化瘀通络灸联合揿针治疗脑梗死后轻中度抑郁疗效观察

Huayu Tongluo moxibustion combined with intradermal needling in patients with mild to moderate depression after cerebral infarction

目的:观察在西药治疗基础上,化瘀通络灸联合揿针治疗对脑梗死后轻中度抑郁患者抑郁症状、生活质量及认知功能障碍的影响。方法:将50例脑梗死后轻中度抑郁患者随机分为针药组和西药组,每组25例。西药组予盐酸帕罗西汀片,每天早餐后顿服20 mg,剂量可根据病情调整至最高40 mg/d,连续治疗4周;在西药组治疗基础上,针药组加用化瘀通络灸(隔附子饼灸百会,悬灸大椎、神庭)联合揿针(穴取神门、间使、足三里等)治疗,化瘀通络灸每周6次,揿针每周3次,均治疗4周。观察两组治疗前后汉密尔顿抑郁量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)、简易精神状态检查表(MMSE)评分,并比较两组临床疗效及不良反应发生情况。结果:治疗后,两组HAMD评分较治疗前降低(P<0.05),且针药组低于西药组(P<0.05);治疗后,针药组SS-QOL、两组MMSE评分较治疗前升高(P<0.05),针药组SS-QOL评分高于西药组(P<0.05)。针药组总有效率为88.0%(22/25),高于西药组的60.0%(15/25,P<0.05)。针药组不良反应发生率与西药组比较差异无统计学意义[4.0%(1/25)vs 16.0%(4/25),P>0.05]。结论:在西药盐酸帕罗西汀片治疗基础上,化瘀通络灸联合揿针治疗能有效改善脑梗死后轻中度抑郁患者抑郁症状,提高生活质量及认知功能。

Objective To observe the effect of Huayu Tongluo(resolving stasis and promoting collateral circulation)moxibustion combined with intradermal needling on depressive symptoms,quality of life and cognitive impairment in patients with mild to moderate depression after cerebral infarction on the basis of western medicine treatment.Methods Fifty patients with mild to moderate depression after cerebral infarction were randomly divided into an acupuncture combined with western medication group(group A,25 cases)and a western medication group(group B,25 cases).In the group B,paroxetine hydrochloride tablets were taken orally,20 mg after breakfast,once a day,and the dose could be adjusted to the maximum 40mg/d according to the patients’condition,for 4 weeks totally.On the basis of the treatment in the group B,the group A was treated with Huayu Tongluo moxibustion,namely aconite cake-separated moxibustion at Baihui(GV 20)and suspended moxibustion at Dazhui(GV 14)and Shenting(GV 24),combined with intradermal needling at Shenmen(HT 7),Jianshi(PC 5),Zusanli(ST 36),etc.Huayu Tongluo moxibustion was performed 6 times a week,and intradermal needling was performed 3times a week,for 4 weeks totally.In the two groups,the scores of Hamilton depression scale(HAMD),stroke specific quality of life scale(SS-QOL)and mini mental state examination(MMSE)were observed before and after treatment,and the clinical efficacy and safety were compared.Results After treatment,the HAMD score in the each group was decreased compared with that before treatment(P<0.05),and that in the group A was lower than the group B(P<0.05);after treatment,the SS-QOL score in the group A and MMSE score in the two groups were increased compared with those before treatment(P<0.05),and the SS-QOL score in the group A was higher than the group B(P<0.05).The total effective rate was 88.0%(22/25)in the group A,which was higher than 60.0%(15/25)in the group B(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(4.0%[1/25]vs 16.0%[4/25],P>0.05).Conclusion On the basis of the treatment of western medication paroxetine hydrochloride tablets,Huayu Tongluo moxibustion combined with intradermal needling therapy can effectively improve the depressive symptoms,quality of life and cognitive impairment of patients with mild to moderate depression after cerebral infarction.