腹部推拿对阈下抑郁大学生自主神经功能调控的临床研究

Clinical Study on the Regulation of Autonomic Nervous Function in College Students with Subthreshold Depression by Abdominal Massage

目的:探究腹部推拿对阈下抑郁大学生自主神经功能的调控作用。方法:选取2022年9月~2023年12月于湖南中医药大学招募的阈下抑郁大学生64例,并随机分为腹部推拿组与对照组各32例;最终完成试验的受试者为,腹部推拿组31例,对照组29例。腹部推拿组以摩腹、按揉腹部、振腹三种手法进行操作,对照组则在腹部予以静止性触摸,每周一、三、五各干预1次,每次25 min,共6周。观察两组受试者干预前后及1个月随访时汉密尔顿抑郁量表17项版(HAMD-17)评分,干预前后心率变异性(HRV)时域指标SDNN、RMSSD、pNN50及频域指标VLF、LF、HF、LF/HF的变化,以及两组临床疗效。结果:治疗后,腹部推拿组患者HAMD-17评分较治疗前显著降低(P<0.01),对照组患者HAMD-17评分较治疗前降低(P<0.05),且腹部推拿组患者HAMD-17评分显著低于对照组(P<0.01);1个月随访时,腹部推拿组HAMD-17评分仍维持治疗后水平,且显著低于对照组(P<0.01):而对照组HAMD-17评分逐渐回升,与治疗前相比差异无统计学意义(P>0.05)。治疗后,腹部推拿组SDNN、RMSSD、pNN50较治疗前显著升高(P<0.01),对照组SDNN、RMSSD、pNN50较治疗前有升高趋势,但差异无统计学意义(P>0.05),且腹部推拿组SDNN、RMSSD、pNN50均高于对照组(P<0.01)。治疗后,腹部推拿组VLF、LF较治疗前升高(P<0.01)、HF较治疗前升高(P<0.05),LF/HF较治疗前降低(P<0.05);对照组VLF、LF、HF较治疗前有升高趋势,LF/HF较治疗前有降低趋势,但差异均无统计学意义(P>0.05);且腹部推拿组VLF、LF均显著高于对照组(P<0.01),HF高于对照组(P<0.05)、LF/HF低于对照组(P<0.05)。腹部推拿组总有效率高于对照组(P<0.01)。结论:腹部推拿能够改善抑郁情绪,并能调控自主神经功能,尤其是激活副交感神经。

Objective:To investigate the impact of abdominal massage on autonomic nervous system function in college students with subthreshold depression.Methods:A total of 64 college students with subthreshold depression,recruited from Hunan University of Chi-nese Medicine between September 2022 and December 2023,were randomly assigned to either the abdominal massage group or the control group,with 32 participants in each group.The study was completed by 31 participants in the abdominal massage group and 29 participants in the control group.In the abdominal massage group,participants received treatment through rubbing,pressing,and shak-ing of the abdomen;while in the control group,static touch on the abdomen was applied.The interventions were conducted once every Monday,Wednesday,and Friday for a duration of 25 minutes per session over a period of six weeks.HAMD-17 scores,HRV time do-main indicators and frequency domain indicators before intervention and at post-intervention were observed in both groups along with clinical efficacy.Results:After treatment,the HAMD-17 scores of patients in the abdominal massage group were significantly lower than those before treatment(P<0.01),and those of patients in the control group were lower than those before treatment(P<0.05),and the HAMD-17 scores of patients in the abdominal massage group were significantly lower than those of the control group(P<0.01);At the 1-month follow-up,the HAMD-17 scores of the abdominal acupressure group remained at the post-treatment level and were signifi-cantly lower than those of the control group(P<0.01);while the HAMD-17 scores of the control group gradually rebounded,and the difference was not statistically significant when compared with that of the pre-treatment period(P>0.05).After treatment,SDNN,RMSSD and pNN50 in the abdominal massage group were significantly higher than those in the pre-treatment group(P<0.01),while SDNN,RMSSD and pNN50 in the control group had a tendency to increase compared with those in the pre-treatment group,but the dif-ference was not statistically significant(P>0.05),and SDNN,RMSSD and pNN50 in the abdominal massage group were higher than those in the control group(P<0.01).After treatment,VLF and LF in the abdominal acupressure group were higher than before treatment(P<0.01),HF was higher than before treatment(P<0.05),and LF/HF was lower than before treatment(P<0.05);in the control group,there was a tendency for VLF,LF,and HF to increase compared with before treatment,and a tendency for LF/HF to decrease compared with before treatment,but none of the differences were statistically significant(P>0.05);and in the abdominal acupressure group VLF and LF were significantly higher than that of the control group(P<0.01),HF was higher than that of the control group(P<0.05),and LF/HF was lower than that of the control group(P<0.05).The total effective rate of the abdominal massage group was higher than that of the control group(P<0.01).Conclusion:Abdominal massage can improve depression,regulate autonomic nerves,especially activate parasympathetic nerves.