醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后恢复期抑郁状态的影响  

Effect of Xing Nao Kai Qiao acupuncture plus transcranial magnetic stimulation on depression state in the recovery stage after ischemic stroke

作　　者：刘彦麟 杨喜兵[2] 任宏斌 王笑梅 于亚洁 罗开涛[2] LIU Yanlin;YANG Xibing;REN Hongbin;WANG Xiaomei;YU Yajie;LUO Kaitao(Zhejiang Chinese Medical University,Hangzhou 310000,China;Jiaxing Hospital of Traditional Chinese Medicine,Zhejiang Chinese Medical University,Jiaxing 314001,China)

机构地区：[1]浙江中医药大学,杭州310000 [2]浙江中医药大学附属嘉兴市中医医院,嘉兴314001

出　　处：《上海针灸杂志》2024年第2期148-154,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：浙江省基础公益研究计划项目(LGF20H270003);浙江省自然基金委员会计划项目(LQ20H270016);浙江省中医药科技计划项目(2019ZB124);浙江省沈来华名老中医专家传承工作室建设项目(GZS2021036);浙江省康复医学会科研专项基金项目(ZKKY2023007);浙江中医药大学附属医院科研专项项目(2023FSYYZQ15);嘉兴市脑血管病中西医结合康复研究重点实验室[嘉科高2022(38)号]。

摘　　要：目的 观察醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后患者恢复期抑郁状态的影响。方法 将80例符合纳入标准的患者随机分为综合组(40例,中止1例)和西药组(40例,脱落2例)。西药组予口服盐酸度洛西汀肠溶片治疗,综合组在西药组口服药物基础上予醒脑开窍针刺法联合经颅磁刺激治疗。分别于治疗前后观察患者美国国立卫生院卒中量表(National Institutes of Health stroke scale,NIHSS)、改良Barthel指数(modified Barthel index,MBI)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)的评分变化,以及血清同型半胱氨酸(homocysteine,Hcy)、中性粒细胞/淋巴细胞的比值(neutrophil/lymphocyte ratio,NLR)、5-羟色胺(5-hydroxytryptamine,5-HT)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)的水平变化。观察两组治疗前后经颅多普勒超声颅内大血管[大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、大脑后动脉(posterior cerebral artery,PCA)及椎动脉(basilar artery,BA)]血流速度的变化。结果 治疗后,两组患者NIHSS、MBI、HAMD和PSQI评分以及血清Hcy、NLR、5-HT和BDNF水平均较治疗前改善(P<0.05),且综合组上述指标均优于西药组(P<0.05)。治疗后,两组ACA、MCA、PCA和BA血流速度均优于治疗前(P<0.05),且综合组上述血管血流速度均优于西药组(P<0.05)。结论 在药物治疗基础上,醒脑开窍针刺法联合经颅磁刺激治疗卒中后患者恢复期抑郁状态的临床疗效优于单一口服西药治疗,可减轻患者的抑郁程度,改善睡眠质量,提高肢体功能和日常生活能力,加快脑血管血流速度,改善血清Hcy、NLR、5-HT和BDNF的水平。Objective To observe the effect of Xing Nao Kai Qiao(brain-awakening and orifice-opening) acupuncture plus transcranial magnetic stimulation(TMS) on the depression state of patients in the recovery stage after ischemic stroke.Method Eighty eligible patients were randomized into a combined group(40 cases,1 suspension case) and a Western medication group(40 cases,2 dropouts).The Western medication group was treated with oral administration of Duloxetine hydrochloride enteric-coated tablets,and the combined group received the same oral medication plus Xing Nao Kai Qiao acupuncture and TMS.Before and after the treatment,the National Institutes of Health stroke scale(NIHSS),modified Barthel index(MBI),Hamilton depression scale(HAMD),and Pittsburgh sleep quality index(PSQI) scores were observed,as well as the levels of serum homocysteine(Hcy),neutrophil/lymphocyte ratio(NLR),5-hydroxytryptamine(5-HT),and brain-derived neurotrophic factor(BDNF).Transcranial Doppler(TCD) was used to measure the blood flow velocity of major intracranial vessels [anterior cerebral artery(ACA),middle cerebral artery(MCA),posterior cerebral artery(PCA),and basilar artery(BA)] before and after the intervention.Result After the treatment,the NIHSS,MBI,HAMD,and PSQI scores and the levels of serum Hcy,NLR,5-HT,and BDNF improved in the two groups(P<0.05),and the combined group was superior to the Western medication group in comparing these indexes(P<0.05).The blood flow velocities of the ACA,MCA,PCA,and BA improved after the intervention in both groups(P<0.05) and were better in the combined group than in the Western medication group(P<0.05).Conclusion Based on the pharmaceutical treatment,Xing Nao Kai Qiao acupuncture plus TMS can produce more significant clinical efficacy than using the oral Western medication alone in treating depression state in the recovery stage after ischemic stroke;this method can reduce the patient's depression severity,improve sleep quality,enhance limb function and activities of daily living,accelerate cerebrovascular

关 键 词：针刺疗法 针药并用 醒脑开窍 经颅磁刺激 中风后遗症 抑郁 血液流变学 

分 类 号：R246.6[医药卫生—针灸推拿学]