耳针联合疏肝活血汤剂对中风后抑郁患者神经功能和睡眠生活质量的影响

Influences of Ear Acupuncture Combined with Shugan Huoxue Decoction(疏肝活血汤)on Neurological Function and Quality of Sleep and Life in Patients with Post Stroke Depression

目的 分析耳针联合疏肝活血汤剂对中风后抑郁(post stroke depression, PSD)患者神经功能和睡眠生活质量的影响。方法 选取2021年1月—2022年8月在张家口市中医研究院附属医院就诊的98例PSD患者作为研究对象,采用随机数字表法将其分为研究组和对照组,每组49例。两组患者入组后均坚持中风康复治疗方案及给予心理疏导,对照组患者口服氟哌噻吨美利曲辛片,每日早晨及中午各服用5 mg,研究组患者给予耳针联合自拟疏肝活血汤剂进行治疗,两组均连续治疗3个月。对两组患者治疗前及治疗3个月末的汉密顿抑郁量表(HAMD)评分进行比较并根据HAMD评分情况对临床疗效进行评价。对两组患者治疗前及治疗3个月末的美国国立卫生研究院卒中量表(NIHSS)评分、匹兹堡睡眠质量指数量表(PSQI)评分、简明健康调查量表(SF-36)评分进行比较。对两组患者治疗期间的不良反应进行比较。结果 在治疗3个月末时,两组患者的HAMD评分总分和各维度评分、NIHSS评分、PSQI评分均较治疗前降低,研究组患者的上述指标均低于对照组,两组患者的SF-36评分各维度评分均较治疗前升高,研究组患者的上述指标均高于对照组,研究组的临床有效率高于对照组,疗效等级分布优于对照组,以上差异均有统计学意义(P<0.05);对照组有18例(36.73%)患者发生不良反应,研究组有3例(6.12%)患者发生不良反应,均为轻度反应,未见因不良反应中断治疗的病例。研究组的治疗不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 针对PSD患者采用耳针联合疏肝活血汤剂进行治疗,能够显著提升治疗效果,在促进神经功能恢复、改善睡眠质量、提高生活质量等方面的作用优于口服抗抑郁药的常规西医治疗方案。

Objective To analyze the influences of ear acupuncture combined with Shugan Huoxue Decoction(疏肝活血汤)on neurological function and quality of sleep and life in patients with post stroke depression(PSD).Methods Ninety-eight patients with PSD who were hospitalized in the Affiliated Hospital of Zhangjiakou Institute of Traditional Chinese Medicine from January 2021 to August 2022 were selected as the study subjects.They were divided into a study group and a control group using a random number table method,with 49 patients in each group.After admission,the patients in both groups adhered to the stroke rehabilitation treatment plan and were treated with psychological counseling.The patients in the control group were treated with dropethiol melitracene tablets orally,5 mg for each in the morning and at noon.The patients in the study group were treated with ear acupuncture combined with Shugan Huoxue Decoction,and both groups were continuously treated for 3 months.The Hamilton depression scale(HAMD)scores of the two groups before and at the end of 3 months of treatment were compared,and the clinical efficacy was evaluated based on the change of HAMD scores.The scores of National Institutes of health stroke scale(NIHSS),Pittsburgh sleep quality index(PSQI)and medical outcomes study 36-item short-form health survey(SF-36)before and at the end of 3 months of treatment were compared of the patients in the two groups.The adverse reactions of the patients in the two groups during treatment were compared.Results At the end of 3 month of treatment,the total score and the every dimensional scores of HAMD,NIHSS score and PSQI score of patients in both groups were lower than those before treatment.The above indicators of patients in the study group were lower than those in the control group,and the every dimensional scores of SF-36 of patients in both groups were higher than those before treatment.The above indicators of patients in the study group were higher than those in the control group,and the clinical efficiency of the study group was higher than that of the control group.The distribution of efficacy grades was better than that of the control group.The above differences were statistically significant(P<0.05).In the control group,18 patients(36.73%)had adverse reactions,while in the study group,3 patients(6.12%)had adverse reactions,all of which were mild reactions.No cases of treatment interruption due to adverse reactions have been found.The incidence of adverse reactions during treatment in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions The application of ear acupuncture combined with Shugan Huoxue Decoction in treatment of PSD patients can significantly improve the therapeutic effects,and its effects on promoting neurological recovery and improving sleep quality and quality of life are superior to those of conventional western medicine treatment schemes using oral antidepressants.