【作者】 杨蕾；

【导师】 符文彬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 硕士

【摘要】 目的评价针刺疏肝调神法治疗脑梗死后抑郁症的临床疗效。方法采用随机对照的临床研究方法,招募符合纳入标准的脑梗死后抑郁症患者70例为研究对象,运用PEMS3.1软件包按1：1比例随机分为治疗组(疏肝调神组)和对照组(基础针刺组),其中治疗组35例,对照组35例。治疗组选穴：百会、印堂、合谷(双)、太冲(双),配合对照组穴位；对照组：内关、极泉、尺泽、委中、三阴交、足三里,均为患侧。两组得气后留针30min,留针期间不行针。疗程：1次／日,每周5次,3周15次为1疗程,共1疗程。分别在治疗前、第二周后、第三周后三个不同观察时点采用HAMD量表、SDS自评量表、美国国立卫生院NIHSS评分、ADL日常生活行为量表Barthel指数来观察同组治疗前后以及两组组间同一观察时点的差异,采用统计软件SPSS17.0软件进行统计分析。结果1.两组患者在治疗前的一般基线情况,包括性别、年龄、文化程度、病程、既往治疗史、中医证候分型和疗效观察指标包括HAMD量表、SDS自评量表、NIHSS评分、Barthel指数方面差异均无统计学意义(p>0.05),说明两组基线特征分布均衡,具有可比性。2.两组治疗结束时,对于改善抑郁症状疗效比较,疏肝调神组总有效率为71.9%,基础针刺组总有效率为60.6%,经秩和检验,差异无统计学意义(p>0.05)。3.两组患者HAMD量表评分,组内比较,疏肝调神组和基础针刺组两组患者,在第二周后、第三周后两个不同观察时点与治疗前比较,HAMD评分均较前降低,差异有显著统计学意义(P<0.01),提示两组均能改善患者抑郁症状。组间比较,疏肝调神组在第二周后、第三周后HAMD评分与基础针刺组比较,差异均有统计学意义(P<0.05),提示疏肝调神组改善抑郁症状方面疗效优于基础针刺组。4.两组患者SDS量表评分,组内比较,疏肝调神组和基础针刺组两组患者,在第二周后、第三周后两个不同观察时点与治疗前比较,SDS评分均较前降低,差异有显著统计学意义(P＜0.01),提示两组均能改善患者抑郁症状。组间比较,疏肝调神组在第二周后、第三周后SDS评分与基础针刺组比较,差异均有统计学意义(P<0.05),提示疏肝调神组改善抑郁症状方面疗效优于基础针刺组。5.两组患者NIHSS评分,组内比较,疏肝调神组和基础针刺组两组患者,在第二周后、第三周后两个不同观察时点与治疗前比较,NIHSS评分均较前降低,差异有显著统计学意义(P<0.01),提示两组均能改善脑梗死患者神经功能缺损症状。组间比较,疏肝调神组在第二周后NIHSS评分与基础针刺组比较,差异无统计学意义(P>0.05),提示治疗两周后疏肝调神组在改善脑梗死患者神经功能缺损症状方面与基础针刺组相当；第三周后疏肝调神组NIHSS评分与基础针刺组比较,差异有统计学意义(P<0.05),提示治疗三周后疏肝调神组疗效优于基础针刺组。6.两组患者BI指数评分,组内比较,疏肝调神组和基础针刺组两组患者,在第二周后、第三周后两个不同观察时点与治疗前比较,BI指数评分均较前升高,差异有显著统计学意义(P<0.01),提示两组均能提高脑梗死患者日常生活自理能力。组间比较,疏肝调神组在第二周后BI指数评分与基础针刺组比较,差异无统计学意义(P>0.05),提示治疗两周后疏肝调神组在提高脑梗死患者日常生活自理能力方面与基础针刺组相当；第三周后疏肝调神组BI指数评分与基础针刺组比较,差异有统计学意义(P<0.05),提示治疗三周后疏肝调神组疗效优于基础针刺组。结论1.疏肝调神组和基础针刺组均能改善脑梗死患者抑郁症状方面,疏肝调神组疗效可能优于基础针刺组。2.疏肝调神组和基础针刺组均能改善脑梗死患者神经功能缺损症状,提高其日常生活自理能力,随着抑郁症状的好转,疏肝调神组疗效优于基础针刺组。更多还原

【Abstract】 ObjectiveTo observe the clinical effect of the method of regulating liver-qi and metality by acupuncture on treating depression after cerebrovascular infarction.MethodA randomized controlled trial of clinical research was conducted,70patients who met the inclusion criteria of depression after cerebrovascular, used PEMS3.1package to allocate the subjects into treatment group (regulating liver-qi and metality group) and control group(basic acupuncture group) randomly with the proportion of1:1,with35cases in treatment group and35cases in control group. Treatment group points:Baihui (DU20), Yintang(EX-HN3), Hegu(LI4),Taichong(LR3), above the points were used bilateral, plus the points of control group. Control group:Neiguan(PC6), Jiquan(HT1), Chize(LU5), Weizhong (BL40), Sanyinjiao(SP6), Zusanli(ST36), above the points were used in diseased side. Manipulating the needles until the Qi arrives, and retain the needles for30minites. Treatment duration:treatment would be done every one day, five times a week, three weeks fifteen times consisted one course, for one course. The curative effect was evaluated by the Hamilton Depression Seale(HAMD), Self-rating Depression Scale(SDS), National Institutes of Health Stroke Scale (NIHSS), Barthel Index(BI)before the course, the two weeks, the three weeks. Used statistical software SPSS17.0on statistical analysis of data collected.Results1. Comparing the gender, age, education level, disease duration, previous treatment history, TCM syndrome type, HAMD, SDS, NIHSS and BI of the two groups before the treatment, there were no statistically significant (P>0.05), showing a balance of baseline characteristics of the two groups and therefore they are comparable.2. In contrast with the effective rate to treat the depression symptoms at the end of treatment, the treatment group was71.9%, while the control group was60.6%, by the rank sun test, there was singnificant difference(P>0.05).3. By comparison the scores of HAMD scale, after two weeks and three weeks, compared the scores before the treatment,the scores were reduced, both the treatment group and control group had singnificant difference(P<0.01), showing both the ways of two groups had effect to treat the depression syptoms. After two weeks and three weeks, at the time, compared the difference between the two groups, both there were statistically difference(P<0.05), indicating the treatment group had better efficacy than the control group to treat the depression symptoms.4. By comparison the scores of SDS scale, after two weeks and three weeks, compared the scores before the treatment, the scores were reduced, both the two groups had significant difference(P<0.01), showing both the ways of two groups had effect to treat the depression syptoms. After two weeks and three weeks, compared the difference between the two groups, both there were statistically significant(P<0.05), indicating the efficacy of the treatment group was better than the control group in improving depression symptoms.5. By comparison the scores of NIHSS scale, after two weeks and three weeks, compared the scores before the treatment, the scores were reduced, both the treatment group and control group had significant difference(P<0.01), showing both the methods had effect to improve the neural function defect symptoms after stroke. After two weeks, compared the difference between the two groups, the scores had no significant difference(P>0.05),showing the similar efficacy to improve the neural function defect symptoms after stroke of the two ways. After the three weeks, the scores had statistically difference between the two groups (P<0.05), indicating the treatment group had better efficacy than the control group.6. By comparison the scores of Barthel Index,after two weeks and three weeks, compared the scores before the treatment,the scores were rasied, both the groups had significant difference(P<0.01), showing both the methods had effect to improve the self care capacity after stroke. After two weeks, compared the scores between the two groups, there was no significant difference(P>0.05), showing the similar efficacy to improve the self care capacity after stroke of the two ways. After the three weeks, there was statistically difference (P<0.05), indicating the treatment group had better efficacy than the control group.Conclusion1. Both the treatment group and control group have effect to treat the depression symptoms after cerebral infarction, and the treatment group may be superior to the control group.2. Both the treatment group and control group have clinical effect for improving the neural function defect symptoms and self care capacity after cerebral infarction, and the effect of the treatment group is superior to the control group as the depression symptoms improves.更多还原