针刺治疗卒中后抑郁症临床疗效研究

目的:探讨“醒脑开窍”针法治疗卒中后抑郁症(poststrokedepression,PSD)的临床疗效。方法:采用“醒脑开窍”针法作为干预手段,设口服阿米替林作为西药对照。针刺组选取内关、水沟、百会、印堂、三阴交穴,每穴留针20min,每天治疗2次。以患者治疗前后的临床症状为指标衡量疗效,并通过抑郁自评量表(SDS)、汉密尔顿抑郁量表(HRSD)评估不同治疗方法对不同心理情绪障碍的作用。结果:经过不同方法治疗后,PSD患者的临床症状和各种抑郁量表相关指标均得到了改善,“醒脑开窍”针法显效率和总有效率明显高于西药组,且对改善抑郁、悲观的精神症状效果明显优于西药(P<0.05),且具有无毒副作用的特点。结论:“醒脑开窍”针法治疗卒中后抑郁症疗效显著。

Clinical Study on the Therapeutic Effect of Acupuncture in the Treatment of Post-stroke Depression

OBJECTIVE: To observe the therapeutic effect of "Xingnao Kaiqiao Zhenfa" (Acupuncture Technique for Restoring Consciousness) in the treatment of post-stroke depression. METHODS: A total of 256 stroke patients were divided into acupuncture group (n = 180, male 138, female 42) and medication group (n = 76, male 57 and female 19) according to their visiting sequence to our hospital. Acupoints used were Neiguan (PC 6), Renzhong (GV 26), Baihui (GV 20), Yintang (EX-HN 3) and Sanyinjiao (SP 6,the affected side) and the needles were retained for 20 min every time. Patients of medication group were asked to take Amitriptyline (50 mg/d at first, 200 mg/d). Acupuncture treatment was conducted twice daily, and after one month's treatment the therapeutic effect was evaluated. Self-Rating Depression Scale (SDS) and Hamilton Rating Scale for Depression (HRSD) were used to assess the patient's state of depression. RESULTS: After the treatment, of the 180 and 76 cases in acupuncture and medication groups, 31 (17.2%) and 13 (17.1%) were cured, 73 (40.6%) and 18 (23.7%) had a marked improvement in their depression state, 27 (15.0%) and 12 (15.8%) had an improvement, 49 (27.2%) and 33 (43.4%) failed, with the effective rates being 72.8% and 56.6% respectively. The markedly effective rate and the total effective rate of acupuncture group were significantly higher than those of medication group (P < 0.05). After the treatment, the total scores of SDS and HRSD and the severity index of two groups decreased pronouncedly in comparison with those of their individual pre-treatment; and the therapeutic effects of acupuncture group were significantly better than those of medication group in reducing SDS, HRSD and severity index (P < 0 .05). In addition, the decreased values of depression, pessimistic mood and irritability of acupuncture group were all bigger than those of medication group (P < 0.05). No significant difference was found between two groups in the decreased value of insomnia (P > 0.05). CONCLUSION: "Acupuncture Technique for Restoring Consciousness" can effectively improve depression patients' symptoms and the therapeutic effect of acupuncture is markedly superior to that of medication for post-stroke patients.