子午流注取穴针刺配合百忧解治疗脑卒中后抑郁疗效观察

Efficacy on post-stroke depression treated with acupuncture at the acupoints based on ziwuliuzhu and prozac

目的:观察子午流注取穴针刺对脑卒中后抑郁患者疗效的影响。方法:将93例患者随机分为综合组、子午流注组、百忧解组,每组31例。子午流注组采用子午流注取穴针刺治疗,每日1次,每周5次;百忧解组口服盐酸氟西汀(百忧解)治疗,每日1次,每次20mg;综合组采用子午流注取穴针刺治疗加口服百忧解,方法同子午流注组和百忧解组。3组均4周为一疗程,共治疗6个疗程。比较3组临床疗效、汉密尔顿抑郁量表(HAMD)评分的变化以及不良反应发生情况。结果:综合组总有效率为96.8%(30/31),优于子午流注组的83.9%(26/31)及百忧解组的80.6%(25/31,均P<0.05)。3组治疗4周、12周、24周后HAMD评分均较治疗前显著降低(均P<0.05),且综合组在治疗后各时点均低于其他两组(均P<0.05);子午流注组在治疗4周、12周后与百忧解组同期比较差异均无统计学意义(均P>0.05),在治疗24周后HAMD评分低于百忧解组(P<0.05)。综合组出现不良反应者2例,百忧解组6例,子午流注组无不良反应发生。结论:子午流注取穴针刺治疗联合口服百忧解治疗,在临床疗效、抑郁状态改善方面均优于单纯口服百忧解治疗和单纯子午流注治疗。单纯子午流注治疗虽然在临床疗效方面与单纯百忧解治疗没有显著差异,但远期HAMD评分方面及安全性方面优于单纯百忧解治疗。

Objective To observe the effects on post-stroke depression treated with acupuncture at the acupoints based on ziwuliuzhu （the midnight-noon ebb-flow theory）. Methods Ninety-three patients were randomized into a comprehensive group, a ziwuliuzhu group and a prozac group, 31 cases in each group. In the ziwu- liuzhu group, acupuncture was applied to the acupoints based on ziwuliuzhu, once a day, 5 times in a week. In the prozac group, fluoxertine hydrochloride （prozac） was prescribed for oral administration, once a day, 20 mg each time. In the comprehensive group, acupuncture based on ziwuliuzhu combined with the oral administration of prozac were adopted and the treatment frequency was the same as the ziwuliuzhu group and the prozac group. The ,1-week treatment was taken as one session in the three groups and 6 sessions were required totally. The clinical efficacy and the Hamilton depression rating scale （HAMD） score and the adverse reaction were compared among the 3 groups. Results The total effective rate was 96.8% （30/31） in the comprehensive group, better than 83.9% （26/31） in the ziwuliuzhu group and 80.6% （25/31） in the prozac group （both P〈0.05）. In 4, 12 and 24 weeks of treatment, HAMD score was lower significantly than that before the treatment in the three groups （all P〈0.05）, and the score in the comprehensive group at each time point after treatment was lower than the other two groups （all P〈0.05）. In 4 and 12 weeks of treatment, there were not different significantly between the ziwuliuzhu group and the prozac group （both P〈0.05）. In 24 weeks of treatment, HAMD score in the ziwuliuzhu group was lower than that in the prozac group （P〈0.05）. For the adverse reaction, there were 2 cases in the comprehensive group, 6 cases in the prozac group and 0 case in the ziwuliuzhu group. Conclusion The comprehensive therapy of acupuncture at the acupoints based on zizvuliuzhu and oral administration of prozac is superior to either the simple oral administration of prozac or the ziwuliuzhu acu-puncture in terms of clinical efficacy and the improvements in depressive state. Regarding the clinical efficacy, the impact of simple ziwuliuzhu acupuncture is not different significantly as compared with the simple oral administration of prozac, but it is better than the simple oral administration of prozac in terms of the long-term HAMD score and safety.