解郁活血汤联合针刺治疗肝郁血瘀型脑卒中后抑郁症的临床观察

Clinical Observation on the Jieyu Huoxue Decoction Combined with Acupuncture in the Treatment of Post-stroke Depression of Liver Stagnation and Blood Stasis Type

【目的】观察解郁活血汤联合针刺百会、印堂穴治疗肝郁血瘀型脑卒中后抑郁症(PSD)的临床疗效。【方法】将80例肝郁血瘀型PSD患者随机分为观察组和对照组,每组各40例,对照组给予西医常规治疗,观察组在对照组治疗的基础上,给予解郁活血汤联合针刺百会、印堂穴治疗。连续治疗6周。治疗6周后,评价2组临床疗效,观察2组患者治疗前及治疗2、4、6周后汉密尔顿抑郁量表(HAMD)评分、美国国立卫生院神经功能缺损(NIHSS)评分、日常生活活动能力量表(ADL)评分的变化情况,以及中医证候积分的变化情况。比较2组患者治疗前后血清5-羟色胺(5-HT)、去甲肾上腺素(NE)及多巴胺(DA)含量的变化情况。并评价2组的不良反应发生情况。【结果】(1)观察组总有效率为95.00%(38/40),对照组为67.50%(27/40)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗2、4、6周后,2组患者的HAMD评分、NIHSS评分、ADL评分明显改善(P<0.05),且观察组在改善HAMD评分、NIHSS评分、ADL评分方面明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗2、4、6周后,2组患者的神情抑郁、思维迟缓、胁肋胀痛明显改善(P<0.05),且观察组在改善神情抑郁、思维迟缓、胁肋胀痛方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗2、4、6周后,2组患者的5-HT、NE、DA水平明显改善(P<0.05),且观察组在改善5-HT、NE、DA水平方面明显优于对照组,差异有统计学意义(P<0.05)。(5)观察组不良反应总发生率为5.00%(2/40),对照组不良反应总发生率为10.00%(4/40),观察组不良反应发生率稍低于对照组,但2组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】解郁活血汤联合针刺百会、印堂穴治疗肝郁血瘀型PSD,能明显改善患者的临床症状,从而提高患者生活质量,疗效显著。

Objective To observe the clinical efficacy of the combination of Jieyu Huoxue Decoction with acupuncture at Baihui(DU20)and Yintang(EX-HN3)points in the treatment of post-stroke depression(PSD)with liver depression and blood stasis syndrome.Methods Eighty patients with liver depression and blood stasis type of PSD were randomly divided into an observation group and a control group,40 patients in each group.The control group was given routine treatment of western medicine,and the observation group was treated with Jieyu Huoxue Decoction combined with acupuncture at Baihui and Yintang points on the basis of treatment in the control group.Both groups were treated for 6 consecutive weeks.After 6 weeks of treatment,the clinical efficacy of the two groups was evaluated and the changes in Hamilton Depression Scale(HAMD)scores,National Institutes of Health Stroke Scale(NIHSS)scores and Activities of Daily Living(ADL)scores,as well as the changes in traditional Chinese medicine(TCM)syndrome scores were observed before treatment,and after 2,4 and 6 weeks of treatment in the two groups.The changes in serum 5-hydroxytryptamine(5-HT),norepinephrine(NE)and dopamine(DA)levels were compared before and after treatment in the two groups.The incidence of adverse reactions in the two groups was also evaluated.Results(1)The total effective rate of the observation group was95.00%(38/40)and that of the control group was 67.50%(27/40).The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P<0.05).(2)After 2,4 and6 weeks of treatment,the HAMD score,NIHSS score and ADL score of the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the HAMD score,NIHSS score and ADL score,and the difference was statistically significant(P<0.05).(3)After2,4 and 6 weeks of treatment,the depression,thinking retardation and distending pain in hypochondrium in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the depression,thinking retardation and distending pain in hypochondrium,and the difference was statistically significant(P<0.05).(4)After 2,4 and 6 weeks of treatment,the levels of 5-HT,NE and DA in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the levels of 5-HT,NE and DA,and the difference was statistically significant(P<0.05).(5)The total incidence of adverse reactions in the observation group was 5.00%(2/40),and the total incidence of adverse reactions in the control group was 10.00%(4/40).The incidence of adverse reactions in the observation group was slightly lower than that in the control group,but there was no significant difference between the two groups(P<0.05).Conclusion Jieyu Huoxue Decoction with acupuncture at Baihui and Yintang points exerts significant effect in treating liver depression and blood stasis type of PSD through significantly improving the clinical symptoms of patients,thereby improving their quality of life.