通督调神针刺法结合认知疗法干预卒中后抑郁患者临床研究

摘要：目的 观察通督调神针刺法结合认知疗法干预卒中后抑郁的临床效应，并探讨其疗效可能的作用机制。方法 将60例卒中后抑郁患者随机分为观察组和西药组，每组30例，两组在予以脑血管疾病基础治疗的同时，采用不同方法干预，观察组采用通督调神针刺法结合认知疗法治疗，西药组予以盐酸帕罗西汀片口服，疗程均为4周，治疗前后进行汉密尔顿抑郁量表(HAMD)、日常生活能力评定（Barthel指数）及副反应量表( TESS) 评估，观察两组临床疗效，测定患者血清 5-HT水平。结果 同组治疗后较治疗前比较，HAMD评分均显著降低(P<0.05)，Barthel 指数均提高（P＜0.05），组间比较，观察组优于西药组，差异具有统计学意义(P<0.05)，治疗后两组血清 5-HT水平均较治疗前升高 (P<0.05) ，两组5-HT升高幅度比较无统计学意义(P>0.05)，观察组总有效率为93. 3%，西药组为86.7%，两组比较差异具有统计学意义(P<0.05)，观察组不良反应发生率较西药组发生率低，差异有统计学意义(P<0.05)。结论 通督调神针刺法结合认知疗法法干预卒中后抑郁，可以显著改善 PSD 患者的抑郁状态，其疗效机制可能与血清 5-HT水平上调有关，通督调神针刺法结合认知疗法是治疗卒中后抑郁行之有效、副反应低、操作重复性好的临床治疗手段。

Clinical Study on Tong-Du Tiao-Shen Needling Combined with Cognitive Therapy for Post-stroke Depression Patients

Abstract: This study was aimed to observe the clinical efficacy of Tong-Du Tiao-Shen (TDTS) needling combined with cognitive therapy in the treatment of post-stroke depression (PSD). Sixty PSD patients were randomized into the observation group and the control group, with 30 cases in each group. Different methods were used to patients in both groups based on basic treatment of cerebrovascular disease for 4 weeks. The observation group was intervened by TDTS needling combined with cognitive therapy. Oral administration of paroxetine hydrochloride tablets was used in the modern medicine group. Clinical effects and side effects were evaluated with the Hamilton Depression Scale (HAMD), the assessment of daily living ability (Barthel index), the Treatment Emergent Symptom Scale (TESS), and serum levels of 5-HT were measured before and after the intervention. The result showed that compared with pretreatment, HAMD scores were significantly lower (P < 0.05), and the Barthel index was increased (P < 0.05) in both groups after treatment. The observation group was significantly better than the modern medicine group, with significant differences between two groups (P < 0.05). The serum levels of 5-HT in both groups were significantly higher than those of the pretreatment (P < 0.05). There was no statistical difference on the increase of 5-HT level in both groups (P > 0.05). The total effective rate was 93.3% in the observation group, and the total effective rate was 86.7% in the modern medicine group. There were significant differences between two groups (P < 0.05). The incidence rate of adverse reactions in the observation group was lower than that of the modern medicine group, with statistical difference (P < 0.05). It was concluded that TDTS needling combined with cognitive therapy can significantly improve the depression of PSD patients. Its therapeutic mechanism may be related to the increasing of serum 5-HT level. TDTS needling combined with cognitive therapy is an effective clinical treatment approach in the treatment of depression among PSD patients with low side effects and good repeatability.