针灸治疗脑卒中后抑郁症疗效与安全性评价

Post-stroke depression treated with acupuncture and moxibustion: an evaluation of therapeutic effect and safety

目的:评价针灸调肝固本法治疗脑卒中后抑郁症的有效性、安全性。方法:遵循随机对照试验原则,将123例患者随机分为针灸组(42例)、药物组(40例)、针药组(41例)。针灸组给予针灸调肝固本法治疗,针刺穴取合谷、太冲、百会、印堂等,并于中脘、下脘、关元、气海穴行麦粒灸,每天1次,周末休息;药物组口服盐酸帕罗西汀片,每天20mg,于早餐后顿服;针药组采用针灸组与药物组的治疗方法。3组均于治疗2周末、4周末分别采用汉密尔顿抑郁量表(HAMD)为主要疗效评价指标、以日常生活能力量表(Barthel指数)为次要疗效评价指标进行疗效评定;采用中医脾胃证候量表进行中医证候疗效评定;采用副反应量表(TESS)进行安全性评价。结果:治疗4周末,针灸组、药物组、针药组愈显率分别为69.0%(29/42)、65.0%(26/40)、70.7%(29/41),组间抗抑郁疗效相当(均P>0.05);治疗2周末时,针灸组、针药组HAMD评分与治疗前及药物组比较均显著改善(P<0.05,P<0.01);针灸组与针药组在提高Barthel指数、减少中医脾胃证候评分、减少TESS副反应评分方面均优于药物组(P<0.05,P<0.01)。结论:针灸调肝固本法抗抑郁疗效肯定,并具有较高的安全性。

Objective To evaluate the efficacy and safety of acupuncture and moxibustion in the treatment of post-stroke depression （PSD） by regulating the liver and strengthening the root prescription. Methods In light of the random controlled trial principle, 123 cases were randomized into an acupuncture-moxibustion group （42 ca- ses）, a medication group （40 cases） and an acupuncture ＋ medication group （41 cases）. In the acupuneture-moxi- bustion group, the therapy of regulating the liver and strengthening the root was applied. Acupuncture was given at Hegu （LI 4）, Taichong （LR 3）, Baihui （GV 20, Yintang （GV 29）, etc. The granule moxibustion was applied at Zhongwan （CV 12）, Xiawan （CV 10）, Guanyuan （CV 4） and Qihai （CV 6）. The treatment was given once a day and stopped in weekend. In the medication group, paroxetine hydrochloride tablets were prescribed for oral ad- ministration, 20 mg each day after breakfast. In the acupuncture ＋ medication group, the therapies were adopted as the acupuncture-moxibustion group and the medication group. In the 2nd and 4th week of treatment, HAMD was used as the primary index and Barthel index as the secondary one for the efficacy assessment in the three groups respectively. The spleen and stomach syndrome scale of TCM was used for the assessment of TCM syn- drome efficacy. Treatment emergent symptom scale （TESS） was applied for the safety assessment. Results In the 4th week of treatment, the markedly effective rates were 69.0% （29/42）, 65.0% （26/40） and 70. 7% （29/41） in the acu- puncture-moxibustion group, the medication group and the acupuncture q- medication group respectively. The efficacies of anti-depression were similar in comparison among groups （P〉0.05）. In the 2nd week of treatment, the improvement of HAMD score was significant in the acupuncture q- medication group as compared with that before treatment and in com- parison with the medication group （P〈0.05, P〈0.01）. As for improving Barthel index, reducing the spleen and stom- ach symptom score of TCM and decreasing the score of TESS, the results in the acupuncture-moxibustion group and the acupuncture q- medication group were superior to those in the medication group （P〈0.05, P〈0.01）. Conclusion The therapy of acupuncture and moxibustion with regulating the liver and strengthening the root achieves the definite efficacy of anti-depression and presents the quite high safety in treatment.