针刺十三鬼穴治疗中风后抑郁的疗效观察

发布时间：2018-06-27 07:27

本文选题：中风后抑郁 + 十三鬼穴　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：通过与常规针刺治疗为对照组的比较,观察“针刺十三鬼穴”治疗中风后抑郁的临床疗效,初步探讨针刺十三鬼穴治疗中风后抑郁的中医治疗机理,为临床中运用针灸疗法治疗中风后抑郁提供新思路。方法：本研究课题病例主要是在2014年12月至2015年12月期间至广东省中医院、广州中医药大学第一附属医院的就诊的门诊病人以及住院病人,严格按照纳入标准的要求纳入60例中风后抑郁患者,并按照1：1的比例随机分为两组,分别为针刺十三鬼穴治疗组与常规针刺对照组。针刺十三鬼穴治疗组与常规针刺组对照组两组中风后抑郁患者患者在接受针刺治疗前统一接受一定的基础治疗,在此基础上,针刺十三鬼穴治疗组的中风后抑郁病例的针刺主穴选用唐代著名医家孙思邈的经验穴“十三鬼穴”基础并剔除临床实际操作穴位选取不便及患者接受难易程度的海泉及会阴两穴,并按特定的鬼穴针刺顺序进行针刺。常规针刺对照组则参照王华主编的《针灸学》中有关郁证的治疗处方选取相关穴位进行常规针刺。针刺十三鬼穴组治疗组与常规针刺组对照组的中风后抑郁患者每天接受的针刺治疗的次数为1次,连续完成10次针刺治疗为1个疗程,整个研究所有中风后抑郁病例需完成2个疗程的治疗,在治疗前后对针刺十三鬼穴治疗组与常规针刺对照组两组的中风后抑郁患者采用不同疗效指标对抑郁状态、神经功能缺损,日常生活能力三个方面的的改善情况进行测评。其中24项汉密尔顿抑郁量表(HAMD)评估针刺十三鬼穴疗法和常规针刺疗法各自对中风后抑郁患者抑郁状态的改善程度；改良爱丁堡-斯堪的那维亚神经功能缺损评分量表(MESSS)评估针刺十三鬼穴疗法和常规针刺疗法各自对中风后抑郁患者神经功能缺损方面的改善程度；日常生活活动能力量表(BI)评估针刺十三鬼穴疗法和常规针刺疗法各自对中风后抑郁患者日常生活能力方面的改善程度。本研究的临床总疗效标准参照《精神科评定量表手册》有关中风后抑郁的疗效评定标准,在本研究中,所有的研究的数据都采用SPSS20.0统计软件进行处理及统计分析。结果：1.治疗前针刺十三鬼穴治疗组与常规针刺对照组的病例两组间的基本资料(性别、年龄、病程、中风类别、HAMD、MESSS、BI评分量表评分)经统计学统计分析比较,差异无统计学意义(P0.05)。表面治疗前针刺十三鬼穴组与常规针刺组的病例两组间的基本资料具有可比性。2.完成了2个疗程的治疗后,我们将针刺十三鬼穴治疗组与常规针刺对照组两组治疗后的HAMD、MESSS、BI评分量表评分与治疗前的评定结果分别进行组内比较发现,差异有统计学意义(P0.05),且针刺十三鬼穴治疗组与常规针刺对照组治疗后HAMD、MESSS评分量表中的总积分比治疗前总积分有所下降,BI评分量表中的总积分较治疗前总积分有所上升,研究结果表明针刺十三鬼穴疗法和常规针刺疗法各自对中风后抑郁患者的抑郁状态、神经功能缺损以及日常生活能力方面均有一定的改善作用。3.完成了2个疗程的治疗后,我们将针刺十三鬼穴治疗组与常规针刺对照组治疗后的HAMD、MESSS、BI评分量表总的评分进行组间比较发现,差异具有统计学意义(P0.05),针刺十三鬼穴治疗组治疗后HAMD、MESS评分量表的总分低于常规针刺对照组的HAMD、MESSS评分量表的总分；针刺十三鬼穴治疗组治疗后BI评分量表的总分高于常规针刺对照组的BI评分量表的总分,研究结果表明在对中风后抑郁患者的抑郁状态、神经功能缺损以及日常生活能力方面的改善方面,针刺十三鬼穴疗法的改善效果优于常规针刺疗法的改善效果。4.完成了2个疗程的治疗后,我们将针刺十三鬼穴治疗组与常规针刺对照组两组临床疗效进行统计分析,结果显示针刺十三鬼穴治疗组临床总有效率为86.67%,其中针刺十三鬼穴治疗组的痊愈的病例数为4例,显效的病例数为15例,有效的病例数为7例,无效的病例数为4例；常规针刺对照组临床总有效率为70.00%,其中常规针刺对照组的痊愈的病例数为3例,显效的病例数为7例,有效的病例数为11例,无效的病例数为9例；针刺十三鬼穴组与常规针刺组两组的临床疗效的差异有统计学意义(P0.05),研究结果表明针刺十三鬼穴疗法治疗中风后抑郁的总临床疗效优于常规针刺治疗中风后抑郁的总临床疗效。结论：针刺十三鬼穴治疗组和常规针刺对照组治疗中风后抑郁都有一定临床疗效,但针刺十三鬼穴组治疗中风后抑郁的临床总疗效比常规针刺组更佳,而且在改善抑郁状态、神经功能缺损,提高日常生活能力方面,针刺十三鬼穴治疗组优于常规针刺组,故针刺十三鬼穴是临床治疗中风后抑郁有效的疗法之一,值得临床推广。
[Abstract]:Objective: To observe the clinical effect of "acupuncture thirteen ghost point" on the treatment of post apoplectic depression by comparison with the conventional acupuncture treatment group, and discuss the mechanism of TCM treatment of acupuncture at thirteen ghost points for the treatment of post apoplectic depression, and provide new ideas for the treatment of post apoplectic depression in clinical practice. Method: the subject of this study is the main case. 60 cases of post apoplectic depression were included in Guangdong Province Traditional Chinese Medical Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the hospitalized patients at the First Affiliated Hospital of Guangzhou University of Chinese Medicine in the period from December 2014 to December 2015. The patients were randomly divided into two groups according to the proportion of 1:1, respectively, the acupuncture thirteen ghosts treatment group and the routine treatment group. The acupuncture control group. The two groups of post apoplectic depression patients in the thirteen ghosts treatment group and the conventional acupuncture group received a certain basic treatment before receiving the acupuncture treatment. On this basis, the acupuncture main points of the post apoplectic post apoplectic depression cases in the thirteen ghosts acupoint treatment group were selected by the famous doctor Sun Simiao in the Tang Dynasty "thirteen points". Hai Quan and two points of the perineum, which are inconvenient to select the acupoints in clinical practice, are removed from the clinical practice, and the patients receive two points of the perineum, which are difficult and easy to accept. The number of acupuncture treatment for post apoplectic depression patients in group treatment group and routine acupuncture group was 1 times a day, and 10 consecutive acupuncture treatments were 1 courses. The whole study of all postapoplectic depression cases needed 2 courses of treatment. Before and after treatment, two groups of acupuncture thirteen ghosts treatment group and conventional acupuncture control group were treated. The patients with depression were evaluated with three aspects of depression, nerve function defect and daily living ability with different therapeutic targets. 24 Hamilton Depression Scale (HAMD) was used to evaluate the improvement of the depressive state of the patients with post apoplectic depression by acupuncture thirteen ghosts and conventional acupuncture. DDF - Scandinavian nerve function defect scale (MESSS) was used to evaluate the improvement of nerve function defects in patients with post apoplectic depression by acupuncture thirteen ghosts and conventional acupuncture. The daily living ability scale (BI) assessed the thirteen ghosts and conventional acupuncture treatments for post apoplectic depression. The degree of improvement in daily living ability. The standard of clinical total efficacy of this study was referred to the psychiatric rating scale manual for the evaluation of the efficacy of post apoplectic depression. In this study, all the data were processed and statistically analyzed by SPSS20.0 software. Results: 1. pre treatment acupuncture thirteen ghosts acupoint treatment group The basic data (sex, age, course of disease, stroke category, HAMD, MESSS, BI score scale) between the two groups of the conventional acupuncture control group were not statistically significant (P0.05). The basic data between the two groups of the thirteen ghosts and the conventional acupuncture groups before the surface treatment were comparable to the.2. completion After 2 courses of treatment, we found that the HAMD, MESSS, BI score of the acupuncture thirteen ghosts and the conventional acupuncture control group were compared with the evaluation results before the treatment, and the difference was statistically significant (P0.05), and the acupuncture group in the acupuncture group and the conventional acupuncture control group were HAMD, MESSS after the treatment. The total integral in the score scale was lower than the total integral before the treatment. The total integral in the BI scale was higher than that before the treatment. The results showed that the acupuncture thirteen ghost point therapy and the conventional acupuncture treatment had certain changes in the depressive state of the patients with post apoplectic depression, the loss of nerve function and the daily living ability. After 2 courses of treatment were completed by.3., we compared the total score of HAMD, MESSS and BI score in the acupuncture thirteen ghosts treatment group and the conventional acupuncture control group. The difference was statistically significant (P0.05), and the total score of the MESS score was lower than that of the conventional acupuncture at the thirteen ghosts treatment group, and the total score of the MESS score was lower than that of the conventional acupuncture. The total score of the HAMD and MESSS score in the control group; the total score of the BI score in the acupuncture thirteen ghosts treatment group was higher than the total score of the BI score in the conventional acupuncture control group. The results showed that the depressive state of the patients with post apoplectic depression, the impairment of nerve function and the daily living ability were improved, and the thirteen ghosts were needled. The effect of acupoint therapy is better than the improvement effect of conventional acupuncture. After 2 courses of treatment completed by.4., the clinical curative effect of two groups of acupuncture thirteen ghosts treatment group and conventional acupuncture control group is statistically analyzed. The results show that the total effective rate of acupuncture at thirteen ghosts acupoint treatment group is 86.67%, of which the acupuncture thirteen ghosts acupoint treatment group is in the treatment group. The number of cured cases was 4 cases, the number of effective cases was 15 cases, the number of effective cases was 7 cases and the number of invalid cases was 4 cases. The total clinical effective rate of the conventional acupuncture control group was 70%, of which 3 cases were cured in the conventional acupuncture control group, 7 cases were markedly effective cases, the effective cases were 11 cases, the number of invalid cases was 9 cases, and the number of invalid cases was 9 cases. Thirteen the difference between the thirteen ghosts group and the two groups of the conventional acupuncture group has a significant difference (P0.05). The results of the study show that the total clinical effect of acupuncture thirteen ghosts therapy on post apoplectic depression is better than that of the conventional acupuncture treatment for post apoplectic depression. Conclusion: the treatment group of acupuncture at thirteen ghosts and the routine acupuncture control group are treated with acupuncture. Depression after wind has a certain clinical effect, but the clinical curative effect of acupuncture thirteen ghosts group is better than that of the conventional acupuncture group in the treatment of post apoplectic depression, and the acupuncture thirteen ghost acupoint treatment group is better than the conventional acupuncture group in improving the depression state, nerve function defect and improving the daily living ability. Therefore, acupuncture at thirteen ghost points is a clinical treatment after apoplexy. One of the effective therapies for depression is worthy of clinical promotion.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246.6

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