Abstract:

Objective　To explore the efficacy of Sanyinjiao warm acupuncture combined with exercise therapy in patients with post-stroke depression. Methods　A prospective study design was used. Eighty patients with post-stroke depression admitted to Xingyuan Hospital of Yulin from January 2020 to October 2023 were included. The patients were divided into two groups using the balloting method, with odd numbers assigned to the control group (40 cases) and even numbers to the experimental group (40 cases). There were 20 males and 20 females in the experimental group; the age was 48-72 (61.87±8.74) years old; the depression degree was mild in 20 cases and moderate in 20 cases; the type of stroke was cerebral infarction in 30 cases and cerebral hemorrhage in 10 cases. There were 21 males and 19 females in the control group; the age was 47-71 (60.13±8.49) years old; the degree of depression was mild in 19 cases and moderate in 21 cases; the type of stroke was cerebral infarction in 31 cases and cerebral hemorrhage in 9 cases. The control group received exercise therapy, and the experimental group received Sanyinjiao warm acupuncture in addition to exercise therapy, over a treatment course of 6 weeks. The changes in traditional Chinese medicine (TCM) symptom score, Montgomery-Asberg Depression Rating Scale (MADRS) score, levels of monoamine neurotransmitters [dopamine (DA), 5-serotonin (5-HT), and norepinephrine (NE)], Carroll Upper Extremity Functional Test (UEFT) score, Burke Lateropulsion Scale (BLS) score, Trunk Control Test (TCT) score, score of Borg scale for perceived exertion, Athens Insomnia Scale (AIS) score, and Hamilton Depression Rating Scale (HAMD) insomnia subsection score were compared between the two groups. Independent sample t test, paired sample t test, and χ² test were used. Results　After 6 weeks of treatment, the TCM symptom score [(7.39±2.13) points] and MADRS score [(11.58±1.53) points] of the experimental group were lower than those of the control group [(9.65±3.34) points and (13.34±1.60) points] (both P<0.05). The levels of DA [(74.08±7.60) ng/L], 5-HT [(280.96±34.85) μg/L], and NE [(45.44±6.51) μg/L] in the experimental groups were higher than those in the control group [(65.19±7.01) ng/L, (248.09±30.21) μg/L, and (37.21±5.48) μg/L] (all P<0.05). The UEFT score [(35.81±6.17) points] and TCT score [(75.34±16.55) points] in the experimental groups were higher than those in the control group [(23.42±3.63) points and (36.32±13.06) points] (both P<0.05). The BLS score [(4.85±1.86) points], AIS score [(4.64±1.36) points], and HAMD insomnia subsection score [(1.77±0.85) points] in the experimental groups were lower than those in the control group [(9.18±1.74) points, (6.52±1.63) points, and (2.62±0.83) points] (all P<0.05). The Borg scale score of the experimental group [(3.77±0.90) points] after walking was lower than that of the control group [(5.34±1.27) points] (P<0.05). Conclusion　Sanyinjiao warm acupuncture combined with exercise therapy significantly improves the TCM syndromes, emotional state, neurotransmitter level, upper limb function, trunk control ability, fatigue level, and sleep quality in patients with post-stroke depression, making it a valuable treatment option.

Key words:

Post-stroke depression, Exercise therapy, Sanyinjiao warm acupuncture, Sleep

摘要：

目的　探讨三阴交温针灸联合运动疗法对脑卒中后抑郁（PSD）患者的疗效。方法　采用前瞻性研究方法，选取2020年1月至2023年10月榆林市星元医院收治的80例PSD患者作为研究对象，采用摸球法进行随机分组，奇数为对照组（40例），偶数为试验组（40例）。试验组男20例，女20例；年龄48～72（61.87±8.74）岁；抑郁程度：轻度20例，中度20例；脑卒中类型：脑梗死30例，脑出血10例。对照组男21例，女19例；年龄47～71（60.13±8.49）岁；抑郁程度：轻度19例，中度21例；脑卒中类型：脑梗死31例，脑出血9例。对照组采用运动疗法治疗，试验组在此基础上接受三阴交温针灸治疗，两组疗程均为6周。比较两组患者中医症候评分、蒙哥马利阿斯伯格抑郁量表（MADRS）评分、单胺神经递质水平［多巴胺（DA）、5-羟色胺（5-HT）和去甲肾上腺素（NE）］、Carroll上肢功能测试量表（UEFT）评分、Burke倾斜量表（BLS）评分、躯干控制试验（TCT）评分、自觉疲劳程度分级量表（Borg）评分、阿森斯失眠量表（AIS）评分和汉密尔顿抑郁量表（HAMD）失眠子部分评分。采用独立样本t检验、配对样本t检验和χ²检验。结果　治疗6周后，试验组中医症候评分［（7.39±2.13）分］、MADRS评分［（11.58±1.53）分］均低于对照组［（9.65±3.34）分、（13.34±1.60）分］（均P<0.05）；试验组DA［（74.08±7.60）ng/L］、5-HT［（280.96±34.85）μg/L］、NE水平［（45.44±6.51）μg/L］均高于对照组［（65.19±7.01）ng/L、（248.09±30.21）μg/L、（37.21±5.48）μg/L］（均P<0.05）；试验组UEFT评分［（35.81±6.17）分］、TCT评分［（75.34±16.55）分］均高于对照组［（23.42±3.63）分、（36.32±13.06）分］（均P<0.05）；试验组BLS评分［（4.85±1.86）分］、AIS评分［（4.64±1.36）分］和HAMD失眠子部分评分［（1.77±0.85）分］均低于对照组［（9.18±1.74）分、（6.52±1.63）分、（2.62±0.83）分］（均P<0.05）；试验组步行后Borg量表评分［（3.77±0.90）分］低于对照组［（5.34±1.27）分］（P<0.05）。结论　三阴交温针灸联合运动疗法在PSD患者的中医症候、情绪状态、神经递质水平、上肢功能、躯干控制能力、疲劳程度及睡眠质量方面均表现出显著的改善效果，具有推广价值。

关键词:

卒中后抑郁, 运动疗法, 三阴交温针灸, 睡眠