本文選題：腦卒中后抑郁 + 孫真人十三鬼穴　； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過辨證選用"孫真人十三鬼穴"治療腦卒中后抑郁,并評價該療法對神經(jīng)功能缺損程度及抑郁狀態(tài)的影響,探討治療腦卒中后抑郁的思路及方法。方法:選取60例于2016年3月至2017年3月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院針灸科門診及病房就診、并符合病例篩選標(biāo)準(zhǔn)的腦卒中后抑郁的患者;隨機(jī)分成兩組,治療組及對照組各30例。兩組患者均按照腦卒中診療常規(guī)進(jìn)行基礎(chǔ)治療。治療組(孫真人十三鬼穴組):以人中、承漿、風(fēng)府為主穴,肝氣郁結(jié)證合申脈、上星,氣郁化火證合勞宮、曲池,憂郁傷神證合大陵、上星,心脾兩虛證合隱白、大陵,陰虛火旺證加申脈、勞宮,每周連續(xù)治療5次,休息2天,10次為1個療程,共治療2個療程。對照組(氟西汀組):予鹽酸氟西汀膠囊20mg,口服,1次/日,2周為1療程,觀察2療程。兩組患者分別在治療前、治療2周后、治療4周后進(jìn)行腦卒中臨床神經(jīng)功能缺損量表(SSS)評分和漢密頓抑郁量表(HAMD)評分。臨床研究的所有資料均采用統(tǒng)計軟件SPSS18.0軟件包進(jìn)行統(tǒng)計處理,計量資料用均數(shù)±標(biāo)準(zhǔn)差(X±S)表示,組間差異的顯著性采用t檢驗,計數(shù)指標(biāo)組間差異的顯著性采用卡方檢驗,等級資料組間差異采用秩和檢驗。結(jié)果:1、治療前,治療組與對照組病例的組間基本資料(性別、年齡、病程、SSS評分、HAMD評分)經(jīng)統(tǒng)計學(xué)分析,差異無統(tǒng)計學(xué)意義(P0.05),表明兩組患者基線資料具有可比性。2、治療2周后,組內(nèi)比較發(fā)現(xiàn),兩組患者SSS評分、HAMD評分均較治療前降低,經(jīng)統(tǒng)計學(xué)分析,差異具有統(tǒng)計學(xué)意義(P0.05),說明兩種療法均能改善神經(jīng)功能缺損程度及抑郁狀態(tài);組間比較發(fā)現(xiàn),兩組患者SSS評分、HAMD評分差異無統(tǒng)計學(xué)意義(P0.05),說明治療2周后兩種方法對神經(jīng)功能缺損程度及抑郁狀態(tài)的改善暫無明顯差別。3、治療4周后,組內(nèi)比較發(fā)現(xiàn),兩組患者SSS評分、HAMD評分均較治療前明顯降低,差異具有統(tǒng)計學(xué)意義(P0.05),說明兩種療法均能改善神經(jīng)功能缺損程度及抑郁狀態(tài);組間比較發(fā)現(xiàn),兩組患者SSS評分及HAMD評分差異具有統(tǒng)計學(xué)意義(P0.05),且治療組較對照組在SSS評分及HAMD評分的改善更明顯,即治療組在卒中后抑郁患者神經(jīng)功能缺損程度及抑郁狀態(tài)的改善方面療效更佳。4、完成4周的治療后,將兩組患者的臨床療效進(jìn)行統(tǒng)計分析,結(jié)果顯示治療組總有效率90.00%,其中臨床控制6例,顯效15例,有效6例,無效3例;對照組總有效率83.33%,其中臨床控制3例,顯效7例,有效15例,無效5例。兩組患者治療后總療效比較具有統(tǒng)計學(xué)意義(p0.05),且治療組療效(總有效率90.00%)優(yōu)于對照組療效(總有效率83.33%)。即"孫真人十三鬼穴"治療卒中后抑郁的療效優(yōu)于西藥氟西汀。結(jié)論:針刺"孫真人十三鬼穴"組和氟西汀組對卒中后抑郁都具有明確的臨床療效,但治療組臨床總療效較對照組更佳,且在改善神經(jīng)功能缺損程度、抑郁狀態(tài)方面,針刺"孫真人十三鬼穴"組優(yōu)于西藥氟西汀,故"孫真人十三鬼穴"治療腦卒中抑郁療效確切,可供臨床醫(yī)生參考應(yīng)用。
[Abstract]:Objective: to select "Sun real thirteen ghost point" to treat post-stroke depression, and to evaluate the effect of this therapy on the degree of neural function defect and depression, and to explore the methods and methods of treating post-stroke depression. Methods: 60 cases were selected from March 2016 to March 2017 in the outpatient department of the Acupuncture Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine and The patients were divided into two groups, the treatment group and the control group were 30 cases. The two groups were all based on the stroke diagnosis and treatment routine. The treatment group (Sun Zhenren thirteen ghosts group): among the people, the Chengdu, the Feng Fu main point, the liver qi stagnation syndrome, the upper star and qi depression syndrome The palace, the Qu Chi, the melancholy syndrome of the dusoleum, the upper star, the heart and spleen two deficiency syndrome combined with hidden white, daling, yin deficiency and fire syndrome plus Shen Mai, Lao Gong, 5 times a week, 2 days rest for 2 days and 2 courses of treatment. The control group (fluoxetine group) was treated with Fluoxetine Hydrochloride Capsules 20mg, orally, 1 times, 2 weeks for 1 courses, 2 courses. Two groups of patients were observed. The clinical nerve function defect scale (SSS) score and the Hamilton Depression Scale (HAMD) score were performed after 2 weeks of treatment. All the data of the clinical study were processed by statistical software SPSS18.0 software package, and the measurement data were expressed with mean mean + standard deviation (X + S). The significant difference between groups was detected by t. The significant difference between the count indexes was checked by chi square test, and the difference between the class data groups was tested by rank sum test. Results: 1, before treatment, the basic data (sex, age, course of disease, SSS score, HAMD score) between the treatment group and the control group were statistically analyzed, the difference was not statistically significant (P0.05), indicating that the two groups of patients had baseline data. Comparability.2, after 2 weeks of treatment, group comparison found that the two groups of patients with SSS score, HAMD scores were lower than before the treatment, statistical analysis, the difference was statistically significant (P0.05), indicating that the two treatments can improve the degree of nerve function defect and depression state. The comparison between groups found that the two groups of patients with SSS score, HAMD score difference was not statistically significant ( P0.05) showed that there was no significant difference between the two methods after 2 weeks of treatment for the improvement of the degree of nerve function defect and depression. After 4 weeks of treatment, it was found that the scores of the two groups were significantly lower than those before the treatment, and the difference was statistically significant (P0.05). The difference was statistically significant (P0.05), indicating that the two treatments could improve the degree of neurological impairment and inhibition. The difference of SSS score and HAMD score between the two groups was statistically significant (P0.05), and the improvement of the SSS score and the HAMD score in the treatment group was more obvious than that in the control group, that is, the treatment group had better effect on the degree of neurological impairment and the improvement of depression in the patients with post-stroke depression, and after 4 weeks of treatment, the treatment group would be better. The clinical efficacy of two groups of patients was statistically analyzed, and the results showed that the total effective rate of the treatment group was 90%, of which 6 cases were clinically controlled, 15 were markedly effective, 6 cases were effective, 3 cases were invalid, and the total effective rate of the control group was 83.33%. The clinical control 3, the effective 7, the 15 effective and 5. The total curative effect of the two group was statistically significant (P0.05), and the treatment after treatment was statistically significant (P0.05), and the treatment after treatment was statistically significant. The curative effect of the treatment group (total effective rate 90%) was better than the control group (total effective rate 83.33%). The effect of "Sun Zhenren thirteen ghost point" on post-stroke depression was better than the western medicine fluoxetine. Conclusion: the acupuncture "Sun real thirteen ghost point" group and fluoxetine group have definite clinical effect on post stroke depression, but the total clinical effect of the treatment group is more than that of the control group. Good, and in improving the degree of nerve function defect, depressive state, acupuncture "Sun real thirteen ghost point" group is better than the western medicine fluoxetine, so "Sun real thirteen ghost point" treatment of stroke depression is effective, for clinicians to refer to the application.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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