CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 mg once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to χ2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.

Efficacy observation on Governor Vessel-regulating and brain-unblocking acupuncture for post-stroke depression

Objective： To observe the clinical effect of Governor Vessel-regulating and brain-unblocking acupuncture on post-stroke depression. Methods： A total of 70 eligible cases were randomly allocated into an observation group and a control group according to the random number table. Patients in the observation group were treated with Governor Vessel-regulating and brain-unblocking acupuncture, whereas patients in the control group were treated with oral Escitalopram Oxalate tablet. The treatment lasted for 8 weeks. The Hamilton depression scale （HAMD）, Montgomery Asberg depression rating scale （MADRS）, and Barthel index （BI） were used to evaluate the patients＇ condition before, 4 weeks and 8 weeks after treatment respectively. In addition, adverse reactions were also recorded. Results： After 4 weeks of treatment, the HAMD and MADRS scores were significantly decreased in both groups （P〈0.05）; and the BI scores were significantly increased in both groups （P〈0.05）. There was no between-group statistical difference in HAMD score （P〉0.05）; the MADRS score in the observation group was significantly lower than that in the control group （P〈0.05） and the BI score in the observation group was significantly higher than that in the control group （P〈0.05）. After 8 weeks of treatment, there were no between-group statistical differences in all aspects （P〉0.05）; however, the adverse reactions in the observation group were significantly less than those in the control group. Conclusion： The Governor Vessel-regulating and brain-unblocking acupuncture is safe and effective for post-stroke depression and can obtain similar efficacy as Escitalopram Oxalate tablet. In addition, it can fast alleviate core symptoms of depression and improve the activities of daily living （ADL） and has fewer adverse reactions.

Effect of acupuncture plus Tai Ji Quan on the recovery of neurological function and depression state in post-stroke depression patients

Objective：To observe the therapeutic efficacy of acupuncture plus Tai Ji Quan （Tai Chi） in recovering the neurological function and treating depression state in post-stroke depression patients,together with a 12-month follow-up.Methods：A total of 105 eligible post-stroke depression patients were randomized into an acupuncture plus Tai Ji group （53 cases） and a control group （52 cases） based on their visiting sequence.The patients all received routine treatment and rehabilitation training for stroke.In addition,the control group was given oral administration of citalopram hydrobromide tablets,1 month as a course of treatment,for 3 courses in total.Meanwhile,the acupuncture plus Tai Ji group received acupuncture and practiced Tai Ji Quan,for 1 month and 12 months respectively.Before the intervention,after 1-month intervention and 12 months later,the National Institute of Health stroke scale （NIHSS）,Barthel index （BI） and Hamilton depression rating scale （HAMD） were adopted for efficacy evaluation.Results：Prior to the intervention,there were no significant differences in HAMD,NIHSS and BI scores between the two groups （all P〉0.05）;after 1-month intervention,there were significant between-group differences in NIHSS,BI and HAMD scores （P〈0.05 or P〈0.01）;the 12-month follow-up revealed significant between-group differences in NIHSS,BI and HAMD scores （all P〈0.01）.In the treatment of stroke,the total effective rate was 84.4% in the acupuncture plus Tai Ji group,significantly higher than 68.9% in the control group （P〈0.05）;in the treatment of depression,the total effective rate was 86.7% in the acupuncture plus Tai Ji group,significantly higher than 77.8% in the control group （P〈0.05）.Conclusion：Acupuncture plus Tai Ji Quan can produce a significant efficacy in improving the limb motor function and depression in post-stroke depression patients.

Clinical Study on Treatment of Post-stroke Depression by Scalp Acupuncture plus Body Acupuncture

Objective： To explore the best method to treat post-stroke depression. Methods： 60 Cases of the patients with post-stroke depression were selected and divided randomly into the two groups, 30 cases in each group. The treatment group was treated by scalp acupuncture plus body acupuncture, and the control group was treated by oral administration of Fluoxetine. The therapeutic effects were assessed after 30 d of the treatments. Results： The total effective rate was 90.0% in the treatment group, with average effective time of 5 d, and was 80.0% in the control group, with average effective time of 15 d. The comparison of the total effective rates between the two groups was not significant statistically （P〉0.05）. But the comparison of the average effective time was significant statistically （P〈0.05）. Conclusion： The therapeutic effect is positive in the treatment of post-stroke depression by scalp acupuncture plus body acupuncture, similar to the therapeutic effect of Fluoxetine, but faster in the effective time.

Clinical Study on Acupuncture Treatment of Post-stroke Depression in Recent Ten Years

Post-stroke depression （PSD） is one of the severe psychological complications after cerebral stroke. In comparison with antidepressants, acupuncture treatment is precise in the therapeutic effects for PSD, low in cost, without side effect, and is an effective method for PSD. By comprehensive analysis on the clinical study on acupuncture treatment of PSD in the recent ten years, we hope this article will be helpful to clinical treatment and scientific study of PSD.

Therapeutic effect observation on acupuncture plus medication for post-stroke depression

Objective: To observe the clinical efficacy of acupuncture with medication for post-stroke depression. Methods: A total of 96 patients with post-stroke depression were randomized into an observation group and a control group, with 48 cases in each group. The control group was treated with oral fluoxetine hydrochloride capsules, and the observati on group was treated with acup un cture on the basis of the treatme nt of the con trol group. After 6 mon ths of treatment, the traditional Chinese medicine (TCM) symptom scores, and Hamilton depression scale (HAMD) component scores and total scores of the two groups before and after treatment were observed, and the clinical efficacy and adverse reaction rate were compared between the two groups. Results: The total effective rate was 95.8% in the observation group and 83.3% in the control group, and the differenee between the two groups was statistically significant (Pv0.05). After treatment, the intra-group differences in TCM symptom scores and HAMD score of both groups were statistically significant (all P<0.01). In the observation group, the scores of in differe nt expressi on, emoti onal restlessness, and sen time ntality in the TCM symptoms were statistically differe nt from those in the control group (all P<0.01). The scores of desperate factor and sleep disorder factor and total score in HAMD in the observation group were significantly different from those in the control group (all P<0.01). The incidenee of adverse reactions was 6.3% in the observation group and 4.2% in the control group, and the differenee was not significant between the two groups (P>0.05). Conclusion: Acupuncture plus medication is an effective method for post-stroke depression, and it can further improve the patient's bad mood.

Effect of Combined Acupuncture with Chinese Medicine on Overall Function of Patients with Post-stroke Depression

Objective：To explore the effect of combined acupuncture with Chinese medicine on the overall function of patients with post-stroke depression （PSD）.Methods：A total of 128 cases were randomly allocated into 4 groups,namely,a Chinese medicine group,an acupuncture group,a combined acupuncture with Chinese medicine group and a Western medication group,32 cases in each group.Other than routine treatment,patients in all 4 groups were respectively treated with Chinese medicine,acupuncture,combined acupuncture with Chinese medicine and Fluoxetine Capsule.Then the treatment effects were evaluated using Hamilton depression rating scale （HAMD）,neurological impairment severity （NIS） and functional comprehensive assessment （FCA） before and after treatments.Results：After treatment,both HAMD and NIS scores were decreased （P〈0.01）,whereas FCA scores were increased （P〈0.01）.Regarding the inter-group comparison,combined acupuncture with Chinese medicine group had statistical difference when compared with the other three groups （P〈0.05 or P〈0.01）.There were no statistical differences among the Chinese medicine group,the acupuncture group and the Western medication group.Conclusion：Each treatment protocol improves the depressive symptoms and neurological functions in PSD patients and enhances their overall function.Combined acupuncture with Chinese medicine can obtain a synergistic effect.

Efficacy observation of Zhi Shen Tiao Sui acupuncture method for depression after ischemic stroke

Objective To observe the clinical efficacy of Zhi Shen Tiao Sui(regulating the mind and marrow)needling in treating depression after ischemic stroke.Methods A total of 145 patients with depression after ischemic stroke were recruited between January 2016 and January 2018 and divided into two groups using random number table method,with 72 cases in the control group and 73 cases in the observation group.The control group received conventional treatment for ischemic stroke and medication,while the observation group was given additional Zhi Shen Tiao Sui acupuncture.The two groups were treated for 4 successive weeks.Clinical efficacy was analyzed after treatment.The neurological function pertinent scores[Hamilton depression scale(HAMD),clinical neurological deficit score(CNDS),activities of daily living(ADL),Fugl-Meyer assessment scale(FMA)and Barthel index(BI)scores],as well as the levels of cortisol(CORT)and adrenocorticotropic hormone(ACTH)were recorded in the two groups.Adverse reactions that occurred during treatment were also observed.Results The clinical total effective rate was 82.2%in the observation group,significantly higher than 66.7%in the control group(P<0.05).After treatment,the HAMD and CNDS scores were markedly reduced in both groups(all P<0.05),and the ADL,FMA and BI scores were markedly increased(all P<0.05).The HAMD and CNDS scores were significantly lower in the observation group than in the control group after treatment(both P<0.05),and the ADL,FMA and BI scores were significantly higher in the observation group than in the control group(all P<0.05).The levels of CORT and ACTH declined significantly after treatment in the two groups(all P<0.05),and were markedly lower in the observation group than in the control group(both P<0.05).The adverse reaction rate was 2.7%in the observation group,versus 4.2%in the control group,and the between-group difference was statistically insignificant(P>0.05).Conclusion Compared with sole use of Western medication,medication combined with Zhi Shen Tiao Sui acupuncture can promote the recovery of neurological function,down-regulate the levels of CORT and ACTH and enhance the clinical efficacy in treating patients with depression after ischemic stroke,with a relatively high safety rating.

醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后恢复期抑郁状态的影响

目的 观察醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后患者恢复期抑郁状态的影响。方法 将80例符合纳入标准的患者随机分为综合组(40例,中止1例)和西药组(40例,脱落2例)。西药组予口服盐酸度洛西汀肠溶片治疗,综合组在西药组口服药物基础上予醒脑开窍针刺法联合经颅磁刺激治疗。分别于治疗前后观察患者美国国立卫生院卒中量表(National Institutes of Health stroke scale,NIHSS)、改良Barthel指数(modified Barthel index,MBI)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)的评分变化,以及血清同型半胱氨酸(homocysteine,Hcy)、中性粒细胞/淋巴细胞的比值(neutrophil/lymphocyte ratio,NLR)、5-羟色胺(5-hydroxytryptamine,5-HT)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)的水平变化。观察两组治疗前后经颅多普勒超声颅内大血管[大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、大脑后动脉(posterior cerebral artery,PCA)及椎动脉(basilar artery,BA)]血流速度的变化。结果 治疗后,两组患者NIHSS、MBI、HAMD和PSQI评分以及血清Hcy、NLR、5-HT和BDNF水平均较治疗前改善(P<0.05),且综合组上述指标均优于西药组(P<0.05)。治疗后,两组ACA、MCA、PCA和BA血流速度均优于治疗前(P<0.05),且综合组上述血管血流速度均优于西药组(P<0.05)。结论 在药物治疗基础上,醒脑开窍针刺法联合经颅磁刺激治疗卒中后患者恢复期抑郁状态的临床疗效优于单一口服西药治疗,可减轻患者的抑郁程度,改善睡眠质量,提高肢体功能和日常生活能力,加快脑血管血流速度,改善血清Hcy、NLR、5-HT和BDNF的水平。

“通督治郁”针刺法对卒中后抑郁患者汉密尔顿抑郁量表各项评分的影响

目的探讨“通督治郁”针刺法治疗卒中后抑郁(PSD)患者的临床疗效以及对患者17项版汉密尔顿抑郁量表(HAMD-17)中各因子和项目评分的影响。方法回顾性收集2022年1月—2023年1月安徽中医药大学第二附属医院脑病六科住院或门诊诊断为PSD患者的资料,应用“通督治郁”针刺法进行治疗,比较治疗前后患者HAMD-17总分及项目评分、因子评分变化情况。结果本研究共纳入122例患者,治疗后疗效确切,无不良反应发生。治疗后,患者兴趣与工作、胃肠道症状、性症状和体质量减轻与治疗前比较,差异无统计学意义(P>0.05),其他HAMD-17项目评分与治疗前比较,差异有统计学意义(P<0.05)。治疗后,除因子2(体质量因子)外,患者HAMD-17各因子评分均较治疗前降低,差异有统计学意义(P<0.05)。结论“通督治郁”针刺法可明显改善PSD患者焦虑/躯体化症候群、睡眠障碍症候群、认知障碍症候群和阻滞症候群症状,是一种安全、有效的治疗方法。

针刺治疗卒中后抑郁的临床观察研究

目的客观评价针刺调节脑卒中后抑郁(Post-stroke depression,PSD)患者情绪的临床疗效与安全性,并探索针刺干预的可能作用靶点。方法将76例PSD患者随机分为治疗组和对照组,对照组采用脑卒中常规治疗措施,治疗组在此基础上加用针刺治疗,以上星、百会、神庭、风池、率谷为主穴,辅以太冲、合谷、曲池、内关、阳陵泉、足三里、太溪进行针刺,每周5次,连续治疗4周,在治疗结束后的第90天进行随访。比较治疗前、治疗后以及随访后患者17项汉密尔顿抑郁量表评分(HAMD)、改良版Barthel指数(MBI)和治疗前、后血清5-羟色胺、去甲肾上腺素水平以及肠道菌群变化。结果两组患者治疗后、随访后的HAMD评分、MBI指数均低于本组治疗前(P<0.01),且治疗组患者治疗后、随访后的汉密尔顿量表评分显著低于对照组(P<0.01);治疗组治疗后患者5-羟色胺、去甲肾上腺素水平优于本组治疗前(P<0.01),且显著高于对照组(P<0.01)。针刺后患者的优势菌群拟杆菌、厚壁菌、布劳特菌有上升趋势(P>0.05)。治疗前后的差异菌群主要富集与ECM-受体相互作用等信号通路上,差异具有统计学意义(P<0.01)。结论针刺可以帮助患者提升日常生活能力,还能在一定程度上改善PSD患者肠道菌群的相对丰度,从而调节5-HT、NE水平以缓解患者的抑郁情绪,在临床上值得推广。

“五音调神”法治疗肝郁脾虚型卒中后疲劳疗效观察

目的探讨“五音调神”法治疗肝郁脾虚型卒中后疲劳(PSF)患者的临床疗效及可能作用机制。方法选取2022年6月—2023年6月山东中医药大学第二附属医院康复医学科诊治的肝郁脾虚型PSF患者74例,采用随机数字表法分为五音调神组和常规治疗组,每组各37例,2组各脱落1例,最终完成72例。常规治疗组进行常规内科基础治疗及常规康复训练,五音调神组在常规治疗组基础上予以“五音调神”法干预。比较2组患者治疗前后疲劳严重程度量表(FSS)评分、汉密尔顿抑郁量表17项版(HAMD-17)评分、汉密尔顿焦虑量表(HAMA)评分、匹兹堡睡眠质量指数量表(PSQI)评分、脑卒中专门化生存质量量表(SS-QOL)评分以及血清5-HT水平,分析五音调神组治疗后HAMD-17评分、HAMA评分、PSQI评分与FSS评分的相关性。结果治疗后2组HAMD-17评分、HAMA评分、PSQI评分及五音调神组FSS评分均较治疗前明显降低(P均<0.05),2组SS-QOL评分及五音调神组血清5-HT水平均较治疗前明显升高(P均<0.05)。治疗后五音调神组FSS评分、HAMD-17评分、HAMA评分、PSQI评分均明显低于常规治疗组(P均<0.05),SS-QOL评分、血清5-HT水平均明显高于常规治疗组(P均<0.05)。HAMD-17评分、HAMA评分、PSQI评分与FSS评分均呈正相关(r=0.644,P<0.001;r=0.691,P<0.001;r=0.632,P<0.001)。结论“五音调神”法可有效减轻肝郁脾虚型PSF患者的疲劳,改善患者焦虑、抑郁、失眠情况,提高患者的生活质量,机制可能与上调5-HT水平相关。

基于脑肠轴理论观察针刺治疗卒中后抑郁的临床疗效

目的基于脑肠轴理论观察针刺治疗卒中后抑郁的临床疗效。方法选取74例卒中后抑郁患者,根据随机数字表法分为试验组和对照组,每组37例。两组均采用常规西药治疗,对照组采用醒脑开窍针刺法治疗,试验组在对照组基础上联合基于脑肠轴理论取穴的电针治疗。比较两组临床疗效,观察两组治疗前后中医主症积分、汉密顿抑郁量表(Hamilton depression scale,HAMD)评分、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分和日常生活能力量表(activity of daily living,ADL)评分的变化,比较两组治疗前后血清胃泌素(gastrin,GAS)、生长抑素(somatostatin,SS)、5-羟色胺(5-hydroxytryptamin,5-HT)和脑源性神经生长因子(brain-derived neuotrophyic factor,BDNF)水平的变化。结果试验组抑郁总有效率和中医证候总有效率均高于对照组(P<0.05)。两组治疗后中医主症积分、HAMD评分和NIHSS评分均较同组治疗前降低(P<0.05),ADL评分较同组治疗前升高(P<0.05);试验组治疗后上述评分均优于对照组(P<0.05)。两组治疗后血清SS水平均降低(P<0.05),血清GAS、5-HT和BDNF水平均升高(P<0.05);且试验组治疗后血清SS水平低于对照组(P<0.05),血清GAS、5-HT和BDNF水平高于对照组(P<0.05)。结论在常规西药治疗基础上,醒脑开窍针刺法联合基于脑肠轴理论取穴的电针治疗可更好地缓解卒中后抑郁患者的临床症状,改善神经功能和日常生活能力,提高临床疗效,这可能与调节血清SS、GAS、5-HT和BDNF水平有关。

电针联合中药治疗脑梗死后抑郁的疗效观察及对神经功能和生活质量的影响

目的观察电针联合归脾汤合血府逐瘀汤治疗脑梗死后抑郁的临床疗效及对患者神经功能和生活质量的影响。方法纳入102例脑梗死后抑郁患者,按随机数字表法分为观察组和对照组,每组51例。对照组采用口服归脾汤合血府逐瘀汤治疗,观察组在对照组治疗基础上联合电针治疗。比较两组临床疗效,比较两组治疗前后中医证候积分、17项汉密尔顿抑郁量表(Hamilton depression scale-17,HAMD-17)评分、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分和脑卒中专用生活质量量表(stroke-specific quality of life scale,SS-QOL)评分的变化,比较两组治疗前后血清5-羟色胺(5-hydroxytryptamine,5-HT)和去甲肾上腺素(norepinephrine,NE)水平的变化。结果观察组总有效率高于对照组,差异具有统计学意义(P<0.05)。两组治疗后中医证候积分、HAMD-17评分和NIHSS评分均较治疗前降低(P<0.05),两组治疗后SS-QOL评分以及血清5-HT和NE水平均较治疗前升高(P<0.05)。观察组治疗后中医证候积分、HAMD-17评分和NIHSS评分均低于对照组(P<0.05),SS-QOL评分以及血清5-HT和NE水平均高于对照组(P<0.05)。结论电针联合归脾汤合血府逐瘀汤治疗脑梗死后抑郁可有效缓解症状,改善神经功能,提高生活质量,疗效优于单纯口服中药治疗。

中医综合疗法治疗卒中后抑郁临床观察

目的观察中医综合疗法治疗卒中后抑郁的临床效果。方法选取2018年3月至2022年3月收治的60例卒中后抑郁患者为研究对象,采用随机数字表法分为2组,对照组30例予米氮平片治疗,治疗组30例采用中医综合疗法治疗。2组均治疗14天为1个疗程,治疗2个疗程后统计疗效,比较2组治疗前后抑郁程度[采用汉密尔顿抑郁量表(HAMD)进行评价,包括抑郁情绪、强迫症状、睡眠障碍、自卑感及偏执症状]、神经功能[采用美国国立卫生研究院卒中量表(NIHSS)进行评价,包括意识水平、语言障碍、视野及面瘫]、日常生活能力[采用日常生活活动能力量表(ADL)进行评价,包括穿衣与进食、洗澡与修饰、上下楼梯、行走及转移床椅]、控制姿势能力[采用卒中患者姿势评定量表(PASS)进行评价,包括无支持下保持坐位、支持下保持站位、无支持保持站位、用非瘫痪侧下肢站立及用瘫痪侧下肢站立]及睡眠质量[采用匹兹堡睡眠质量指数(PSQI)进行评价,选用其中睡眠质量、睡眠时间、睡眠效率、日间功能障碍及使用催眠药物5项]变化情况。结果与本组治疗前比较,2组治疗后HAMD抑郁情绪、强迫症状、睡眠障碍、自卑感及偏执症状评分均降低(P<0.05),且治疗组治疗后HAMD各项评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后NIHSS意识水平、语言障碍、视野、面瘫评分均降低(P<0.05),且治疗组治疗后NIHSS各项评分及低于对照组(P<0.05)。与本组治疗前比较,2组治疗后ADL穿衣、进食、洗澡、修饰、上下楼梯、行走及转移床椅评分均升高(P<0.05),且治疗组治疗后ADL各项评分均高于对照组(P<0.05)。与本组治疗前比较,2组治疗后PASS无支持下保持坐位、支持下保持站位、无支持保持站位、用非瘫痪侧下肢站立及用瘫痪侧下肢站立评分均升高(P<0.05),且治疗组治疗后PASS各项评分均高于对照组(P<0.05)。与本组治疗前比较,2组治疗后PSQI睡眠质量、睡眠时间、睡眠效率、日间功能障碍及使用催眠药物评分均降低(P<0.05),且治疗组治疗后PSQI各项评分均低于对照组(P<0.05)。结论中医综合疗法治疗卒中后抑郁临床疗效确切,可有效改善患者抑郁症状,促进神经功能修复,提高日常生活能力,改善睡眠质量。

针刺联合正念疗法对脑卒中后抑郁患者认知功能及预后的影响

目的:观察针刺联合正念疗法对脑卒中后抑郁(PSD)患者认知功能及预后的影响。方法:选取80例PSD患者,按随机数字表法分为对照组与观察组各40例。对照组给予正念疗法,观察组给予针刺联合正念疗法,2组均连续治疗8周。比较2组临床疗效,比较2组治疗前后中医证候积分、焦虑状况[特质焦虑量表(T-AI)、状态焦虑量表(S-AI)、焦虑自评量表(SAS)]、抑郁状况[汉密尔顿抑郁量表-17(HAMD-17)、抑郁症筛查量表(PHQ-9)、抑郁自评量表(SDS)]、正念水平[正念注意觉知量表(MAAS)]及认知功能[蒙特利尔认知评估量表(MoCA)]的变化。结果:观察组临床疗效总有效率为95.00%,对照组为80.00%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组精神不振、兴趣索然、胸闷胁胀、悲忧善哭、不思饮食、易烦易怒、失眠善忘、口苦口干中医证候积分均较治疗前下降(P<0.05),观察组上述8项中医证候积分均低于对照组(P<0.05)。治疗后,2组T-AI、S-AI、SAS评分均较治疗前下降(P<0.05),观察组T-AI、S-AI、SAS评分均低于对照组(P<0.05)。治疗后,2组HAMD-17、PHQ-9及SDS评分均较治疗前下降(P<0.05),观察组HAMD-17、PHQ-9及SDS评分均低于对照组(P<0.05)。治疗后,2组MAAS、MoCA评分均较治疗前上升(P<0.05),观察组MAAS、MoCA评分均高于对照组(P<0.05)。结论:针刺联合正念疗法能改善PSD临床症状,缓解焦虑、抑郁状况,提升正念水平,恢复认知功能,改善预后。

三阴交温针灸联合运动疗法对脑卒中后抑郁患者的疗效

目的探讨三阴交温针灸联合运动疗法对脑卒中后抑郁(PSD)患者的疗效。方法采用前瞻性研究方法,选取2020年1月至2023年10月榆林市星元医院收治的80例PSD患者作为研究对象,采用摸球法进行随机分组,奇数为对照组(40例),偶数为试验组(40例)。试验组男20例,女20例;年龄48~72(61.87±8.74)岁;抑郁程度:轻度20例,中度20例;脑卒中类型:脑梗死30例,脑出血10例。对照组男21例,女19例;年龄47~71(60.13±8.49)岁;抑郁程度:轻度19例,中度21例;脑卒中类型:脑梗死31例,脑出血9例。对照组采用运动疗法治疗,试验组在此基础上接受三阴交温针灸治疗,两组疗程均为6周。比较两组患者中医症候评分、蒙哥马利阿斯伯格抑郁量表(MADRS)评分、单胺神经递质水平[多巴胺(DA)、5-羟色胺(5-HT)和去甲肾上腺素(NE)]、Carroll上肢功能测试量表(UEFT)评分、Burke倾斜量表(BLS)评分、躯干控制试验(TCT)评分、自觉疲劳程度分级量表(Borg)评分、阿森斯失眠量表(AIS)评分和汉密尔顿抑郁量表(HAMD)失眠子部分评分。采用独立样本t检验、配对样本t检验和χ^(2)检验。结果治疗6周后,试验组中医症候评分[(7.39±2.13)分]、MADRS评分[(11.58±1.53)分]均低于对照组[(9.65±3.34)分、(13.34±1.60)分](均P<0.05);试验组DA[(74.08±7.60)ng/L]、5-HT[(280.96±34.85)μg/L]、NE水平[(45.44±6.51)μg/L]均高于对照组[(65.19±7.01)ng/L、(248.09±30.21)μg/L、(37.21±5.48)μg/L](均P<0.05);试验组UEFT评分[(35.81±6.17)分]、TCT评分[(75.34±16.55)分]均高于对照组[(23.42±3.63)分、(36.32±13.06)分](均P<0.05);试验组BLS评分[(4.85±1.86)分]、AIS评分[(4.64±1.36)分]和HAMD失眠子部分评分[(1.77±0.85)分]均低于对照组[(9.18±1.74)分、(6.52±1.63)分、(2.62±0.83)分](均P<0.05);试验组步行后Borg量表评分[(3.77±0.90)分]低于对照组[(5.34±1.27)分](P<0.05)。结论三阴交温针灸联合运动疗法在PSD患者的中医症候、情绪状态、神经递质水平、上肢功能、躯干控制能力、疲劳程度及睡眠质量方面均表现出显著的改善效果,具有推广价值。

Clinical observation of acupuncture plus repetitive transcranial magnetic stimulation in the treatment of post-stroke insomnia

Objective:To evaluate the clinical efficacy of the Governor Vessel-unblocking and mind-regulating acupuncture method plus repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke insomnia.Methods:A total of 72 patients with post-stroke insomnia were randomly divided into 2 groups,with 36 cases in each group.The control group received rTMS treatment with a frequency of 1 Hz and a motion threshold value of 90%.The observation group received acupuncture with Governor Vessel-unblocking and mind-regulating method based on the rTMS treatment of the control group.The points were Baihui(GV 20),Shenting(GV 24),Yintang(GV 29),Fengfu(GV 16),Sishencong(EX-HN I),Shenmen(HT I),Sanyinjiao(SP 6);Shenmai(BL 62)and Zhaohai(Kl 6).The treatment was performed once a day for 5 d a week followed by 2 d of rest for 4 weeks.The improvements of Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores were observed after treatment,and the clinical efficacy was compared between the two groups.Results:After 4 weeks of treatment,the PSQI,SAS,and SDS scores of the two groups were all reduced,and the intra-group differences were statistically significant(all P<0.001).After treatment,the three scores in the observation group were all lower than those in the control group,and the differences between the two groups were statistically significant(P<0.05,P<0.05,P<0.001).There was a statistically significant difference between the observation group and the control group comparing the clinical efficacy(P<0.05).Conclusion:The therapeutic effect of the Governor Vessel-unblocking and mind-regulating acupuncture method plus rTMS in treating post-stroke insomnia is better than rTMS alone,and it can better improve the anxiety and depression of patients.

Case of post-stroke depression

By adopting the psychosomatic therapy, the author treated 1 case of post-stroke depression through applying traditional acupuncture, acupoint injection combined with TCM five-element music therapy. After treatment, the neurological functions of the patient obviously recovered, Hamilton Depression（HAMD）Scale（17 items） score reduced, the levels of tumor necrosis factor and hypersensitive C-reactive protein both declined, and all the indicators were improved significantly, indicating that the curative effect of acupuncture combined with TCM five-element music therapy on this PSD patient was significant, and this treatment method was worthy of further exploration.

醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁对自噬相关蛋白水平的影响

目的观察醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁的临床疗效及对患者自噬相关蛋白水平的影响。方法将132例卒中后抑郁患者按随机数字表法分为对照组(66例)和联合组(66例)。两组均接受常规治疗,对照组另予口服乌灵胶囊治疗,联合组另予醒脑开窍针法联合口服乌灵胶囊治疗。比较两组临床疗效和不良反应发生率。观察治疗前后两组美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、汉密顿抑郁量表(Hamilton depression scale,HAMD)和日常生活能力量表(activity of daily living,ADL)的评分变化。比较两组治疗前后血清炎症因子[白介素-1β(interleukin-1β,IL-1β)、白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和核因子-κB(nuclear factor kappa-B,NF-κB)]的水平以及自噬相关蛋白[微管相关蛋白1轻链3-Ⅱ(microtubule-associated protein light chain 3-Ⅱ,LC3-Ⅱ)、自噬底物蛋白(autophagy substrate protein,p62)和自噬相关蛋白1(autophagy related protein 1,Beclin1)]的水平。结果联合组总有效率高于对照组(P<0.05)。与治疗前比较,两组治疗后HAMD和NIHSS评分均降低(P<0.05),ADL评分均升高(P<0.05);联合组治疗后HAMD和NIHSS评分低于对照组(P<0.05),ADL评分高于对照组(P<0.05)。与治疗前比较,两组治疗后血清IL-1β、IL-6、TNF-α和NF-κB水平均降低(P<0.05);联合组治疗后上述血清炎症因子水平均低于对照组(P<0.05)。与治疗前比较,两组治疗后血清Beclin1和LC3-Ⅱ水平均降低(P<0.05),血清p62水平均升高(P<0.05);联合组治疗后血清Beclin1和LC3-Ⅱ水平低于对照组(P<0.05),血清p62水平高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在常规治疗基础上,醒脑开窍针法联合乌灵胶囊治疗卒中后抑郁可以改善患者抑郁程度和神经功能、提高日常生活能力、降低炎症反应及减轻自噬程度,疗效优于单纯乌灵胶囊治疗。