针刺“孙真人十三鬼穴”治疗脑卒中后抑郁的临床疗效观察

发布时间：2018-05-05 17:58

本文选题：脑卒中后抑郁 + 孙真人十三鬼穴　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:通过辨证选用"孙真人十三鬼穴"治疗脑卒中后抑郁,并评价该疗法对神经功能缺损程度及抑郁状态的影响,探讨治疗脑卒中后抑郁的思路及方法。方法:选取60例于2016年3月至2017年3月在广州中医药大学第一附属医院针灸科门诊及病房就诊、并符合病例筛选标准的脑卒中后抑郁的患者;随机分成两组,治疗组及对照组各30例。两组患者均按照脑卒中诊疗常规进行基础治疗。治疗组(孙真人十三鬼穴组):以人中、承浆、风府为主穴,肝气郁结证合申脉、上星,气郁化火证合劳宫、曲池,忧郁伤神证合大陵、上星,心脾两虚证合隐白、大陵,阴虚火旺证加申脉、劳宫,每周连续治疗5次,休息2天,10次为1个疗程,共治疗2个疗程。对照组(氟西汀组):予盐酸氟西汀胶囊20mg,口服,1次/日,2周为1疗程,观察2疗程。两组患者分别在治疗前、治疗2周后、治疗4周后进行脑卒中临床神经功能缺损量表(SSS)评分和汉密顿抑郁量表(HAMD)评分。临床研究的所有资料均采用统计软件SPSS18.0软件包进行统计处理,计量资料用均数±标准差(X±S)表示,组间差异的显著性采用t检验,计数指标组间差异的显著性采用卡方检验,等级资料组间差异采用秩和检验。结果:1、治疗前,治疗组与对照组病例的组间基本资料(性别、年龄、病程、SSS评分、HAMD评分)经统计学分析,差异无统计学意义(P0.05),表明两组患者基线资料具有可比性。2、治疗2周后,组内比较发现,两组患者SSS评分、HAMD评分均较治疗前降低,经统计学分析,差异具有统计学意义(P0.05),说明两种疗法均能改善神经功能缺损程度及抑郁状态;组间比较发现,两组患者SSS评分、HAMD评分差异无统计学意义(P0.05),说明治疗2周后两种方法对神经功能缺损程度及抑郁状态的改善暂无明显差别。3、治疗4周后,组内比较发现,两组患者SSS评分、HAMD评分均较治疗前明显降低,差异具有统计学意义(P0.05),说明两种疗法均能改善神经功能缺损程度及抑郁状态;组间比较发现,两组患者SSS评分及HAMD评分差异具有统计学意义(P0.05),且治疗组较对照组在SSS评分及HAMD评分的改善更明显,即治疗组在卒中后抑郁患者神经功能缺损程度及抑郁状态的改善方面疗效更佳。4、完成4周的治疗后,将两组患者的临床疗效进行统计分析,结果显示治疗组总有效率90.00%,其中临床控制6例,显效15例,有效6例,无效3例;对照组总有效率83.33%,其中临床控制3例,显效7例,有效15例,无效5例。两组患者治疗后总疗效比较具有统计学意义(p0.05),且治疗组疗效(总有效率90.00%)优于对照组疗效(总有效率83.33%)。即"孙真人十三鬼穴"治疗卒中后抑郁的疗效优于西药氟西汀。结论:针刺"孙真人十三鬼穴"组和氟西汀组对卒中后抑郁都具有明确的临床疗效,但治疗组临床总疗效较对照组更佳,且在改善神经功能缺损程度、抑郁状态方面,针刺"孙真人十三鬼穴"组优于西药氟西汀,故"孙真人十三鬼穴"治疗脑卒中抑郁疗效确切,可供临床医生参考应用。
[Abstract]:Objective: to select "Sun real thirteen ghost point" to treat post-stroke depression, and to evaluate the effect of this therapy on the degree of neural function defect and depression, and to explore the methods and methods of treating post-stroke depression. Methods: 60 cases were selected from March 2016 to March 2017 in the outpatient department of the Acupuncture Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine and The patients were divided into two groups, the treatment group and the control group were 30 cases. The two groups were all based on the stroke diagnosis and treatment routine. The treatment group (Sun Zhenren thirteen ghosts group): among the people, the Chengdu, the Feng Fu main point, the liver qi stagnation syndrome, the upper star and qi depression syndrome The palace, the Qu Chi, the melancholy syndrome of the dusoleum, the upper star, the heart and spleen two deficiency syndrome combined with hidden white, daling, yin deficiency and fire syndrome plus Shen Mai, Lao Gong, 5 times a week, 2 days rest for 2 days and 2 courses of treatment. The control group (fluoxetine group) was treated with Fluoxetine Hydrochloride Capsules 20mg, orally, 1 times, 2 weeks for 1 courses, 2 courses. Two groups of patients were observed. The clinical nerve function defect scale (SSS) score and the Hamilton Depression Scale (HAMD) score were performed after 2 weeks of treatment. All the data of the clinical study were processed by statistical software SPSS18.0 software package, and the measurement data were expressed with mean mean + standard deviation (X + S). The significant difference between groups was detected by t. The significant difference between the count indexes was checked by chi square test, and the difference between the class data groups was tested by rank sum test. Results: 1, before treatment, the basic data (sex, age, course of disease, SSS score, HAMD score) between the treatment group and the control group were statistically analyzed, the difference was not statistically significant (P0.05), indicating that the two groups of patients had baseline data. Comparability.2, after 2 weeks of treatment, group comparison found that the two groups of patients with SSS score, HAMD scores were lower than before the treatment, statistical analysis, the difference was statistically significant (P0.05), indicating that the two treatments can improve the degree of nerve function defect and depression state. The comparison between groups found that the two groups of patients with SSS score, HAMD score difference was not statistically significant ( P0.05) showed that there was no significant difference between the two methods after 2 weeks of treatment for the improvement of the degree of nerve function defect and depression. After 4 weeks of treatment, it was found that the scores of the two groups were significantly lower than those before the treatment, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05), indicating that the two treatments could improve the degree of neurological impairment and inhibition. The difference of SSS score and HAMD score between the two groups was statistically significant (P0.05), and the improvement of the SSS score and the HAMD score in the treatment group was more obvious than that in the control group, that is, the treatment group had better effect on the degree of neurological impairment and the improvement of depression in the patients with post-stroke depression, and after 4 weeks of treatment, the treatment group would be better. The clinical efficacy of two groups of patients was statistically analyzed, and the results showed that the total effective rate of the treatment group was 90%, of which 6 cases were clinically controlled, 15 were markedly effective, 6 cases were effective, 3 cases were invalid, and the total effective rate of the control group was 83.33%. The clinical control 3, the effective 7, the 15 effective and 5. The total curative effect of the two group was statistically significant (P0.05), and the treatment after treatment was statistically significant (P0.05), and the treatment after treatment was statistically significant. The curative effect of the treatment group (total effective rate 90%) was better than the control group (total effective rate 83.33%). The effect of "Sun Zhenren thirteen ghost point" on post-stroke depression was better than the western medicine fluoxetine. Conclusion: the acupuncture "Sun real thirteen ghost point" group and fluoxetine group have definite clinical effect on post stroke depression, but the total clinical effect of the treatment group is more than that of the control group. Good, and in improving the degree of nerve function defect, depressive state, acupuncture "Sun real thirteen ghost point" group is better than the western medicine fluoxetine, so "Sun real thirteen ghost point" treatment of stroke depression is effective, for clinicians to refer to the application.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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