逍遥散合温胆汤治疗躯体化障碍临床观察

目的用中药与选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitors,SSRI)氟西汀治疗躯体化障碍,对比疗效差异,探讨中药应用的优势。方法用汉密尔顿抑郁诊断量表(HamiltonDepression,HAMD)选择神经症躯体化障碍患者,随机分为两组。氟西汀组34例,采用盐酸氟西汀,每日20mg,每日早餐后口服1次;中药组采用逍遥散合温胆汤煎剂,每日晚餐前1次温服。每4周为1个疗程,共治疗8周。观察治疗前后症状严重程度、躯体化不适以及焦虑、抑郁和伴随的其他症状改善与变化。治疗前后分别用临床总体印象量表(clinical general i mpression,CGI)和症状自评量表90项(symptomchecklist-90,SCL-90)评分,观察其因子评分变化的情况,并观察不良反应。结果治疗前后观察两组CGI量表分变化显著,2周后平均减分率>30%,8周后平均减分率>70%;而两组之间CGI评分差异无显著性(P>0.05)。SCL-90量表评分显示,两组躯体化因子平均分值比较,差异有显著性(P<0.05),中药组不良反应轻。结论中药在治疗躯体形式障碍中有可观的优势,可与新型抗抑郁剂相媲美。

英文摘要:

ObjectiveTo compare the efficacy of Chinese medicine and selective serotonin reuptake inhibitors(SSRI),fluoxetine,on somatic disorder(SD)and to explore the advantage of Chinese medicine.MethodsPatients with SD screened with Hamilton depression scale(HAMD)were randomly assigned to the fluoxetine group treated with fluoxetine 20 mg once per day administered after breakfast,and the Chinese medicine group with combination of Xiaoyao Decoction(XD)and Wendan Decoction(WD)one dose a day given before supper everyday,the treatment for both groups was lasted for 8 weeks.Clinical general impression(CGI)and symptom checklist 90(SCL-90)were applied to evaluate the changes in symptoms before and after treatment,and a self-made rating scale was used to evaluate the adverse reaction.ResultsCGI score changed significantly in both groups after treatment,showed the average 2-week reduction rate of more than 30% and the average 8-week reduction rate of more than 70%,without significant difference shown between the two groups(P>0.05).SCL-90 scoring showed the average score of somatic factor was significantly lower in the Chinese medicine group than in the fluoxetine group(P<0.05)with few adverse reaction,while no significant difference was found in the respective scores of other factors between the two groups(P>0.05).ConclusionChinese medicine shows noticeable superiority in treating SD,it has the effect similar to that of new anti-depressants.

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