目的 观察智三针为主穴针刺治疗中风后抑郁症的疗效.方法 采用前瞻性研究方法.选择2009年4月至2011年4月在三亚市中医院神经内科门诊及病房就诊的36例符合中风后抑郁症诊断的患者,按入院顺序均分为针刺组与对照组两组.两组基础治疗与康复治疗原则相同,针刺组取智三针(双本神、神庭穴)为主穴,肝气郁结型加用太冲、内关穴,心脾两虚型加用公孙、内关穴,每日针刺1次,每次30 min,15 min行针1次,每周休息2 d,4周为1个疗程,共4个疗程.对照组口服百忧解20 mg,每日1次,4周为1个疗程.治疗前后使用汉密尔顿抑郁量表(HAMD)17项进行抑郁评定,并观察临床疗效.结果 对照组与针刺组患者治疗前HAMD评分(分)差异无统计学意义(20.7±6.2比21.3±5.9,P＞0.05);治疗后抑郁评分(15.7±6.5、11.9±4.3)均较治疗前明显降低(均P＜0.05),且针刺组较对照组降低更明显(P＜0.05).针刺组显效率较对照组明显升高(77.8%比38.9%,P＜0.05).结论 采用智三针为主穴的针刺治疗中风后抑郁症较单纯使用西药百忧解临床疗效明显提高.%Objective To observe the clinical efficiency of Zhisanzhen (MAZ) as primary acupuncture in treating patients with post-stroke depressive disorder (PSD). Methods Thirty-six patients with PSD were involved in this prospective research, and they were diagnosed by Neurological Internal Medicine Outpatient Service and Ward of this hospital from April 2009 to April 2011. According to the sequence of admission,these patients were divided into treatment group (18 patients) and control group (18 patients). The basic treatment in the two groups was the same. MAZ including Shuangbenshen (双本神) and Shenting (神庭) was chosen as the primary acupoints, in patients with syndrome of stagnancy of liver qi (肝气郁结), Taichong (太冲) and Neiguan (内 关) acupoints were added, and in cases with deficiency of both heart and spleen (心脾两虚), Gongsun (公孙) and Neiguan acupoints were applied; the needle was retained for 30 minutes and manipulated to induce needle sensation once every 15 minutes, once per day and 5 times per week,4 weeks as a therapeutic course and 4 courses completing the whole treatment. The control group took Fluose fine hydrochloride, 20 mg per day, 4 weeks as a therapeutic course and the whole treatment period lasting for 4 courses. All patients were evaluated by hamilton depression rating scale (HAMD) containing 17 items before and after treatment. The clinical efficacy was compared between the two groups. Results There was no notable difference between treatment and control groups in constituent ratio of HAMD scores before treatment (20. 7±6.2 vs. 21.3±5.9, P＞0. 05). The HAMD scores (15.7±6.5, 11.9±4. 3) of two groups both were reduced significantly after treatment in comparison to those before treatment (both P＜0. 05), and the HAMD scores of treatment group were decreased more obviously than those of control group (P＜0.05). The rate of significant therapeutic effect of treatment group increased more markedly than that of control group (77.8％ vs. 27.6％, P＜0. 05). Conclusion The clinical therapeutic effect of MAZ as primary acupuncture increased more obviously in comparison to that of simply using Fluose fine hydrochloride for treatment of patients with PSD.
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