颐脑解郁方联合针刺治疗脑卒中后抑郁的临床效果观察

杜凤其 方亮 张朝霞 黄奕旻 郑芙蓉 徐珊

【摘要】 目的：探討颐脑解郁方联合针刺治疗脑卒中后抑郁（PSD）的临床效果。方法：选2017年5月-2019年4月本院收治的PSD患者120例，随机分为两组。对照组在一般治疗基础上采用氟西汀治疗，观察组在一般治疗基础上采用颐脑解郁方加针刺治疗，治疗63 d后评估两组治疗效果，比较两组HAMD评分、血清总胆红素水平、中医证候积分、治疗依从性、医疗费用。结果：两组治疗63 d后中医证候评分均低于治疗前，且观察组均低于对照组（P<0.05）;观察组治疗63 d后总有效率为95.0%，高于对照组的81.7%（P<0.05）;两组治疗后21、42、63 d后血清胆红素水平均低于治疗前，且观察组均低于对照组（P<0.05）;两组治疗后21、42、63 d后HAMD评分均低于治疗前，且观察组均低于对照组（P<0.05）;观察组随访期间不良反应发生率、治疗费用均低于对照组，用药依从性高于对照组（P<0.05）。结论：应用颐脑解郁方加针刺治疗PSD患者效果较好，可以降低不良反应发生率，改善血清总胆红素水平，提高用药依从性，减少治疗费用，降低患者的经济压力，改善抑郁情况，提高治疗效果。

【关键词】 颐脑解郁方 针刺 脑卒中后抑郁

[Abstract] Objective： To investigate the clinical effect of Yinao Jieyu Formula combined with acupuncture in the treatment of post stroke depression （PSD）. Method： A total of 120 patients with PSD in our hospital from May 2017 to April 2019 were selected and randomly divided into two groups. The control group was treated with Fluoxetine on the basis of general treatment， and the observation group was treated with acupuncture combined with Yinao Jieyu Formula on the basis of general treatment. The effects of two groups were evaluated after 63 d of treatment， HAMD score， serum total bilirubin level， TCM syndrome score， treatment compliance and medical expenses of two groups were compared. Result： The TCM syndrome scores of two groups after 63 d of treatment were lower than those of before treatment， and the observation group were lower than those of the control group （P<0.05）. The total effective rate of the observation group after 63 d of treatment was 95.0%， which was higher than 81.7% of the control group （P<0.05）. The levels of serum bilirubin of two groups after 21， 42 and 63 d of treatment were lower than those of before treatment， the observation group were lower than those in the control group （P<0.05）. The HAMD scores of two groups after 21， 42 and 63 d of treatment were lower than those of before treatment， and the observation group were lower than those in the control group （P<0.05）. The incidence of adverse reactions and treatment costs of the observation group during the follow-up period were lower than those of the control group， the medication compliance was higher than that of the control group （P<0.05）. Conclusion： Yinao Jieyu Formula combined with acupuncture has a good therapeutic effect in the treatment of PSD， which can reduce the incidence of adverse reactions， improve the level of serum total bilirubin， improve medication compliance， reduce the cost of treatment， reduce the economic pressure of patients， improve the depression， and improve the therapeutic effect.

[Key words] Yinao Jieyu Formula Acupuncture Post stroke depression

First-authors address： Haizhu Hospital of Traditional Chinese Medicine， Guangzhou 510220， China

doi：10.3969/j.issn.1674-4985.2021.09.023

脑卒中患者最常见的一种并发症是脑卒中后抑郁（post stroke depression，PSD），可在卒中后的各个阶段发生，卒中后1个月内PSD的发生率最高，年轻患者更易发生PSD。PSD的主要表现为自我认同感低，情绪低落，恐惧焦虑，睡眠障碍，同时伴有不愿活动、自闭、悲观和身体不适等，目前此病的发病率不断增长[1]。PSD发病隐匿，患者在不良情绪的刺激下，可能会出现自残、轻生现象，且会影响其自身神经功能的恢复，同时会降低治疗的依从性和治疗效果[2]。西医针对PSD患者主要是应用抗抑郁药物进行治疗，此类药物均有不同程度的禁忌证与副作用，效果不佳。中医在PSD的治疗中有独特的优势，安全性高，副作用小，且临床经验丰富，因此中医药联合针灸治疗PSD对患者的康复和生存意义重大[3]。本研究探讨颐脑解郁方加针刺治疗PSD的临床效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年5月-2019年4月本院收治的PSD患者120例。西医诊断标准：参考《中国精神障碍分类与诊断标准（第三版）》、全国第四届脑血管学术会议中脑卒中的诊断标准，患者神志清楚，无失语，能配合评定，且均经MRI、头颅CT检查确诊。……