醒脑开窍针刺法联合重复经颅磁刺激治疗肝郁气滞型脑卒中后抑郁临床研究OA

Objective:To observe the clinical efficacy of Xingnao Kaiqiao acupuncture combined with repetitive transcranial magnetic stimulation(rTMS)on the basis of routine symptomatic treatment during the recovery phase of stroke for post-stroke depression(PSD)of liver qi stagnation type.Methods:A total of 88 PSD patients of liver qi stagnation type admitted to Department of Rehabilitation,Jinhua Municipal Central Hospital from January 2022 to December 2024 were enrolled and randomly divided into the study group and the control group using the random number table method,with 44 cases in each group.Both groups received routine symptomatic treatment during the stroke recovery phase.The control group received additional rTMS treatment,while the study group received Xingnao Kaiqiao acupuncture combined with rTMS.Both groups were treated for three weeks.Before and after treatment,traditional Chinese medicine syndrome scores,neurological deficit severity[National Institutes of Health Stroke Scale(NIHSS)score],depression severity[24-item Hamilton Depression Rating Scale(HAMD-24)score],and sleep quality[Pittsburgh Sleep Quality Index(PSQI)score]were assessed.Serum levels of monoamine neurotransmitters[5-hydroxytryptamine(5-HT),dopamine(DA),norepinephrine(NE)],brain-derived neurotrophic factor(BDNF),and inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6)]were measured.The clinical efficacy and incidence of adverse reactions were compared between the two groups.Results:After three weeks of treatment,the total effective rate in the study group was superior to that in the control group(P＜0.05).Scores of traditional Chinese medicine syndrome,NIHSS,HAMD-24,and PSQI decreased in both groups compared with those before treatment(P＜0.05),and all four scores were lower in the study group than in the control group(P＜0.05).Serum levels of 5-HT,DA,NE,and BDNF increased in both groups compared with those before treatment(P＜0.05),while serum levels of IL-1β and IL-6 decreased(P＜0.05).The study group showed higher serum levels of 5-HT,DA,NE,and BDNF(P＜0.05)and lower serum levels of IL-1β and IL-6(P＜0.05)compared with those in the control group.No statistically significant difference was found in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:On the basis of routine symptomatic treatment during the stroke recovery phase,Xingnao Kaiqiao acupuncture combined with rTMS demonstrates significant efficacy in the treatment of PSD patients of liver qi stagnation type.It positively alleviates clinical symptoms,reduces neurological deficit and depression severity,and improves sleep quality,with good safety.The mechanism of action may be related to regulating monoamine neurotransmitter and BDNF levels,as well as reducing inflammatory responses.