“开四关”加三阴交、足三里针刺治疗血液透析伴有轻、中度抑郁状态患者的临床研究

Clinical Observation on the Treatment of Patients with Mild or Moderate Depression on Hemodialysis by Acupuncture at Hegu(LI 4),Taichong(LR 3),Sanyinjiao(SP 6),and Zusanli(ST 36)

目的探讨“开四关”加三阴交、足三里针刺治疗血液透析患者轻、中度抑郁状态的临床疗效。方法选取2018年1月—2019年3月期间首都医科大学附属北京中医医院血液透析室60例血液透析伴有轻、中度抑郁状态患者,按随机数字表法分为治疗组和对照组,每组各30例。治疗组选择针刺“开四关”加三阴交、足三里治疗,对照组选择针刺非穴。治疗8、16周后,观察比较两组患者贝克抑郁量表(BeckDepression Inventory-II,BDI-II)、蒙哥马利-阿斯伯格抑郁量表(Montgomery-Asberg Depression Rating Scale,MADRS)分期、生活量表(Short-Form-12,SF-12)、血浆白蛋白(Serum albumin,ALB)、尿素清除指数(spKt/V,简称为Kt/V)指标的变化。结果治疗后治疗组BDI-II和MADRS分期、生活量表及血浆白蛋白及透析充分性较治疗前有改善,治疗组治疗8、16周后BDI-II及MADRS评分较治疗前降低,差异有统计学意义(P<0.05),治疗16周后BDI-II评分及MADRS评分较8周时降低,差异有统计学意义(P<0.05);治疗组BDI-II评分及MADRS评分在治疗8、16周后均低于对照组同期,差异有统计学意义(P<0.05)。治疗组治疗16周时SF-12评分较治疗前升高,差异有统计学意义(P<0.05);治疗组BDI-II评分在治疗16周后低于对照组同期,差异有统计学意义(P<0.05)。治疗组治疗8、16周后ALB及Kt/V较治疗前升高,差异有统计学意义(P<0.05),治疗16周后ALB及Kt/V较8周时升高,差异有统计学意义(P<0.05);治疗组ALB及Kt/V在治疗8、16周后均高于对照组同期,差异有统计学意义(P<0.05)。治疗过程中两组患者均未出现晕针、针刺后遗感、断针等严重不良反应,无严重血肿。结论“开四关”加三阴交、足三里针刺治疗血液透析伴有轻、中度抑郁状态患者疗效确切。

Objective To observe the clinical efficacy of acupuncture at Hegu(LI 4),Taichong(LR 3),Sanyinjiao(SP 6),and Zusanli(ST 36)in the treatment of patients with mild or moderate depression on hemodialysis.Methods Sixty patients with mild or moderate depression on hemodialysis in the Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University from January 2018 to March 2019 were assigned into an observation group and a control group,with 30 patients in each group.The observation group was treated with acupuncture at Hegu(LI 4),Taichong(LR 3),Sanyinjiao(SP 6),and Zusanli(ST 36),and the control group with acupuncture at non-acupoints.After 8 and 16 weeks of treatment,the changes in Beck Depression Inventory-II(BDI-II)score,Montgomery-Asberg Depression Rating Scale(MADRS)score,Short-Form-12(SF-12)score,plasma albumin(ALB)level,and dialysis adequacy(Kt/V)were analyzed.Results The BDI-II,MADRS,and SF-12 scores,ALB level,and Kt/V were recovered in the observation group after treatment compared with those before treatment.In the observation group,the scores of BDI-II and MADRS after 8 and 16 weeks of treatment were lower than those before treatment(P<0.05),and the scores of BDI-II and MADRS after 16 weeks of treatment were lower than those after 8 weeks of treatment(P<0.05).The scores of BDI-II and MADRS in the observation group were lower than those in the control group after 8 and 16 weeks of treatment(P<World Journal of Integrated Traditional and Western Medicine 2023,Vol.18,No.30.05).After 16 weeks of treatment,the SF-12 score in the observation group elevated compared with that before treatment(P<0.05)and the BDI-II score in the observation group was lower than that in the control group(P<0.05).The observation group showed elevated ALB and Kt/V after 8 and 16 weeks of treatment(P<0.05),and the values after 16 weeks of treatment were higher than those after 8 weeks(P<0.05).Moreover,the ALB and Kt/V in the observation group were higher than those in the control group after 8 and 16 weeks of treatment(P<0.05).During the treatment period,neither group showed adverse reactions such as fainting,lingering feeling after acupuncture,needle breakage,and severe hematoma.Conclusion Acupuncture at Hegu(LI 4),Taichong(LR 3),Sanyinjiao(SP 6),and Zusanli(ST 36)is effective in the treatment of patients with mild or moderate depression on hemodialysis.