世界中医药

目的:探讨温阳通脉方联合抗抑郁药及认知行为干预治疗恐惧性姿势性眩晕(PPV)的临床疗效。方法:选取2015年6月至2017年6月新乡医学院第一附属医院收治的PPV患者78例作为研究对象,随机分为对照组和观察组,每组39例,对照组采用抗抑郁药及认知行为干预治疗,观察组在对照组基础上给予温阳通脉汤加减治疗,连续治疗4周,随访6个月。治疗前后采用国际眩晕评分量表(DHI)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定患者的临床症状及心理状态改善情况,检测并比较2组治疗前后凝血功能指标变化,统计2组临床疗效及随访期间复发情况。结果:治疗后,观察组临床总有效率89.74%,明显高于对照组的69.23%(P<0.05)。治疗后2组躯体症状评分、心理因子评分、社会功能评分、DHI总分、HAMD评分及HAMA评分均较治疗前明显下降(P<0.01),且观察组各项评分均低于对照组(P<0.05或P<0.01)。治疗后对照组各项凝血功能指标无明显变化(P>0.05),观察组PT、APTT明显延长,且长于对照组,FIB及D-D水平明显降低,且低于对照组(P<0.01)。随访期间,观察组、对照组复发率分别为12.82%、17.95%,2组间复发率差异无统计学意义(P>0.05)结论:PPV患者在抗抑郁药及认知行为干预的基础上应用温阳通脉方治疗效果显著,不仅有效降低患者各种负面情绪,同时改善了血液高凝状态及眩晕症状,具有一定的临床推广价值。

English Summary:

To explore the clinical effect of Wenyang Tongmai Decoction combined with antidepressants and cognitive behavior intervention on phobic postural vertigo (PPV) patients.Methods:A total of 78 cases of PPV patients in First Affiliated Hospital of Xinxiang Medical College from June 2015 to June 2017 were selected and randomly divided into the control group (n＝39) and the observation group (n＝39).The control group was treated with antidepressants and cognitive behavior intervention，and the observation group was treated with Wenyang Tongmai Decoction on the basis of the control group，and continuously treated for 4 weeks，followed up for 6 months.The clinical symptoms and mental status of the patients were assessed by the Dizziness Handicap Inventory (DHI)，the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) before and after treatment，the changes of coagulation function before and after treatment were detected and compared.The clinical efficacy and recurrence of the 2 groups were analyzed.Results:After treatment，the total effective rate in the observation group was 89.74%，which was significantly higher than 69.23% in the control group (P<0.05).After treatment，physical symptoms，psychological factor scores，social function scores，DHI total score，HAMD score and HAMA score in the 2 groups were significantly decreased than before treatment (P<0.01)，and the scores in the observation group were lower than the control group (P<0.05 or P<0.01).After treatment，there was no significant change in the coagulation function of the control group (P>0.05)，compared with before treatment and the control group，the levels of PT and APTT in the observation group prolonged，the levels of FIB and D-D were significantly decreased than before treatment and lower than the control group (P<0.01).During the follow-up period，the relapse rates of the observation group and the control group were 12.82% and 17.95% respectively，and there was no significant difference between the 2 groups (P>0.05).Conclusion:Wenyang Tongmai Decoction combined with antidepressants and cognitive behavior intervention on PPV has significant curative effects，which can improve the patients' vertigo symptoms and hypercoagulable state of blood，reduce the negative emotions such as anxiety and depression，and have certain clinical promotion value.

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