电针联合重复经颅磁刺激治疗脑卒中后抑郁伴失眠的临床研究

The clinical study of electric acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)treatment of poststroke depression with insomnia

目的观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义(P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation(rTMS)treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method.Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS(n=32),rTMS group(n=32)and drug treatment group(n=32).The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment,and also were regularly and continuously administrated with antidepressant drug(escitalopram citalopram).The rTMS group were only given with rTMS for 2 weeks,and the patients of the drug treatment group were administrated with the same antidepressant.At the baseline and 2th week,the 17-item Hamilton depression scale(17-HAMD),Pittsburgh Sleep Quality Index(PSQI)and polysomnography(PSG)were evaluated.Results The sleep parameters,PSQI scores and HAMD scores among three groups had no significant difference at baseline.After 2 weeks,the overall difference of HAMD score reduction between different treatment groups was statistically significant(P<0.001).The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group(P<0.05),and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group(P<0.05).The overall difference of PSQI score reduction between groups was significant(P<0.05).The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group(P<0.05),while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group(P<0.05).The overall difference of total sleep duration(F=16.735,P<0.001)and sleep efficiency(F=87.548,P<0.001)evalted by PSG among groups was significant.The changes of both the total sleep duration and sleep ef-ficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group(P<0.001),while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups(P>0.05).Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression,sleep quality,the total sleep duration and sleep efficiency of PSD,and the effect is better than that of the drug treatment group and the rTMS group,which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.