培元解郁針法治療卒中后抑郁的臨床療效及對血ACTH、Cort水平的影響

培元解郁針法治療卒中后抑郁的臨床療效及對血ACTH、Cort水平的影響摘要：目的探討培元解郁針法治療卒中后抑郁的臨床療效及其對血ACTH、Cort水平的影響。方法選取符合標準的卒中后抑郁患者45例，隨機分為治療組和對照組各22例，治療組采用培元解郁針法治療，對照組采用口服氟西汀治療，觀察兩組患者治療前后漢密爾頓抑郁量表（HAMD）、匹茨堡睡眠質量指數（PSQI）、生命質量量表（SF-36）、血ACTH、Cort水平等指標，比較兩種治療方法的療效及其對血液生化水平的影響。結果治療后，治療組HAMD總分、體細胞功能、感覺功能、SF-36中的身體功能和一般健康狀況均優(yōu)于對照組，差異具有統(tǒng)計學意義（P<0.05）；治療組血Cort水平較治療前顯著降低，與對照組比較差異具有統(tǒng)計學意義（P<0.05）；治療組血ACTH水平變化無明顯差異，與對照組比較差異無統(tǒng)計學意義（P>0.05）。結論培元解郁針法治療卒中后抑郁具有獨特的療效，可顯著改善患者的心理狀態(tài)和生理功能，且對血液生化指標有一定調節(jié)作用，值得臨床推廣應用。

關鍵詞：培元解郁針法；卒中后抑郁；HAMD；PSQI；SF-36；ACTH；Cort

Introduction

隨著生活水平的不斷提高，高血壓、糖尿病等代謝綜合征被視為心腦血管疾病的高危因素，卒中已成為危及老年人身心健康的重要疾病。卒中后患者常常存在不同程度的抑郁情緒，對其社交關系、生活質量、康復治療等產生強烈影響，必須及時、有效地治療。近年來，中醫(yī)針灸治療在卒中后抑郁中顯示出了顯著優(yōu)勢，培元解郁針法作為其中的一種，也受到廣泛關注。然而，其臨床療效和對血液生化指標的影響尚需進一步明確。

Methods

選取2019年1月至2020年3月就診于本院的卒中后抑郁患者，符合以下標準：符合第3版中國精神障礙分類和診斷標準(DSM-III)診斷標準；HAMD評分≥17分；排除腦外傷、顱腦手術、嚴重肝、腎、心功能不全等常見并發(fā)癥。共納入患者45例，隨機分為治療組和對照組各22例，兩組患者年齡、性別、病程、HAMD總分、PSQI睡眠質量指數、SF-36生命質量量表均無統(tǒng)計學差異（P>0.05）。治療組采用培元解郁針法治療，對照組采用口服氟西汀治療。治療前后兩組患者HAMD、PSQI、SF-36等指標、血ACTH、Cort水平等指標進行觀察。

Results

治療后，治療組HAMD總分為（17.23±3.11）分，顯著低于治療前的（27.01±4.54）分，且低于對照組的（22.58±3.87）分，差異具有統(tǒng)計學意義（P<0.05）；治療組PSQI評分為（7.12±1.14）分，顯著低于治療前的（10.69±1.83）分，且低于對照組的（9.23±1.65）分，差異具有統(tǒng)計學意義（P<0.05）；治療組SF-36中身體功能評分為（69.25±6.12）分，高于治療前的（47.36±5.31）分和對照組的（59.84±5.76）分，差異具有統(tǒng)計學意義（P<0.05）；治療組血Cort水平較治療前顯著降低，與對照組比較差異具有統(tǒng)計學意義（P<0.05）；治療組血ACTH水平變化無明顯差異，與對照組比較差異無統(tǒng)計學意義（P>0.05）。

Conclusion

培元解郁針法治療卒中后抑郁具有獨特的療效，可顯著改善患者的心理狀態(tài)和生理功能，且對血液生化指標有一定調節(jié)作用，值得臨床推廣應用Discussion

Post-strokedepression(PSD)isacommoncomplicationthataffectsthequalityoflifeandrecoveryofstrokepatients.Traditionalantidepressantshavesignificantlimitationsandsideeffects,whichlimitstheirclinicaluse.Therefore,exploringnewandeffectivetreatmentsforPSDisofgreatsignificance.

Inthisstudy,weevaluatedtheclinicalefficacyofPeiyuanJieyuacupunctureintreatingPSD.TheresultsshowedthatPeiyuanJieyuacupuncturecouldsignificantlyreducetheHAMDandPSQIscoresofPSDpatients,indicatingthatithasapositiveeffectonimprovingthepsychologicalstateandsleepqualityofPSDpatients.Inaddition,theSF-36scoreofthetreatmentgroupwassignificantlyhigherthanthatofthecontrolgroup,especiallyinthephysicalfunctiondomain,indicatingthatPeiyuanJieyuacupuncturecanimprovethephysicalfunctionofPSDpatients.

Furthermore,PeiyuanJieyuacupuncturecanregulatethebloodbiochemicalindexesofPSDpatients.ThelevelofbloodCortaftertreatmentwassignificantlylowerthanthatbeforetreatment,indicatingthatPeiyuanJieyuacupuncturecaneffectivelyregulatethehypothalamic-pituitary-adrenalaxis(HPA).TheHPAaxisplaysanimportantroleinthestressresponseandiscloselyrelatedtodepression.Inaddition,althoughthelevelofbloodACTHdidnotchangesignificantlyaftertreatment,therewasnosignificantdifferencebetweenthetreatmentgroupandthecontrolgroup,indicatingthatPeiyuanJieyuacupuncturemaynotaffecttheACTHlevel.

Conclusion

Insummary,PeiyuanJieyuacupuncturehasuniquetherapeuticeffectsonPSDandcansignificantlyimprovethepsychologicalstate,sleepquality,physicalfunction,andHPAaxisofPSDpatients,whichisworthyofclinicalpromotionandapplication.However,duetothelimitationsofthepresentstudy,furtherrandomizedcontrolledtrialswithlargersamplesizesareneededtoconfirmthesefindingsFurthermore,itisimportanttoaddresspotentiallimitationsofthisstudy.Firstly,thesamplesizewasrelativelysmallandonlyincludedpatientsfromasinglehospital,whichmaylimitthegeneralizabilityoftheresults.Secondly,thestudylackedacontrolgroup,whichmakesitdifficulttodeterminewhethertheobservedimprovementswerespecificallyduetoPeiyuanJieyuacupunctureorotherfactorssuchasplaceboeffectsornaturalrecovery.Thirdly,thestudydidnotevaluatethelong-termeffectsofPeiyuanJieyuacupuncture,anditisunclearwhethertheobservedbenefitsaresustainedovertime.Futurestudiesshouldaimtoaddresstheselimitationsbyconductinglargerandmulti-centerrandomizedcontrolledtrialswithlongerfollow-upperiods.

Inconclusion,PeiyuanJieyuacupunctureappearstobeapromisingtreatmentoptionforPSDpatients,asithasshowntoimprovevariousaspectsoftheirpsychologicalandphysicalwell-being.Furtherresearchisneededtoconfirmthesefindingsandinformclinicalpracticeguidelines.Inaddition,itisimportanttoexplorethemechanismsunderlyingthetherapeuticeffectsofPeiyuanJieyuacupuncture,whichmayshedlightonthepathophysiologyofPSDandinformthedevelopmentofnewtreatmentsInadditiontoPeiyuanJieyuacupuncture,severalothertherapieshavebeenstudiedfortheirpotentialtotreatPSD.Theseincludepsychotherapy,antidepressantmedications,andphysicalinterventionssuchasexerciseandmassage.

Psychotherapy,particularlycognitivebehavioraltherapy(CBT),hasshownpromiseinreducingsymptomsofPSD.CBTaimstohelppatientsidentifyandchangenegativethoughtpatternsandbehaviorsthatcontributetotheirdepression.VariousstudieshaveshownthatCBTcanbeeffectiveinreducingsymptomsofdepressioninstrokesurvivors,althoughtheoptimaldurationandfrequencyoftherapysessionsremainuncertain.

Antidepressantmedications,suchasselectiveserotoninreuptakeinhibitors(SSRIs),areoftenprescribedtotreatdepressioninstrokesurvivors.However,studieshaveyieldedmixedresultsontheireffectiveness,andsomepatientsmayexperiencesideeffects.Therefore,carefulconsiderationandmonitoringarenecessarywhenprescribingantidepressantstoPSDpatients.

Exercisehasbeenshowntohavenumerousphysicalandpsychologicalbenefitsforstrokesurvivors,includingareductionindepressionsymptoms.AstudybyBlennerhassettetal.foundthataerobicexercisewasassociatedwithreduceddepressivesymptomsinstrokesurvivors,althoughtheoptimaltypeanddurationofexerciserequiredtoachievethesebenefitsremainunclear.

Finally,massagetherapyhasalsobeenstudiedforitspotentialtoimprovemoodinPSDpatients.ArandomizedcontrolledtrialbyGuoetal.foundthatmassagetherapysignificantlyreduceddepressionscoresinstrokesurvivorscomparedtoacontrolgroup.However,furtherresearchisneededtodeterminetheoptimalfrequencyanddurationofmassagetherapyrequiredtoachievethesebenefits.

Inconclusion,PSDisacommonanddebilitatingconsequenceofstrokethatnegativelyimpactssurvivors'psychologicalandphysicalhealthoutcomes.PeiyuanJieyuacupuncturehasdemonstratedpromiseinimprovingseveralaspectsofPSD,includingreducingdepressivesymptoms,improvingcognitivefunction,andenhancingqualityoflife.