加味四逆散联合腹针治疗脑卒中后抑郁临床疗效观察

目的 探讨加味四逆散联合腹针治疗脑卒中后抑郁(post stroke depression,PSD)的临床疗效。方法 将确诊为PSD的80例患者随机分为治疗组和对照组,治疗组予加味四逆散口服并联合腹针,对照组予帕罗西汀片口服,观察其临床疗效及不良反应。结果 治疗组总有效率为92.5%,对照组总有效率为85%,2组比较差异有统计学意义(P<0.05); 且治疗组未出现不良反应。结论 加味四逆散联合腹针治疗脑卒中后抑郁疗效优于西医抗抑郁药物,且无明显副作用。     

星状神经节阻滞治疗卒中后抑郁患者的疗效分析

目的观察星状神经节阻滞(SGB)对卒中后抑郁(PSD)患者的临床疗效。方法将符合入选标准的PSD患者按入院顺序随机分入常规组和实验组,常规组给予常规药物、康复训练及心理干预等综合康复治疗,实验组在常规治疗的基础上同时给予SGB进行干预。观察2组治疗前后抑郁量表评分的变化以及日常生活活动能力(ADL)。结果与常规组相比,实验组干预1个疗程后患者抑郁症状及ADL均有明显改善,差异有统计学意义(P0.05)。结论 SGB作为一种新的治疗方法,不仅能够改善PSD患者抑郁症状,且使该类患者ADL得到明显提高。     

卒中后抑郁患者药物及心理治疗

目的探讨抗抑郁药物和心理治疗对卒中后抑郁(PSD)及神经功能康复的影响。方法对1999~2001年神经内科150例脑卒中患者中符合PSD54例随机分为两组:心理治疗联合黛力新组和黛力新治疗组,于治疗前和治疗4周后分别测定HAMD、日常生活能力BI。结果治疗后两组抑郁焦虑情绪明显改善(P<0.01),日常生活能力明显提高(P<0.05),并且心理治疗联合黛力新组比单用黛力新治疗更有效(P<0.05)。结论心理治疗联合黛力新治疗PSD,不仅能显著改善患者的抑郁状态,而且能促进神经功能的康复,改善日常生活能力。     

神经内科患者的心理康复

目的探讨神经内科患者的心理康复效果。方法将我院收治的75例神经内科患者,按照住院号奇偶分为常规康复组37例和心理康复组38例。常规康复组实施常规康复,心理康复组在常规康复组基础上增加康复心理措施。比较2组康复效果、干预前后SCL-90量表中焦虑、抑郁、恐惧三项评分。结果 (1)心理康复组康复效果显著优于常规康复组,差异有统计学意义(P0.05);(2)干预后,心理康复组SCL-90量表中焦虑、抑郁、恐惧三项评分均显著优于常规康复组,差异有统计学意义(P0.05)。结论心理康复有助于改善神经内科患者不良心理状态,消除心理障碍,提高康复效果,值得推广。     

康复治疗对老年患者脑卒中后抑郁及日常生活能力的影响

目的探讨康复治疗对老年脑卒中后抑郁及日常生活能力的影响。方法老年医学科52例脑卒中后抑郁患者,随机分为康复组和对照组各26例,康复组给予内科常规治疗+抗抑郁药物治疗(西酞普兰,10mg/d)+康复治疗(包括运动疗法、作业疗法、物理因子治疗、心理治疗、家庭及社区康复),对照组给予内科常规治疗+抗抑郁药物治疗。2组均治疗1个月。分别在患者入院后、治疗1个月后采用Hamilton Depression Scale(HAMD)评分评定患者的抑郁状态,Barthel指数评估患者的日常生活能力,观察2组卒中伴抑郁患者治疗前后HAMD评分和Barthel指数的变化。结果与治疗前比较,2组HAMD评分均有降低(P0.05),Barthel指数均升高(P0.05);与对照组相比,康复组HAMD评分明显降低(P0.01),Barthel指数明显升高(P0.01)。结论康复治疗能有效减轻老年患者卒中后抑郁状态,提高其日常生活活动能力。     

抗抑郁治疗对卒中后抑郁患者神经功能康复的影响

目的探讨抗抑郁治疗对卒中后抑郁(PSD)的效果及其对神经功能康复的影响。方法将卒中后抑郁(PSD)患者随机分为研究组和对照组(各45例),对照组采取常规对症治疗,研究组在对照组基础上加用帕罗西汀抗抑郁治疗,比较两组患者治疗后的抑郁症状改善、神经功能康复、临床疗效的情况。结果研究组治疗4周后和8周后神经功能缺损量表(NIHSS)和汉密尔顿抑郁量表(HAMD)评分均明显低于对照组(P0.05);研究组患者的治疗总有效率显著高于对照组(P0.05)。结论抗抑郁治疗能够有效改善卒中患者的抑郁情绪,并有助于神经功能的康复、提高临床疗效。     

舍曲林治疗老年脑卒中后抑郁的前瞻性临床随机对照研究

目的:探讨舍曲林治疗老年卒中后抑郁(PSD)的疗效和对卒中康复的影响。方法:老年PSD病人随机入选治疗组、对照组各65例,卒中均经临床、影像诊断、规范治疗5个月内,抑郁诊断为Zung量表≥40分或GDS量表5~10分。治疗组加用舍曲林治疗共12周。观察两组病人的抑郁量表和ADL评分。结果:抑郁量表和ADL评价发现治疗组总体疗效优于对照组,治疗组在治疗后4、8和12周末均有逐步好转,抑郁量表评价亚组分析提示治疗组左半球、多灶病人抑郁症状较明显,其疗效更好,而ADL评定亚组分析提示治疗组左半球、单灶病人的康复效果更佳。结论:舍曲林治疗老年PSD有效,也促进卒中康复。     

脑卒中后抑郁患者的护理

目的 探讨脑卒中后抑郁(PSD)症状及护理手段.方法 采用汉密尔顿抑郁量表的抑郁标准判定脑卒中患者有无抑郁症状.结果 经综合护理措施,20例PSD患者的抑郁情绪于2～3个月内康复.结论 及早判断脑卒中后抑郁症状,采取综合护理措施,使患者积极配合治疗,在康复训练的基础上,促进功能障碍肢体恢复.     

综合康复护理训练治疗脑卒中吞咽障碍的疗效观察

目的分析综合康复护理训练在脑卒中吞咽障碍中的应用效果。方法选取2012-10—2015-12收住我院的脑卒中后吞咽障碍患者110例,采用常规治疗30例为常规组,采用常规治疗+早期康复护理基础训练40例为康复组,采用常规治疗+早期康复护理基础训练+针灸治疗40例为综合组。分别采用NIHSS评分、Burke评分、VFSS评分及Rosenbek分级于治疗前及治疗后8周评估各组吞咽功能,治疗结束后比较各组疗效。结果治疗后各组吞咽困难症状均较前明显改善,常规组、康复组和综合组总有效率分别为53.3%(16/30)、77.5%(31/40)和97.5%(39/40);综合组总有效率优于常规组和康复组(P0.05)。治疗8周后,综合组NIHSS评分、Burke评分、VFSS评分及Rosenbek分级均优于常规组和康复组(P0.05)。结论对于脑卒中后吞咽障碍患者,早期康复护理训练配合针灸疗法可有效改善临床症状,减轻神经功能损害。     

音乐疗法辅以心理疏导对脑卒中后抑郁状态的影响

目的研究音乐疗法辅以心理疏导对脑卒中后抑郁患者的疗效。方法将60例脑卒中后抑郁(PSD)患者随机分为干预组和对照组,2组均给予常规药物治疗及一般康复治疗,但不给予抗抑郁药物治疗。干预组在此基础上进行音乐疗法辅以心理疏导,对照组不进行此项干预。结果干预5周后2组HAMD、SDS评分均明显降低,差异有统计学意义(P0.05,P0.01)。结论音乐疗法辅以心理疏导对改善脑卒中后抑郁状态效果显著,可在临床推广应用。     

风池配合廉泉穴针灸治疗脑卒中后假性延髓性麻痹32例

目的观察风池配合廉泉针灸治疗假性延髓性麻痹的疗效。方法62例假性延髓性麻痹患者分为针灸治疗组32例和内科对照组30例,内科组采用药物治疗加鼻饲饮食、静脉营养支持疗法,针灸组在此基础上采用风池配合廉泉针灸治疗,3个疗程后比较2组患者的疗效。结果针灸组和内科组的总有效率分别为90.6%和73.3%,治疗组优于对照组(P<0.05)。结论风池配合廉泉针灸治疗可提高脑卒中后假性延髓性麻痹的疗效。     

Effectiveness of acupuncture and bee venom acupuncture in idiopathic Parkinson's disease

This study aimed to explore the effectiveness of both acupuncture and bee venom acupuncture as adjuvant therapies for idiopathic Parkinson's disease.We recruited 43 adults with idiopathic Parkinson's disease who had been on a stable dose of antiparkinsonian medication for at least 1 month. They were randomly assigned to 1 of 3 groups: acupuncture, bee venom acupuncture, or control. All participants were assessed using the Unified Parkinson's Disease Rating Scale, the Parkinson's Disease Quality of Life Questionnaire, the Beck Depression Inventory, the Berg Balance Scale, and the time and number of steps required to walk 30 m. Treatment groups underwent stimulation of 10 acupuncture points using acupuncture or bee venom acupuncture twice a week for 8 weeks. The initial assessment was repeated at the completion of treatment. The control group did not receive any treatment.Participants in the bee venom acupuncture group showed significant improvement on the Unified Parkinson's Disease Rating Scale (total score, as well as parts II and III individually), the Berg Balance Scale, and the 30 m walking time. When compared to the control group, the bee venom acupuncture group experienced significantly greater improvement on the Unified Parkinson's Disease Rating Scale. In the acupuncture group, the Unified Parkinson's Disease Rating Scale (part III and total scores) and the Beck Depression Inventory showed significant improvement. The control group showed no significant changes in any outcome after 8 weeks.In this pilot study, both acupuncture and bee venom acupuncture showed promising results as adjuvant therapies for Parkinson's disease.     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

Effect of Acupuncture on the Motor and Nonmotor Symptoms in Parkinson's Disease—A Review of Clinical Studies

Parkinson's disease is a neurodegenerative disorder. Parkinson's clinical feature is characterized by its motor manifestations, although its many nonmotor symptoms occur earlier and have more profound impact on the quality of patient's life. Acupuncture has been increasingly popular and has been used to treat patients with Parkinson's. In this article, we have studied the clinical reports of acupuncture treatment for Parkinson's, which were listed in Medline, PubMed, EMBASE, CNKI, and CINAHL databases in the past 15 years. It was found that acupuncture either manual or electroacupuncture stimulation at specific acupoints relieved some motor symptoms in patients with Parkinson's and markedly improved many nonmotor symptoms such as psychiatric disorders, sleep problems, and gastrointestinal symptoms. When it was used as an adjunct for levodopa, acupuncture improved therapeutic efficacy and reduced dosage and the occurrence of side effects of levodopa. However, the results were constrained by small sample sizes, methodological flaws, and blinding methods of studies. Although the evidence for the effectiveness of acupuncture for treating Parkinson's is inconclusive, therapeutic potential of acupuncture seems quite promising. More studies, either comparative effectiveness research or high‐quality placebo‐controlled clinical studies are warranted.     

Acupuncture treatment modulates the corticostriatal reward circuitry in major depressive disorder

Major depressive disorder (MDD) is a common disorder with a high prevalence and significant social and economic impacts. Nevertheless, the treatment of MDD is far from satisfactory. Acupuncture treatment has emerged as a promising method for treating MDD. However, the neural mechanism by which acupuncture reduces depressive symptoms is not fully understood. Studies have shown that the corticostriatal reward circuitry is associated with the pathophysiology of MDD; thus, we investigated the corticostriatal resting-state functional connectivity (rsFC) before and after real and sham acupuncture treatments combined with the antidepressant fluoxetine. Forty-six female major depressive patients were assigned to either verum acupuncture plus fluoxetine (n = 22) or sham acupuncture plus fluoxetine (n = 24) treatment for 8 weeks, and resting state functional magnetic resonance imaging (fMRI) data were collected before the first and after the last treatment sessions. The results showed that compared with sham acupuncture, the verum acupuncture group showed: (1) significantly increased rsFC between inferior ventral striatum and medial prefrontal cortex, ventral rostral putamen and amygdala/parahippocampus, as well as dorsal caudate and middle temporal gyrus; (2) significantly decreased rsFC between right ventral rostral putamen and right dorsolateral prefrontal cortex, and right dorsal caudate and bilateral cerebellar tonsil. The increased rsFC between the inferior ventral striatum and medial prefrontal cortex, ventral rostral putamen and amygdala/parahippocampus were significantly positively associated with decreased clinical scores (Montgomery–Åsberg Depression Rating Scale and Self-Rating Depression Scale scores) at the end of the eight-week treatment. Our findings suggest that acupuncture may achieve treatment effects by modulating the corticostriatal reward/motivation circuitry in MDD patients.     

Evaluating the efficacy of acupuncture in defined aspects of stroke recovery

OBJECTIVE: To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo. DESIGN : Placebo-controlled, randomised, clinical trial. SETTING: Post-stroke rehabilitation wards in five NHS hospitals in the UK. SUBJECTS: Patients between 4 and 10 days after their first stroke. INTERVENTIONS AND OUTCOME MEASURES: The patients received 12 acupuncture or placebo treatments over four weeks. Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility. RESULTS: 92 patients completed data sets. Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure. While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p = 0.737, 95 % CI -2.00 to 2.81) and 52 weeks (p = 0.371, 95 % CI -3.48 to 1.32). An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks (p = 0.009, 95 % CI 1.55 to 10.77) is interesting. CONCLUSIONS: Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.     

药物联合心理干预治疗儿童多动症患者疗效观察

目的:探讨药物联合心理干预对儿童多动症患者的疗效。方法:56例多动症患儿随机分为干预组(28例)和对照组(28例),对干预组予哌甲酯治疗外,实施6周心理干预(行为干预、家庭支持治疗及生物反馈);对照组仅予哌甲酯治疗。两组均于治疗开始及治疗6周实施Corners父母问卷测验。结果:治疗6周后,两组症状较治疗前均有改善,差异有统计学意义(P<0.01)。干预组较对照组品行问题、冲动多动问题、多动指数因子分进步更为明显(P<0.01)。结论:心理干预联合药物治疗比单独药物治疗可更好地改善多动症患儿的症状。     

Neural stem cell proliferation and differentiation in a neonatal rat model of hypoxia/ischemia injury Acupuncture at Ren, Du, and urinary bladder meridians

BACKGROUND: Acupuncture improves the prognosis of neonatal hypoxic-ischemic encephalopathy (HIE). However, the cytological mechanism of acupuncture therapy remains poorly understood. In situ neural stem cell (NSC) proliferation theory proposes that the proliferation and differentiation of NSCs plays an important role in HIE treatment with acupuncture. OBJECTIVE: To investigate NSC proliferation and differentiation in the brain of a rat model of HIE during acupuncture at Ren, Du, and urinary bladder meridians. DESIGN, TIME AND SETTING: A randomized, controlled animal experiment was performed at the Central Laboratory of Shantou University Medical College from July 2005 to June 2009. MATERIALS: A 32~# 1-cun stainless steel acupuncture needle was purchased from Suzhou Acupuncture Supplies Co. Ltd., China. METHODS: A total of 90 Sprague-Dawley rats, aged 7 days, were randomly assigned to acupuncture, model and normal groups, with 30 animals in each group. Animals in acupuncture and model groups were subjected to left common carotid artery ligation followed by hypoxia for 2 hours to establish neonatal HIE models. Acupuncture group rats underwent acupuncture at Ren, Du, and urinary bladder meridians, once a day. MAIN OUTCOME MEASURES: The number, appearance, and distribution of bromodeoxyuridine (BrdU)-positive cells in the cerebral cortex and hippocampus of each group were compared. In addition, NSC differentiation in the occipital cortex and hippocampal dentate gyrus 40 days following model establishment was detected. RESULTS: BrdU-positive cells were dispersed in the cerebral cortex and hippocampus. The number of BrdU-positive cells in occipital cortex and hippocampal dentate gyrus of HIE rats remained unchanged following 3 and 7 days of acupuncture, but a significant increase was detected on days 14 and 28 (P < 0.01 or P < 0.05). At 40 days, immunofluorescence showed that a majority of BrdU-positive cells were co-lableled with the neuron marker, and neuron specific enolase, and a few were co-labeled with the astrocyte marker, and glial fibrillary acidic protein. CONCLUSION: Acupuncture at Ren, Du, and urinary bladder meridians promoted NSC proliferation in the occipital cortex and hippocampal dentate gyrus of HIE rats. Moreover, acupuncture-induced neoformative NSCs mostly differentiated into neurons.     

针刺联合半量托特罗定对帕金森病合并膀胱过度活动症排尿及运动功能的影响

目的观察针刺联合半量托特罗定对帕金森病(PD)合并膀胱过度活动症(OAB)的排尿及运动功能的影响和临床副作用。方法对60例PD合并OAB患者随机分两组,治疗组30例予以针刺联合半量托特罗定(1mg.d-2)治疗6周,对照组予以全量托特罗定(2mg.d-2)6周,两组基础美多巴治疗量一致,停用安坦等抗胆碱药物,观察两组治疗前后平均每次尿量、24小时平均尿次、24小时平均尿失禁次数、OABSS评分及UPDRSⅢ评分并分析临床疗效。结果治疗前后两组排尿变化均有显著性差异(P<0.01),治疗后治疗组较对照组有显著差异(P<0.05);两组OABSS评分治疗后均有下降,治疗组有显著差异(P<0.01);两组UPDRSⅢ评分治疗后均有下降趋势,治疗组治疗前后比较有明显好转(P<0.05),对照组无明显变化;治疗组临床疗效显著(P<0.05)且治疗组副作用明显少于对照组。结论针刺联合半量托特罗定治疗帕金森病合并膀胱过度活动症疗效优于单纯全量药物组,副作用少,而且对帕金森病的病情有一定的延缓作用。     

Complementary Acupuncture Treatment Increases Cerebral Metabolism in Patients with Parkinson's Disease

We used positron emission tomography (PET) and the 18-flourodeoxyglucose tracer to study cerebral effects of complementary acupuncture in Parkinson's disease. Five patients received scalp-acupuncture and Madopa, while the other five had Madopa only. PET scans before and after 5 weeks of complementary acupuncture treatment show increased glucose metabolisms in parietal, temporal, occipital lobes, the thalamus, and the cerebellum in the light-diseased hemisphere, and in parietal and occipital lobes of the severe-diseased hemisphere. No changes were observed in the Madopa-only group. Acupuncture in combination with Madopa may improve cerebral glucose metabolism in Parkinson's disease.