School of Chinese Medicine, University of Hong Kong, Hong Kong, China.
Department of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center of Traditional Chinese Medicine, Tianjin, China.
Psychiatry Clin Neurosci. 2020 Mar;74(3):183-190. doi: 10.1111/pcn.12959. Epub 2019 Dec 20.
AIM: Acupuncture has benefits in the rehabilitation of neuropsychiatric sequelae of stroke. This study was aimed to evaluate the effectiveness of dense cranial electroacupuncture stimulation plus body acupuncture (DCEAS+BA) in treating poststroke depression (PSD), functional disability, and cognitive deterioration. METHODS: In this assessor- and participant-blinded, randomized controlled trial, 91 stroke patients who initially had PSD were randomly assigned to either DCEAS+BA (n = 45) or minimum acupuncture stimulation as controls (n = 46) for three sessions per week over 8 consecutive weeks. The primary outcome was baseline-to-end-point change in score of the 17-item Hamilton Depression Rating Scale. Secondary outcomes included the Montgomery-Åsberg Depression Rating Scale for depressive symptoms, the Barthel Index for functional disability, and the Montreal Cognitive Assessment for cognitive function. RESULTS: DCEAS+BA-treated patients showed strikingly greater end-point reduction than MAS-treated patients in scores of the three symptom domains. The clinical response rate, defined as an at least 50% baseline-to-end-point reduction in 17-item Hamilton Depression Rating Scale score, was markedly higher in the DCEAS+BA-treated group than that of controls (40.0% vs 17.4%, P = 0.031). Incidence of adverse events was not different in the two groups. Subgroup analysis revealed that DCEAS+BA with electrical stimulation on forehead acupoints was more apparent in reducing Barthel-Index-measured disability than that without electrical stimulation. CONCLUSION: DCEAS+BA, particularly with electrical stimulation on forehead acupoints, reduces PSD, functional disability, and cognitive deterioration of stroke patients. It can serve as an effective rehabilitation therapy for neuropsychiatric sequelae of stroke.
目的:针刺在中风神经精神后遗症的康复中具有益处。本研究旨在评估密集颅电刺激加体针(DCEAS+BA)治疗中风后抑郁(PSD)、功能障碍和认知恶化的疗效。
方法:在这项评估者和参与者设盲、随机对照试验中,91 名最初患有 PSD 的中风患者被随机分为 DCEAS+BA 组(n=45)或最低针刺刺激对照组(n=46),每周 3 次,连续 8 周。主要结局是汉密尔顿抑郁量表(17 项)评分的基线至终点变化。次要结局包括抑郁症状的蒙哥马利-阿斯伯格抑郁评定量表、功能障碍的巴氏指数和认知功能的蒙特利尔认知评估。
结果:DCEAS+BA 治疗组在三个症状领域的评分中,终点降低幅度明显大于 MAS 治疗组。DCEAS+BA 治疗组的临床反应率(定义为汉密尔顿抑郁量表评分至少减少 50%)明显高于对照组(40.0%比 17.4%,P=0.031)。两组的不良事件发生率无差异。亚组分析显示,与不进行电刺激相比,在前额穴位进行电刺激的 DCEAS+BA 更能明显降低巴氏指数测量的残疾程度。
结论:DCEAS+BA,特别是在前额穴位进行电刺激,可减轻中风患者的 PSD、功能障碍和认知恶化。它可以作为中风神经精神后遗症的有效康复治疗方法。
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