“五音调神”法对卒中后抑郁及相关躯体症状和血清5-HT的影响

Effect of"Wuyin Tiaoshen"(五音调神)Method on Post-Stroke Depression and Related Physical Symptoms and Serum 5-HT

目的:观察音乐联合针刺疗法对卒中后抑郁(PSD)患者抑郁情绪、躯体化症状的影响,并探讨其可能的作用机制。方法:将69例PSD患者采用随机数字表法分为药物组、针刺组、音乐针刺组,每组23例。3组患者均接受常规康复治疗,药物组采用口服艾司西酞普兰治疗,针刺组取神庭、印堂、百会,音乐针刺组采用五行音乐角调联合针刺治疗,穴位同针刺组。对比3组治疗前后汉密尔顿抑郁量表17项(HAMD-17)、抑郁和躯体症状量表(DSSS-22)、临床副反应量表(TESS)评分,分析治疗前后血清5-羟色胺(5-HT)含量变化。结果:药物组总有效率为71.4%(15/21),针刺组总有效率为77.7%(17/22),音乐针刺组总有效率为91.3%(21/23),3组患者总有效率比较,差异有统计学意义(P<0.05),音乐针刺组总有效率优于针刺组(P<0.05)。治疗后3组患者HAMD-17量表综合积分较治疗前均下降,差异均有统计学意义(P<0.05);音乐针刺组HAMD-17量表综合积分低于药物组(P<0.05);而针刺组与药物组比较,差异无统计学意义(P>0.05)。治疗后音乐针刺组DSSS-22总分、SS评分低于针刺组和药物组(P<0.05);治疗后针刺组DS评分高于音乐针刺组和药物组(P<0.05);音乐针刺组PS评分低于药物组和针刺组(P<0.05)。药物组发生不良反应4例,针刺组发生不良反应2例,音乐针刺组发生不良反应1例,3组患者不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后3组患者清5-HT水平均升高(P<0.05),且音乐针刺组、针刺组血清5-HT水平高于药物组(P<0.05),而音乐针刺组5-HT水平高于针刺组(P<0.05)。结论:音乐联合针刺治疗PSD患者伴躯体症状疗效显著,能提高血清5-HT含量,改善患者抑郁情绪、躯体症状。

Objective:To observe the efficacy of music combined with acupuncture therapy on depressed mood and somatization symptoms in post-stroke depression(PSD)patients and to explore its possible mechanism of action.Methods:Totally 69 patients with PSD were divided into drug group,acupuncture group and music acupuncture group according to the random number table method,23 patients in each group.Patients received conventional rehabilitation treatment in three groups.The drug group was treated with oral escitalopram.The acupuncture group was treated with acupuncture on Shenting(GV 24),Yintang(GV 29)and Baihui(GV 20),and the music acupuncture group was treated with Jiao tone of Wuyin Tiaoshen combined with acupuncture,with the same acupuncture points as the acupuncture group.The Hamilton Depression Scale 17(HAMD-17),Depression and Somatic Symptoms Scale(DSSS-22)and Clinical Side Effects Scale(TESS)scores were compared among the three groups before and after treatment.The changes in serum 5-hydroxytryptamine(5-HT)levels were analyzed before and after treatment.Results:The total effective rate was 71.4%(15/21)in drug group,77.7%(17/22)in acupuncture group and 91.3%(21/23)in music acupuncture group.There was statistically significant difference in the total effective rate among the three groups(P0.05).The music acupuncture group showed lower DSSS-22 total score and SS score than acupuncture group and drug group after treatment(P0.05).The relative serum 5-HT levels increased in the three groups after treatment(P<0.05),and music acupuncture group and acupuncture group showed higher 5-HT levels than drug group after treatment(P<0.05).The music accupuncture group showed higher 5-HT level than that accupuncture group.Conclusion:The efficacy of music combined with acupuncture in the treatment of PSD patients with somatic symptoms is significant.It can increase the serum 5-HT level and improve patients’depression and somatic symptoms.