电针联合重复经颅磁刺激治疗老年中重度卒中后抑郁的临床随机对照试验研究

A clinical randomized controlled trial study of electroacupuncture combined with repetitive transcranial magnetic stimulationin the treatment of moderate⁃to⁃severe post⁃stroke depression in elderly patients

目的 观察电针联合重复经颅磁刺激(rTMS)治疗中重度卒中后抑郁的临床疗效。方法 将2021年12月—2023年1月上海中医药大学附属第七人民医院康复医学科病房收治的78例中重度卒中后抑郁的患者按照数字表法随机分为观察组和对照组,每组39例。对照组接受重复经颅磁刺激治疗,观察组接受电针联合重复经颅磁刺激治疗,选取穴位有百会(DU20)、四神聪(EX-HN1)、本神(GB13)、曲池(LI11)、内关(PC6)、足三里(ST36)、申脉(BL62)。2组每周治疗5次,共治疗4周。治疗前后,观察并比较2组汉密尔顿抑郁量表(HAMD)和简式Fugl-Meyer评分(FMA)的评分变化,同时测量并比较2组运动诱发电位(MEP)的变化;比较2组的临床疗效。结果 治疗4周后,2组的HAMD评分、 MEP潜伏期及中枢运动传导时间(CMCT)均下降,FMA评分均升高,组内比较差异均具有统计学意义(P<0.01);治疗后,观察组的HAMD评分、MEP潜伏期及中枢运动传导时间(CMCT)均明显低/少于对照组,而FMA评分高于对照组,差异均有统计学意义(P<0.05)。观察组治疗总有效率高于对照组(P<0.05)。结论 电针联合重复经颅磁刺激(rTMS)治疗中重度卒中后抑郁疗效优于单纯重复经颅磁刺激,能更好的改善患者的抑郁情绪,同时可能更好的促进运动功能恢复。

Objective To observe the clinical efficacy of electroacupuncture combined with repetitive transcranial mag⁃netic stimulation(rTMS)in the treatment of moderate⁃to⁃severe post⁃stroke depression.Methods 78 patients with moderate⁃to⁃severe post⁃stroke depression admitted to the ward of Centre of Rehabilitation Medicine of the Seventh People's Hospital Af⁃filiated to Shanghai University of Traditional Chinese Medicine from December 2021 to January 2023 were randomly divided in⁃to observation group and control group according to the numerical table method,with 39 cases in each group.The control group received rTMS treatment.The observation group received electroacupuncture combined with rTMS treatment,and the selected acupoints included Baihui(DU20),Sishencong(EX⁃HN1),Benshen(GB13),Quchi(LI11),Neiguan(PC6),Zusanli(ST36),and Shenmai(BL62).Two groups were treated 5 times a week for a total of 4 weeks.Before and after treatment,the changes in scores of the Hamilton Depression Scale(HAMD)and short⁃form Fugl⁃Meyer Scale(FMA)between the two groups were observed and compared,meanwhile,the changes in motor evoked potential(MEP)were measured and compared between the two groups.The clinical efficacy of the two groups was compared.Results After 4 weeks of treatment,the HAMD score,the latency period of MEP and central motor conduction time(CMCT)decreased and the FMA scores increased in both groups.The differences within each group were statistically significant(P<0.01).After treatment,the HAMD score,the latency period of MEP and CMCT in the observation group were lower or less than those in the control group,and the FMA score was higher than that in the control group.The differences between the two groups were statistically significant(P<0.05).The total effective rate of the observation group was higher than that of the control group(P<0.05).Conclusion The com⁃bination of electroacupuncture and rTMS has a better therapeutic effect on moderate⁃to⁃severe post⁃stroke depression than simple rTMS,which can better improve patients'depressive mood and may also promote motor function recovery.