通督调神针刺干预对药物治疗脑卒中后抑郁的影响

The effect of the acupuncture intervention of dredging Governor Vessel and regulating mentality for the medication treatment of post-stroke depression

目的:观察通督调神针刺结合百忧解与单纯百忧解相比治疗脑卒中后抑郁(PSD)起效时间和总体疗效差异。方法:将63例患者随机分为通督调神针刺干预组(针药组)33例和对照组(药物组)30例。药物组予以口服百忧解20mg,每日1次,早上7:00服药,连续服药4周;针药组在口服百忧解基础上予以通督调神针刺干预,取督脉穴百会、风府、神庭、水沟、大椎、神道为主穴,每日1次,每周6次,连续治疗4周。两组患者分别于治疗前、治疗2周、治疗4周时运用24项汉密尔顿抑郁量表(HAMD)、改良爱丁堡-斯堪的那维亚神经功能缺损评分量表(MESSS)和日常生活活动能力量表(ADL,Barthel指数,BI)进行评分,比较两组间的疗效差异。结果:治疗2周时,针药组HAMD评分、MESSS评分显著下降,BI评分显著上升(均P<0.01),而药物组各量表评分与治疗前比较差异无统计学意义(均P>0.05);治疗4周时,两组HAMD评分、MESSS评分均显著下降,BI评分均显著上升(均P<0.01);治疗2周、4周时,针药组HAMD评分、MESSS评分均低于药物组,BI评分均高于药物组(P<0.01,P<0.05)。针药组抗抑郁总有效率97.0%(32/33)、神经功能缺损总有效率90.9%(30/33)、日常生活活动能力总有效率97.0%(32/33),均优于药物组的80.0%(24/30)、80.0%(24/30)、83.3%(25/30,均P<0.05)。结论:通督调神针刺能缩短抗抑郁药物治疗PSD的起效时间,且能提高总体疗效,从而提高患者临床治疗的依从性。

Objective To observe the differences in onset time and the overall efficacy of the acupuncture therapy of dredging Governor Vessel and regulating mentality combined with fluoxetine and the fluoxetine for poststroke depression（PSD）.Methods Sixty-three patients were randomly divided into an acupuncture intervention of dredging Governor Vessel and regulating mentality group（acupuncture and medication group,33cases）and a control group（medication group,30cases）.In the medication group,20 mg fluoxetine was used by oral administration,once a day at 7：00in the morning,continuously for 4weeks.In the acupuncture and medication group,based on the oral administration of fluoxetine,the acupuncture intervention of dredging Governor Vessel and regulating mentality was applied mainly at Baihui（GV 20）,Fengfu（GV 16）,Shenting（GV 24）,Shuigou（GV 26）,Dazhui（GV 14）and Shendao（GV 11）,once a day,6times a week,continuously for 4weeks.Twenty-four items in Hamilton Depression Scale（HAMD）,modified Edinburgh Scandinavia Stroke Scale（MESSS）and activity of daily life scale（ADL,Barthel index,BI）were used before and after 2-week and 4-week treatment.The efficacy was compared between the two groups.Results After 2-week treatment,the HAMD score and the MESSS score in the acupuncture and medication group were obviously decreased and the BI score was apparently increased（all P〈0.01）.In the medication group,however,the score of every scale was not statistically different from that before treatment（P〉0.05）.After4-week treatment,HAMD scores and MESSS scores in the two groups were obviously decreased and the BI scores were apparently increased（all P〈0.01）.After 2-week and 4-week treatment,the HAMD scores and the MESSS scores in the acupuncture and medication group were lower than those in the medication group and the BI scores were higher than those in the medication group（P〈0.01,P〈0.05）.The total effective rate of anti-depression（97.0%,32/33）,the total effective rate of nerve function impairment（90.9%,30/33）and the total effective rate of daily life activity（97.0%,32/33）in the acupuncture and medication group were better than 80.0%（24/30）,80.0%（24/30）,83.3%（25/30）in the medication group（all P〈0.05）.Conclusion The acupuncture therapy of dredging Governor Vessel and regulating mentality could reduce the onset time of anti-depression medicine treatment of PSD and enhance the overall efficacy.Therefore,it enhances the clinical compliance.