| Objective:As the cerebral vascular disease displays a trend of yearlyincrease,accompanying depression after stroke(post-stroke depression,PSD)also increased.Foreign literature reports the total incidence of PSD set in40%-50%,and the domestic in34.2%-76.1%.The occurrence of PSD not onlyextend the rehabilitation process of stroke,but also increases the reoccurrencefactors and reduce the patients’ quality of life,and brought a heavy burden tofamilies and society.PSD has become an independent risk factor for recoveryof neurological function of cerebrovascular disease and stroke occurrence,soearly identification and effective treatment of PSD is important. The modernmedicine treats PSD mainly to use the medicine treatment,including tricyclicantidepressants(TCAs),monoamine oxidase inhibitors(MAOIs),selectiveserotonin reuptake inhibitors(SSRIs),selective serotonin-norepinephrinereuptake inhibitors(SNRIs).Although Western medicine in the treatment ofPSD have a certain effect,but there are varying degrees of side effects andwithdrawal rebound phenomenon,reducing medication compliance.Theresearch of Chinese medicine to this sickness has also made the amazingprogress,including the pathogeny and pathogenesis,dialecticalmedication,clinical observation and experimental research,unfolded thetraditional Chinese medicine(TCM) to treat PSD to have certain potential.Butdue to the problem of Chinese medicine treatment of PSD work slow,thecombination of TCM and Western medicine has attracted considerableattention.PSD can be effectively treated by TCM and Western medicine oftheir respective advantages,paying attention to the causes and symptoms andlong-term effect,which is easy to patient to accept.The subject is adhering toacademic ideological essence of TCM and western medicine,to furtherexplore the efficacy of TCM and western medicine in treatment of PSD., TCM believed stroke was equivalent to the cerebral apoplexy,and the cite wasbrain,the pathogenesis was liver-kidney yin-deficiency,yin yangdisharmony,disorder of qi-blood, brain collaterals injured,irregular of qicausing blood stasis,and blood stasis became new pathogenic factor,mingledclear head,in addition to macronosia consumed qi-yin.So supplementing qiand nourishing yin,activating blood circulation and dispersing stasis is one ofthe important therapies in PSD.Yi Xin Shu capsule aimed at the nervefunction defect symptoms and depressive symptoms at the same time,andclinical co-mirtazapine in the treatment of PSD will work as soon aspossible.This topic examined the effect of yi xin shu capsule combinedmirtazapine in the treatment of PSD of deficiency of both qi and yin withblood stasis,and partial mechanism.PSD study indicated that thenerve-endocrine-immune disorder is the main reason,and monoamineneurotransmitter is most closely connected, so we picked serum serotonin(5-HT) and norepinephrine (NE) as indicators to illustrate some of itsmechanisms.Methods:60cases of PSD were randomly divided into yi xin shucapsule combined mirtazapine group (32cases) and mirtazapine group(28cases) who were selected from Neurology clinic outpatient and inpatient ofthe TCM hospital of HeBei.There was no significant difference of the twogroups in age,gender,depression duration and type of stroke.Both groups weretreated conventionally for primary neurological disease,including theexpansion of cerebrovascular agent,inhibition of platelet aggregation agentto protect brain cells,and the activation of brain metabolism drugs.The twogroups have not carried on rehabilitation training.The treatment group tookevery yi xin shu capsules once,three times a day,combined with mirtazapine30mg,per night serving dayton for8weeks.The control group was given onlymirtazapine also for8weeks.The treatment of depression outcome wereevaluated by HAMD assessment scale; the clinical depression efficacy werecalculated by the reduced rate of HAMD assessment scale; the neuralfunction recovery was calculated by SSS and BI;the content change of5-HT and NE were detected by high performance liquid chromatographymethod(HPLC).The detection of blood routine tests, urine routine tests, liverbiochemical tests, kidney function tests and ECG and adverse reaction werechecked before and after the treatment.Results: Through the clinical observation showed that,HAMD scorechanged before and after treatment,and compared with the control group,thetreatment group of HAMD score after treatment were more significantlyreduced;The treatment group of the HAMD score decreased after4weeks oftreatment,compared with that before treatment,the difference wasstatistically significant(p<0.05);In the treatment of4weeks，HAMD score ofthe control group was no statistically significant difference;by the HAMDreduced rate of clinical assessment，treatment group of the total effective ratewas87.5%,compared with that of control group78.6%，the difference wasstatistically significant(p<0.05);In speeding up the improvement ofneurological deficit，both groups was significant difference,the treatmentgroup was better than the control group.In improving the ability of dailylife,the two groups was significant difference,the treatment group was betterthan the control group;8weeks after treatment with the two groups,5-HT andNE concentration in the blood increased compared with before treatment,thetwo groups had no significant difference(p>0.05).Blood and urine routine,liverand kidney function and ECG before and after treatment had no significantabnormalities.In adverse actions in c1inical applications，the observationsshowed that the treatment group had no significant side effects,while therewere5cases(17.9%) in the control group had dry mouth,dizziness and so on.Conclusion: In the treatment of PSD both qi and yin deficiency withblood stasis,yi xin shu capsule combined with mirtazapine was better thancontrol group in the improvement of depression symptoms,nerve function,andability of daily life;there was rapid on set and few side effects.The mechanismcould have a relationship with the regulation of the serum5-HT and NE. |
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