标题：柴胡加龙骨牡蛎汤联合艾司西酞普兰治疗急性脑梗死伴焦虑抑郁障碍患者的疗效及对血清单胺类神经递质水平的影响

      作者：任庆萍 1，赵嘉诚 2，林海 1，王玮 2    西安市中医医院脑病科二病区 1、针灸推拿康复科 2，陕西 西安 710021

      卷次： 2023年34卷10期

      【摘要】 目的 研究柴胡加龙骨牡蛎汤联合艾司西酞普兰治疗急性脑梗死伴焦虑抑郁障碍患者的疗效及对血清单胺类神经递质水平的影响。方法 选取2020年2月至2021年2月期间西安市中医医院收治的120例急性脑梗死伴焦虑抑郁障碍患者作为研究对象，按随机数表法分为研究组和对照组各60例。两组患者均进行溶栓、抗血小板聚集、调脂稳斑、保护脑神经、改善脑缺血、降压等常规治疗，在此基础上对照组患者采用艾司西酞普兰治疗，研究组患者采用柴胡加龙骨牡蛎汤联合艾司西酞普兰治疗。两组患者均连续治疗4周，比较两组患者的治疗效果、治疗前及治疗4周后的神经功能(NIHSS)评分、日常生活活动能力(Barthel)评分、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分、去甲肾上腺素(NE)、5-羟色胺(5-HT)以及多巴胺(DA)水平。结果 研究组患者的治疗总有效率为96.67%，明显高于对照组的73.33%，差异有统计学意义(P<0.05)；治疗前，两组患者的NIHSS评分与Barthel评分比较差异均无统计学意义(P>0.05)，治疗后，两组患者的NIHSS评分均降低，且研究组患者的NIHSS评分为(11.48±3.24)分，明显低于对照组的(16.46±2.86)分，两组患者的Barthel评分均升高，且研究组患者的Barthel评分为(81.62±9.06)分，明显高于对照组的(71.56±8.24)分，差异均有统计学意义(P<0.05)；治疗后，两组患者的HAMA、HAMD评分均明显降低，且研究组患者的HAMA、HAMD评分分别为(30.26±4.27)分、(32.51±5.28)分，明显低于对照组的(46.84±4.52)分、(44.62±5.32)分，差异均有统计学意义(P<0.05)；治疗后，两组患者的NE、5-HT、DA水平均明显升高，且研究组患者的NE、5-HT、DA水平分别为(63.26±7.82) μg/L、(354.41±64.58) μg/L、(200.63±53.25) μg/L，明显高于对照组患者的(58.42±7.36) μg/L、(312.64±62.17) μg/L、(180.72±51.34) μg/L，差异均有统计学意义(P<0.05)。结论 柴胡加龙骨牡蛎汤联合艾司西酞普兰治疗急性脑梗死伴焦虑抑郁障碍患者的效果显著，其不仅能有效提高血清单胺类神经递质水平与日常生活活动能力，还能改善患者的焦虑抑郁程度与神经功能，具有临床应用价值。
      【关键词】 急性脑梗死；焦虑抑郁障碍；柴胡加龙骨牡蛎汤；艾司西酞普兰；疗效；单胺类神经递质
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2023）10—1397—05

Therapeutic effect of Falcatum Plus Dragon Bone and Oyster Shell Decoction combined with Escitalopram in thetreatment of patients with acute cerebral infarction complicated with anxiety and depression and its effect on thelevel of serum monoamine neurotransmitters.
REN Qing-ping 1, ZHAO Jia-cheng 2, LIN Hai 1, WANG Wei 1. SecondWard, Department of Encephalopathy 1, Department of Acupuncture and Moxibustion, Massage, and Rehabilitation 2, Xi'anHospital of Traditional Chinese Medicine, Xi'an 710021, Shaanxi, CHINA
【Abstract】 Objective To study the curative effect of Falcatum Plus Dragon Bone and Oyster Shell Decoctioncombined with Escitalopram in the treatment of patients with acute cerebral infarction complicated with anxiety and de-pression and its effect on the level of serum monoamine neurotransmitters. Methods A total of 120 patients with acutecerebral infarction accompanied by anxiety and depression admitted to Xi'an Hospital of Traditional Chinese Medicinefrom February 2020 to February 2021 were selected as the research objects. According to the random number table meth-od, they were randomly divided into a study group and a control group, with 60 cases in each group. Both groups of pa-tients received routine treatment, including thrombolysis, antiplatelet aggregation, lipid-lowering and plaque-stabilizingtherapy, brain nerve protection, improvement of cerebral ischemia, and antihypertensive therapy. On this basis, the con-trol group was treated with Escitalopram, and the study group was treated with Falcatum Plus Dragon Bone and Oys-ter Shell Decoction. The two groups of patients were treated for 4 weeks. The therapeutic effects, neurological functionscores, activities of daily living scores, Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD)scores, noradrenaline (NE), 5-hydroxytryptamine (5-HT), dopamine (DA) levels before and after treatment were record-ed and compared between the two groups. Results The total effective rate of the study group was 96.67%, which wassignificantly higher than 73.33% of the control group (P<0.05). Before treatment, there was no significant difference inNIHSS score between the two groups and Barthel score (P>0.05); after treatment, NIHSS score of the two groups de-creased, and NIHSS score of the study group was (11.48±3.24) points, significantly lower than (16.46±2.86) points of thecontrol group; Barthel score of the two groups increased, and Barthel score of the study group was (81.62±9.06) points,significantly higher than (71.56±8.24) points of the control group; the differences were statistically significant (P<0.05).After treatment, the HAMA and HAMD scores of patients in both groups decreased significantly, and the HAMA andHAMD scores of patients in the study group were (30.26±4.27) points and (32.51±5.28) points, which were significantlylower than (46.84±4.52) points and (44.62±5.32) points of the control group (P<0.05). After treatment, the levels of NE,5-HT, and DA in the two groups increased significantly, and the levels of NE, 5-HT, and DA in the study group were(63.26±7.82) μg/L, (354.41±64.58) μg/L, (200.63±53.25) μg/L, which were significantly higher than (58.42±7.36) μg/L,(312.64±62.17) μg/L, (180.72±51.34) μg/L of the control group (P<0.05). Conclusion Falcatum Plus Dragon Bone and Oys-ter Shell Decoction combined with Escitalopram in the treatment of patients with acute cerebral infarction complicatedwith anxiety and depression has a significant effect. It can effectively improve the level of serum monoamine neurotrans-mitters and the ability of daily living activities, and improve the degree of anxiety and depression and neurological func-tion of patients, which has high clinical application value and is worth popularizing.
      【Key words】 Acute cerebral infarction; Anxiety and depression disorder; Falcatum Plus Dragon Bone and Oys-ter Shell Decoction; Escitalopram; Curative effect; Monoamine neurotransmitter