针刺结合氟哌噻吨美利曲辛治疗脑卒中后中度抑郁:随机对照研究

Post-stroke moderate depression treated with acupuncture and Deanxit:A randomized controlled trial

目的:研究调脏补虚安神针刺法结合氟哌噻吨美利曲辛(黛力新)对脑卒中后中度抑郁的影响。方法:将68例脑卒中后1—4个月伴中度抑郁患者采用随机信封法分为观察组及对照组,两组均给予常规康复、常规针刺及口服黛力新治疗,观察组在此基础上加用调脏补虚安神针刺法。治疗前及治疗6周后分别评测24项汉密尔顿抑郁量表(HAMD),美国国立卫生研究院卒中量表(NIHSS),改良Barthel指数,心率变异性指标:RR间期标准差(SDNN)、相邻RR间期之差的均方根值(rMSSD)、相邻R—R间期差值>50ms占总R—R间期数的百分数(PNN50)、平均心率(M-HRT)、高频(HF)、低频(LF)、低频/高频比值(LF/HF)。结果:经过6周治疗后,两组HAMD评分、NIHSS评分、M-HRT均显著低于治疗前(P<0.01),且观察组HAMD评分、NIHSS评分低于对照组(P<0.01、P<0.05);两组Barthel指数、SDNN、rMSSD、PNN50、HF、LF、LF/HF均显著高于治疗前(P<0.01),且除SDNN、rMSSD外,观察组高于治疗组(P<0.05、P<0.01)。观察组总有效率高于对照组(P<0.05)。治疗后两组间M-HRT、SDNN、rMSSD比较,差异无显著性意义(P>0.05)。结论:调脏补虚安神针刺法结合黛力新治疗脑卒中后中度抑郁的效果以及对神经功能、日常生活活动能力、心率变异性指标中时域指标PNN50及所有的频域指标的改善作用优于常规针刺法结合黛力新治疗。

Objective:To research the curative effect of Tiaozang Buxu Anshen acupuncture and Deanxit in stroke patients with moderate depression.Method:Sixty-eight patients with moderate depression 1-4 months after stroke were divided into an observation group and a control group by random envelope method,with 34 cases in each group.In two groups,the rehabilitation,acupuncture at the acupoints along the affected meridians and Deanxit were adopted.Additionally,In the observation group,acupuncture was applied to the acupoints for"Tiaozang Buxu Anshen".The indexes were observed before and after 6 weeks treatment,including the Hamilton depression scale of 24 items(HAMD),National Institutes of Health Stroke Scale(NIHSS),Modified Barthel index.And heart rate variability indices:the standard deviation of normal to normal(SDNN),root mean square of successive differences(rMSSD),the percentage of RR interval more than 50 ms(PNN50),mean heart rate(M-HRT),high frequency(HF),low frequency(LF),LF/HF.Result:After 6 weeks treatment,the scores of HAMD,NIHSS,M-HRT in the two groups were all lower than those before treatment(P<0.01),and HAMD,NIHSS in the observation group were lower than those in the control group(P<0.01,P<0.05).After treatment,Modified Barthel index,SDNN,rMSSD,PNN50,HF,LF,LF/HF were all significantly higher than those before treatment(P<0.01),and Modified Barthel index,PNN50,HF、LF、LF/HF in the observation group improved much more than those in the control group(P<0.05,P<0.01).The total effective rate in the observation group was higher than that in the control group(P<0.05).But after treatment,there were no statistically significant differences between the two groups in MHRT,SDNN,rMSSD(P>0.05).Conclusion:The effect of acupuncture combined with Deanxit on moderate poststroke depression was better than that of conventional acupuncture combined with Deanxitin,as well as the improvement of neurological function,activity of daily living,heart rate variability index PNN50 and all frequency domain indices.