9FGA0GFCGA1GA2学GA3GA4(P005),具G9DGBEG97性。1.2诊断标准GA0符合美GD0GBAGBB学GE41994G9AGBAGBB疾GCE的诊断与GA1GA2手册中制G94的产后抑郁症的诊断标准(1)G9A产后2G8BGD6出GDC下列5条GFB5条GAD上的症GC8,必须具备①②两条。①GAE绪抑郁;②对全部GFBGEB数GE8GC2GA6GA7缺乏兴趣GFB愉悦;③GC7重GA7著下降GFB增加;④失眠GFB睡眠过度;⑤GBAGBB运GC2性兴奋GFBG80G81;⑥G82G83GFB乏G84;⑦G85G86G87GAFG88GFCGA3GA4GFBG89G8AGAF;⑧GC0GC1G84减G8BGFB注GA3G84G8C散;⑨GF3G8D出GDCG8EG8F想法。(2)G9A产后4G8BGD6GCDGCE。1.3G90G91GC5G92G93标准①符合上G94诊断标准;②G92G93G95重GC6GC7疾GCEG9BG96器G97性疾GCEG9BG98G97依G99G9B药G98过G9A者;③G92G93治疗GEAG9B用过G9CGBAGBBGCE药G98者;④G92G93G9DG95重G89G9DG9EG9F者;⑤GA0别诊断G92G93产后抑郁GA1合GB9GC5产后抑郁性GBAGBBGCE。2方法2.1G88G89方法对照组G80G81G82西G8320MG,GA2日1次。GA3GA4后G9B用。观察组柴胡疏肝散合甘麦大枣汤柴胡15G,GA5GA612G,GA7GA8L0G,GA9GAA15G,GABGAC12G,GADGAEL0G,甘GAF12G,GB0GAA麦30G,大枣15G。肝GB1郁结加郁GB210G,GB3GAA15G;GB1郁G91GB4加GB5GB66G,GB7GB8GAF15G;GB1G81GB9郁加GBAGBBG9BGBCGBDGBE10G,GBFGC015G;GC1郁GC2GBB加GAA麦30G,GBFGBB15G;GB0GC3两GC4加GC5GC620G,GBFGBBG9BGC7GC8G9BGC9GCAGBE18万方数据北方药学2011年第8卷第2期15G;阴虚火旺加熟地30G,山茱萸15G,黄柏12G。每日1剂,水煎服,早晚各1次。两组均治疗4周,均不合用其他抗抑郁药物。2.2疗效评价患者的抑郁程度采用汉密顿抑郁量表(HAMD)进行量化评分,治疗前、治疗2周末、4周末,以汉密顿抑郁量表评分的减分率作为疗效观察指标,减分率(治疗前总分一治疗后总分)/治疗前总分。采用全国统一的4级标准6,临床痊愈HAMD评分(减分至7分以G80)减分率80%;G81效(G82G83G84G85分G86G87,减分10分以G88)减分率50~80%;G89G8A(G82G83G85分G86G87G8B程度G8C减G8D,减分8~10分)减分率25~49%;G8E效(G82G83G8EG8F化G8BG90前加G91)减分率25%。2.3统G92学方G93采用SPSSL60统G92G94G95G96进行统G92学G97G98,G92量G99G9A用均G9B标准G9C(XS),G92G9BG99G9A采用X2G9DG9E,G92量G99G9A进行TG9DG9E,以P005表G9FGA0G81GA1G9CGA2GA3。3结果31治疗前、2周末GA44周末的HAMD总分GA5G90两组GA6治疗前的HAMD总分G9CGA2G8EG81GA1GA3GA7P005),GA8G9F两组GA0GA9GA5GA3。治疗后两组HAMD总分均G90治疗前GA0G81GA1GA3G80GAAGA7P001),GABGACGAD治疗GAEGAF的GB0GB1均GB2GB3GB1GA3G80GAA;GB4GB5期GB6GB7组均G90GB8GB9组G80GAAG81GA1,G9CGA2GA0GBAG81GA1GA3GA7P001),GBB表1。表11两组治疗前、治疗2周末、4周末的HAMD评分比较GBCGBDGBE组治疗前GA5G90P001;GBDGB8GB9组GB5GAEGBFGA5G90,◆P005GC032两组临床疗效的GA5G90治疗组的总GA0效率为921%,GB8GB9组的总GA0效率为794%,两组G9CGA2GA0G81GA1GA3GA7P005),GA8G9F治疗组的总GA0效率G90GC1,GBB表2。表21两组临床疗效比较GBC两组总GA0效率GA5G90P005。33不GC2GC3GC4GB8GB9组服用GC5GC6GC7GC8GC9不GC2GC3GC4GA0GCAGCB5GCC、GCDGCE3GCC、GCFGD0减GD14GCC、GD2GD3GD4GD52GCC、GD6GD7不GD82GCC;治疗组GD9GBBGDAG81不GC2GC3GC4。4讨论GDB后抑郁G82GDC指GA6GDB后6周GDDGDE次GDFGE0GE1GE2G8EGE3GE4GD4GD5GE5,表GE6为抑郁GE7GE8GE9、GEAGEB、GECGEDGEE、GEFGF0GF1,G91者GF2GE6GF3GF4G8BGF5GF6GF1一GF7GF8临床G82G83。其GDFGF9GBDGE4GFAGDD分GFBGFCGFD、GDBGFEGFCGFDGFF遗传GFCGFDGA0关7、8GC0中医认为,GDB后抑郁G82属“郁证”范畴,严G91者GA9表GE6为“癔证”、“狂证”,其常GBB的GE0GFC为GCB脾两虚、肝气郁结9所致,故总的治则为养GCB补脾、疏肝解郁GC0方选用柴胡疏肝散合甘麦G84枣汤加减,柴胡疏肝散GF2GF5景岳全书,该方具疏肝G98气解郁之功,方中柴胡G98气疏肝,为君药;枳壳、香附调气宽中,GBD柴胡合而升GAA调气GDC为臣药;白芍、川芎GFF血养肝,体用兼顾,血气GB5调共为佐药;炙甘草甘温健脾为使,调GFF药GA3以助药力GDF挥GC0诸药配伍,GA9补肝体,助肝用,气血兼顾,肝脾GAB治;甘麦G84枣汤GF2GF5汉代医圣张仲景金匮要略,以甘草润燥缓急,小麦养GCBGD8GE4,G84枣补中益气,甘润滋补、养GCB益脾GD8GE4,主治“妇人G80GF0GC0G81GE8GE9GD0G82GC0G83G84GE4G85所作GC0G9BG86G87G88GC0以G88两方合用,疏G89GBD健脾GABG8A,养血GBDGD8GE4GABG8B,GCBG89脾G8CG80GAB调,G8D中GE0GFC,G8EG8FGE0G90GC0GE6代GB6GB7证G9110~12,柴胡疏肝散加减主要GA9G92使G80G93G94GFFG95G96DAGE4GFAG97G98,GC3G99G9A药GA9使DAGE4GFAG97G98,GB4抑G9B5G9CG9DG9EGE4GFAG9FGA0,GA1GA2中GA3GE4GFAGA4GA5代GA6,具GA0抗抑郁G9FGA0GC0G91G9EGB6GB713、14GA7表GDA甘麦G84枣汤GA9GA0GA8GA9G80调抑郁G82G84GAAG95G96GABGACG8AGADCAMPGAEPKAGAFGB0,GB1加BDNF表GB2GA0GB3GC0GBEGB6GB7G81G9F,治疗后两组HAMD总分均G90治疗前GA0G81GA1GA3G80GAAGA7P001),GB4GB5期GB6GB7组均G90GB8GB9组G80GAAGB4G81GA1GA7P001),GB5两组总GA0效率GA5G90GA0G81GA1G9CGA2GA7P005),GA8G9FGA6GDB后抑郁的治疗中,柴胡疏肝散合甘麦G84枣汤加减G90GC7GC8GC9GB6GA0缓解抑郁G82G83,GBDGE6代G91G9EGB6GB7结GB7GB8一致,而GB5柴胡疏肝散合甘麦G84枣汤G8EGDAG81不GC2GC3GC4GFFGB9作用,GA0一GBA的临床GC4用价GBBGC0参考文献1金GBC,GBDGBEGDBGBF期GCBG98GC0GF9M//GC1GC2GC3中GC4妇GDBGFE学,第2GC5,北GC6人GC7GC0GF9GF2GC5GC8,2004128012812WISNERKL,PARRYBL,PIONTEKCMCLINICALPRACTICEPOSTPARTUMDEPRESSIONJNENGLJMED,2002,347GA73)19493DENNISCL,JANSSENPA,SINGERJIDENTIFYINGWOMENATRISKFORPOSTPARTUMDEPRESSIONINTHEIMMEDIATEPOSTPARTUMPERIODJAC-TAPSYCHIATRSCAND,2004,110GA75)338464GC9GCA,GCBGCCGCD,GCEGCFGD0,GF1GDBGBF期抑郁G82的GDFGF9率GA4其GC8GD1学GA1GA2GFCGFD分GD2J中国妇GD3GD4健,2006,21GA710)138813905GD5GCFGD6GD7GD8GC8GC9结合GCBG98治疗GB8GDB后抑郁疗效观察J中国妇GD3GD4健,2006,21GA722)318931906GD9GDA,GDBGDC,汤GDDGDE,GF1GDBGFE抑郁G82的GDFGE0GBDG97G98J国GE1医学GA7妇GD3GD4健分GE2),2005,16GA76)3553577GE3GE4升,GE5GE6,GE7GFFGE8中医学GB8抑郁G82的认GE9JGEAGEB中医药,2007,39GA78)70718BLOCHM,DALYRC,RUBINOWDRENDOCRINEFACTORSINTHEETI-OLOGYOFPOSTPARTUMDEPRESSIONJCOMPRPSYCHIATRY,2003,44GA73)234469张GECGEDGDB后抑郁G82GDFGE0GFCGFDGBD治疗进GEEJ中国妇GD3GD4健,2002,17GA712)764765组GEF治疗前治疗后2周末治疗后4周末治疗组22162461265215◆1162119◆GB8GB9组237425916433221409213组GEFN痊愈GA7GCC)G81效GA7GCC)GA0效GA7GCC)G8E效GA7GCC)总GA0效率GA7)治疗组38111665921GB8GB9组346813779419万方数据北方药学2011年第8卷第2期10简珮玉,彭雪琼,王铭霞,等产后抑郁症中西医病因及中西药结合治疗J现代中西医结合杂志,2010,19(2)25425511KIMSH,HANJ,SEOGDH,ETALANTIDEPRESSANTEFFECTOFCHAI-HUSHUGANSANEXTRACTANDITSCONSTITUENTSINRATMODELSOFDE-PRESSIONJLIFESCI,2005,76(11)129730612陈煜辉,周莺柴胡疏肝散抗抑郁作用的药理学实验研究J江西中医学院学报,2004,16(4)596013熊振芳,朱清静柴胡疏肝散对慢性束缚应激性肝郁证大鼠的影响J中国中西医结合消化杂志,2004,12(4)22022114张学礼,金国琴,戴薇薇,等甘麦大枣汤加G80对抑郁症大鼠G81G82CAMPG83G84激G85AG86G87的影响JG88G81中医药大学学报,2006,20G894)7375,G8A315G8BG8CG8D加G80甘麦大枣汤对抑郁症大鼠G81G82G8EBDNFG8FG90的影响JG91江中医杂志,2010,45(8)604605尿激酶静脉溶栓联用低分子肝素治疗急性心肌梗死疗效分析张G92G93(G94G95G96G97G98G99G9AG9BG9CG9D中G9EG9FGA0院GA1GA2G98G99516820)摘要GA3的GA4GA5GA6GA7激G85静GA8GA9GAAGAB用GACGADGAE肝GAF治疗GB0性G9EGB1GB2GB3G89AMI)的GB4GB5GB6GB7GB8方GB9GA460GBAGB0性G9EGB1GB2GB3GBBGBCGBDGBEGADGBFGA9GAAGC0GC1GC222GBAGC3GA9GAAGC4GC1GC28GBAGC5GC4GA9GAAGC230GBA,GA9GAAGC2GC6用GA7激G85静GA8GA9GAA加GC7GC8GC9GCAGCBGCCGCDGACGADGAE肝GAF治疗GCEGC4GA9GAAGC2GCF用GA9GAA治疗,GC6用GD0GD1治疗,GD2GD3GD4GC2疗GB6GC5GCAGD5GADGD6GC3GB3GD7GD8GB8结GB7GA4GA9GAAGC0GC1GC222GBA(730)G8DGD9GDAGDBGA9GAAGC4GC1GC28GBA(266)(X24125,P005)GCEGA9GAAGC0GC1GC2GDCGDDGB6GD8900,G8DGD9GDAGDBGA9GAAGC4GC1GC2750GC5GC4GA9GAAGC2666(X24228,X25128,PGDE005)GCEGA9GAAGC0GC1GC2GDFGE0GE1GE2,GA9GAAGC4GC1GC21GBAGB3GD7G89128),GC4GA9GAAGC25GBAGB3GD7G89166)GB8结GE3GA4GA7激G85静GA8GA9GAA治疗GB0性G9EGB1GB2GB3GE4GE5GE6GDAGE7GE8GE9GA8GC0GC1GD8GC5GEAGACGB3GD7GD8GC3GEBGECGED后GB8关键词GA4GB0性G9EGB1GB2GB3GA7激G85GA9GAAGACGADGAE肝GAF中图分类号R5422文献标识码B文章编号16728351(2011)02002002ANALYSISOFCURETIVEEFFECTINTHEPATIENTSWITHAMIBYUROKINAESTHROMBOLYTICWITHLOWMOLECULARWEIGHTHEPARINTHERAPYZHANGYUNXING89DEPARTMENTOFMEDICINE,LONGMENCOUNTYPINGLINGTOWNCENTERHOSPITAL,HEYUAN,GUANGDONG516820,CHINA)ABSTRACTGA4OBJECTIVEGA4TOINVESTIGATECLINICALEFFECTOFUSINGURKINAESWITHLOWMOLECULARWEIGHTHEPARING89LMWH)THERAPYINTHEPATIENTSWITHACUTEMYOCARDIALINFARCTIONG89AMI)METHODSGA460CASESWITHACUTEMYOCARDIALINFARCTIONWERERANDOMLYDIVIDEDINTOTHROMBOLYTICRECANALIZATIONGROUP22CASESANDTHROMBOLYTICUNCANALIZATION8CASESANDNONTHROMBOLYTICGROUP30CASES,THETHROMBOLYTICGROUPGAVEINTRAVENOUSTHROMBOLYTICTREATMENTWITHUROKINASEWITHLMWH,NONTHROMBOLYTICGROUPGAVECONVENTIONALTHERAPYTHECURATIVEEFFECT,EJECTIONFRACTIONANDMORTALITYINTHETHREEGROUPSWEREOBSERVEDRESULTSGA422CASESG89730)INRECANALIZATIONGROUPWERESIG-NIFICANTLYHIGHETHATTHE8CASESG89266)G89X24125,P005)GCETOTALEFFECTIVERATE900INTHROMBOLYTICRECANALIZATIONWERESIGNIFI-CANTLYHIGHERTHAT750INTHETHROMBOLYTICUNCANALIZATIONAND666INNOTHROMBOLYSISGROUPG89X24228,X25128,ALLP005)GCETHEMORTALITYOFRECANALIZATIONGROUPGC5UNCANALIZATIONGC5NONTHROMBOLYTICGROUPWERENONGC5128GC5166RESPECTIVELYCONCLUSIONGA4INTRA-VENOUSTHROMBOLYTICTHERAPYCANIMPROVECORONARYARTERYRECANALIZATION,LOWERMORTALITYANDMAKETHEPROGNOSISMOREBETTERKEYWORDSGA4MYOCARDIALINFARCTIONURKINAESTHROMBOLYTICTHERAPYLOWMOLECULARWEIGHTHEPARINGB0性G9EGB1GB2GB3G89ACUTEMYOCARDIALINFARCTION,AMI)的治疗GEE研究GEFGF0GF1大医院GF2GF3GF4GF5大GF6GF7,GF8GEFGF9GFA医院对AMI的治疗GFBGFCGDBGFDGFE治疗GFF段GB8本文GD2GD3GF4GA7激G85静GA8GA9GAAGAB用GACGADGAE肝GAF对GB0性G9EGB1GB2GB3的治疗GB6GB7,对60GBAAMIGBBGBC进行GAD别治疗,评价GA9GAA对GBBGBCG9E功能的影响及GED后GB81资料与方法11GB4GB5资料收集2007年1月~2010年12月我院GB0性G9EGB1GB2GB3G89AMI)GBBGBC60GBAG89男38GBA,女22GBA),年龄40~73岁GCEGB0性GC8壁G9EGB1GB2GB320GBA,GB0性前壁G9EGB1GB2GB310GBA,GB0性前间壁G9EGB1GB2GB320GBA,GB0性GDA侧壁G9EGB1GB2GB310GBAGB8所选GBBGBCGDE符合世界G9FGA0GC2织G89WHO)1979年制定的缺GD5性G9E脏病命名及诊断标准1,并符合GE5GC8条件2①胸痛持续30MIN,含服硝酸甘
编号:201312191349376067    类型:共享资源    大小:580.07KB    格式:PDF    上传时间:2013-12-19
  
5
关 键 词:
管理 组织 经营
  人人文库网所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
关于本文
本文标题:柴胡疏肝散合甘麦大枣汤加减治疗产后抑郁症的临床观察.pdf
链接地址:http://www.renrendoc.com/p-246067.html

当前资源信息

4.0
 
(2人评价)
浏览:27次
abingge上传于2013-12-19

官方联系方式

客服手机:17625900360   
2:不支持迅雷下载,请使用浏览器下载   
3:不支持QQ浏览器下载,请用其他浏览器   
4:下载后的文档和图纸-无水印   
5:文档经过压缩,下载后原文更清晰   

相关搜索

精品推荐

相关阅读

人人文库
关于我们 - 网站声明 - 网站地图 - 资源地图 - 友情链接 - 网站客服客服 - 联系我们

网站客服QQ:2846424093    人人文库上传用户QQ群:460291265   

[email protected] 2016-2018  renrendoc.com 网站版权所有   南天在线技术支持

经营许可证编号:苏ICP备12009002号-5