| 刘乐,朱宗俊,罗金发,等.“醒脑疏肝”针法联合氟西汀治疗脑卒中后抑郁的效果及对血清5-羟色胺与去甲肾上腺素浓度的影响[J].中国临床保健杂志,2025,28(1):78-82. |
| “醒脑疏肝”针法联合氟西汀治疗脑卒中后抑郁的效果及对血清5-羟色胺与去甲肾上腺素浓度的影响 |
| Observation on the therapeutic effect of "Xingnao Shugan" acupuncture combined with fluoxetine on post-stroke depression and its impact on serum 5-HT and NE concentrations |
| 投稿时间：2024-10-08 |
| DOI：10.3969/J.issn.1672-6790.2025.01.014 |
| 中文关键词: 卒中 抑郁 针灸疗法 血清素 去甲肾上腺素 氟西汀 康复 |
| 英文关键词: Stroke Depression Acupuncture moxibustion therapy Serotonin Norepinephrine Fluoxetine Rehabilitation 〖FL |
| 基金项目:安徽省临床医学研究转化专项(202304295107020101) |
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| 中文摘要: |
| 目的 观察“醒脑疏肝”针法联合氟西汀治疗脑卒中后抑郁的有效性和安全性,及对血清5-羟色胺(5-HT)、去甲肾上腺素(NE)浓度的影响。方法 选取2022年10月至2023年10月安徽中医药大学第一附属医院针灸康复一科收住的62例脑卒中后抑郁患者,运用随机数字表法分为观察组(31例)和对照组(31例)。2组患者均给予改善脑循环、促进神经细胞修复、康复支持、普通针刺等常规治疗,针对基础疾病(高血压病、高脂血症、糖尿病等)患者,给予控制血压、血糖、血脂及抗血小板聚集治疗等。对照组在常规治疗的基础上给予盐酸氟西汀胶囊口服,每次20 mg,1次/d,清晨服用；观察组在常规治疗的基础上给予盐酸氟西汀胶囊口服+“醒脑疏肝”针法(针刺百会穴、神庭穴、四神聪、太冲穴等穴位,1次/d)。2组患者均连续治疗1个月。观察2组患者治疗前后汉密顿抑郁量表(HAMD)、美国国立卫生研究院卒中量表(NIHSS)量表、日常生活活动独立能力(Barthel),评定2组患者的临床疗效,并于治疗前后测定患者血清5-HT、NE水平,行相关性分析。结果 2组患者治疗前HAMD、NIHSS及Barthel指数评分比较,差异无统计学意义(P>0.05)；治疗1个月后,HAMD、NIHSS评分均较治疗前明显下降(P<0.05)；与治疗前比较,2组患者的Barthel指数评分均提高(P<0.05)；治疗后,2组间HAMD、NIHSS及Barthel指数评分比较,差异均有统计学意义(均P<0.05)。观察组总有效率为96.77%(30/31),显著高于对照组的80.65%(25/31),差异有统计学意义(P<0.05)。2组患者治疗前血清5-HT、NE浓度比较,差异无统计学意义(P>0.05)。2组患者治疗1个月后血清5-HT、NE浓度均较治疗前明显上升(P<0.05)。2组间治疗1个月后血清5-HT、NE浓度比较,差异均有统计学意义(均P<0.05)。结论“醒脑疏肝”针法联合氟西汀治疗脑卒中后抑郁,能有效改善患者的抑郁状态,提高患者康复效果优于单纯氟西汀口服,其改善患者抑郁状态的机制可能与升高血清5-HT、NE浓度有关。 |
| 英文摘要: |
| Objective To observe the efficacy and safety of "Xingnao Shugan" acupuncture combined with fluoxetine in the treatment of post-stroke depression,and the effect on serum 5-hydroxytryptamine(5-HT)and norepinephrine(NE)concentration.Methods Sixty-two patients with post-stroke depression admitted to the First acupuncture and moxibustion Rehabilitation Department of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from October 2022 to October 2023 were randomly divided into an observation group (31 cases) and a control group (31 cases).Both groups were given conventional treatment to improve cerebral circulation,promote neural cell repair,rehabilitation support,and ordinary acupuncture.For patients with basic diseases (hypertension,hyperlipidemia,diabetes,etc.),they were given treatment to control blood pressure,blood sugar,blood lipids,and anti platelet aggregation.The control group was given hydrochloric acid on the basis of conventional treatment.Fluoxetine capsules,20 mg each time,once a day,taken in the morning.On the basis of conventional treatment,the observation group was given acupuncture for awakening the brain and soothing the liver,as well as oral fluoxetine hydrochloride capsules.Acupuncture was applied to Baihui,Shenting,Sishencong,Taichong and other acupoints once a day.Both groups of patients were treated continuously for one month.Observe the Hamilton Depression Rating Scale (HAMD),National Institutes of Health Stroke Scale (NIHSS),and Activities of Daily Living Independence (Barthel) of two groups of patients before and after treatment,evaluate the clinical efficacy of the two groups of patients,and measure the serum levels of 5-HT and NE before and after treatment for correlation analysis.Results There was no statistically significant difference in HAMD,NIHSS,and Barthel index scores between the two groups before treatment (P>0.05).After one month of treatment,both HAMD and NIHSS scores significantly decreased compared to before treatment (P<0.05);compared with before treatment,the Barthel index scores of both groups of patients increased significantly (P<0.05).After treatment,there were statistically significant differences in HAMD,NIHSS,and Barthel index scores between the two groups (all P<0.05).The total effective rate of the observation group was 96.77% (30/31),significantly higher than that of the control group′s 80.65% (25/31),the difference was statistically significant (P<0.05).There was no statistically significant difference in serum 5-HT and NE concentrations between the two groups before treatment (P>0.05).After treatment,the serum concentrations of 5-HT and NE in both groups of patients increased significantly compared to before treatment (P<0.05).The comparison of serum 5-HT and NE concentrations between the two groups after treatment showed statistically significant differences (both P<0.05).Conclusions The combination of "Xingnao Shugan" acupuncture and fluoxetine treatment for post-stroke depression can effectively improve the depression status of patients and enhance their rehabilitation effect.The overall efficacy is better than that of fluoxetine oral alone.The mechanism of improving the depression status of patients is related to the increase of serum 5-HT and NE concentrations. |
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