针刺治疗女性更年期抑郁症60例

Acupuncture in the treatment of female climacteric depression in 60 cases

目的:观察针刺方法对60例女性更年期抑郁症患者的治疗效果。方法:选择2005-09/2006-06山东中医药大学第二附属医院精神科门诊收治的60例女性更年期抑郁症患者,均符合中国精神障碍分类与诊断标准第三版抑郁发作的诊断标准。平均(50±3)岁,其中自然绝经者40例,人工绝经1例;未绝经者19例(月经基本正常者2例,月经紊乱者17例)。采用抽签法将患者随机分成针刺组和对照组,每组30例。所有患者均对治疗项目知情同意。①针刺组:处方:肝俞、肾俞、心俞、足三里、三阴交(均双取)、神庭、本神、神聪。采用平补平泻的手法,针刺1次/d,连针6d后休息1d,连续治疗6周为1个疗程。于针刺前及针刺的第2,4,6周分别进行抗抑郁量表(21项5级评分法,0分:无;1分:轻度;2分:中度;3分:重度;4分:很重)评定。对照组患者口服盐酸氟西汀20mg(由美国礼来亚洲公司生产),1次/d,连续服用6周为1个疗程。于用药前及用药后的2,4,6周进行量表评定。②以汉密顿抑郁量表(HAMD)减分率作为疗效评定的标准(HAMD减分率=│治疗后的评分数-治疗前的评分数│/治疗前的评分数×100%)。其中:痊愈:HAMD减分率≥75%;显著进步:HAMD减分率≥50%;进步:HAMD减分率≥25%;无效:HAMD减分率<25%,痊愈+显著进步为显效,痊愈+显著进步+进步为显效,计算患者治疗不同时间点的显效率及有效率。③对所有患者出现副反应的情况给予观察。结果:①两组患者治疗前后HAMD评分比较结果:治疗后2,4,6周对照组HAMD评分分别为(18.79±3.64),(11.52±5.31),(6.36±3.23)分,低于治疗前[(24.17±5.26)分,P<0.05-0.01],治疗后4,6周针刺组HAMD评分分别为(16.51±4.47),(8.90±4.06)分,低于治疗前[(25.83±5.72)分,P<0.01]。②针刺组治疗6周,显效率分别为26.7%(8/30),42.8%(12/28),高于治疗后2周[3.3%(1/30),7.1%(2/28),P<0.05,0.01];针刺组及对照组治疗后6周有效率分别为86.7%(26/30),92.9%(26/28),高于治疗后4周[33.3%(10/30),64.2%(18/28),P<0.01]。③针刺组在治疗过程中未见有副反应出现,抗抑郁剂对照组有5例患者出现恶心、头晕等轻度副反应,未出现肝、肾功能损害等其他中度以上副反应。针刺组与对照组治疗前、后副反应出现情况组间比较,差异具有统计学意义(P<0.05)。结论:针刺治疗女性更年期抑郁症有较好的疗效,且没有副作用。

AIM：To observe the therapeutic effect of acupuncture on 60 patients of female climacteric depression. METHODS： Totally 60 patients of female climacteric depression were enrolled from Psychiatrical Clinic of the Second Hospital attached to Shandong University of Traditional Chinese Medicine between September 2005 and June 2006. All of them accorded with diagnostic criteria of depressive episode of the Chinese Classification and Diagnostic Criteria of Mental Disorders Third-Edition （CCMD-3）. The average age was （50±3） years, 40 cases were natural climacteric, 1 case was artificial climacteric; 19 patients had catamenia （17 cases with disorder catamenia, 2 cases with normal catamenia）. All of patients were randomly divided into acupuncture group and control group, 30 cases in each. They knew and agreed the treating methods.①Acupuncture group： prescription： Ganshu （BL 18）, Shenshu （BL 23）, Xinshu （BL 15）, Zusanli （ST 36）, Sanyinjiao （SP 6） of bilateral, Shenting （DU 24）, Benshen （GB 13）, Shencong （Extra）. Moderate reinforcing and reducing techniques was used to treat patients once a day, rest 1 day after treating 6 days, and 6 continuous weeks as one course. The patients were accessed with Hamilton Rating Scale for Depression （HAMD） at pre-treatment and the end of weeks 2, 4, 6 during the course of t（eatment, respectively （21 items, graded by 5 classes, 0： none, 1： mild degree, 2： moderate degree, 3： severe degree, 4： very severe degree）. Control group was administrated with 20 mg Fluoxetine Hydrochloride Capsules （Eli Lilly and Company）, once daily and 6 continuous weeks as a course. The controls were evaluated at pre-treatment and the end of weeks 2, 4, 6 during the course of treatment, respectively. ② HAMD reducing rate was regarded as the criteria to assess the therapeutic effect （HAMD reducing rate= （post-treatment scores-pre-treatment scores）/pre-treatment scores ×100% ）. Recovery： HAMD reducing rate ≥75%; remarkable improvement： HAMD reducing rate ≥50%; improvement： HAMD reducing rate ≥25%; ineffective： HAMD reducing rate 〈 25%. Recovery and remarkable improvement were obviously effective, recovery and remarkable improvement added improvement were effective, the rates of obviously effective and effective at different time were calculated.③Side effects appeared in the patients were observed. RESULTS： ①Comparison of HAMD scores between pre- and post- treatment of two groups： HAMD scores of the control group at the end of weeks 2, 4, 6 after treatment was （18.79±3.64）, （11.52±5.31）, （6.36±3.23） points, which were lower than the scores of pre-treatment [（24.17±5.26） points, P 〈 0.05-0.01]. HAMD scores of the acupuncture group at the end of weeks 4, 6 after treatment were （16.51±4.47）, （8.90±4.06） point, which were lower than that of pre-treatment [（25.83± 5.72） points, P 〈 0.01]. ②After being treated for 6 weeks, the obviously effective rate of the acupuncture group was 26.7% （8/30） and 42.8% （12/28）, which was higher than that of week 2 after treatment [3.3% （1/30）, 7.1% （2/28）, P 〈 0.05, 0.01]. After being treated for 6 weeks, the effective rate of acupuncture group and control group were 86.7% （26/30） and 92.9% （26/28） respectively, which was higher than that of week 4 after treatment [33.3% （10/30）, 64.2% （18/28）, P〈 0.01]. ③There was no side effect in acupuncture group during the course of treatment, and there were 5 patients in control group appeared light side effect such as nausea, dizzy etc. But no other high-grade side effect was found. There were significant differences between two groups in the side effect pre- and post- treatment （P 〈 0.05）. CONCLUSION： Acupuncture is effective on female climacteric depression, and there is no side effect.