Clinical Study On Improving The Quality Of Life Of Patients With Mild To Moderate Depression By Acupuncture And Moxibustion

Objective1.To evaluate acupuncture and moxibustion of improving the quality of life of patients with evidence-based evidence medicine,basing on a system review of the literature and meta-analysis for the acupuncture treatment of depression.2.To evaluate the efficacy and safety of "one acupuncture two moxibustion and three solidification" integrated acupuncture and moxibustion program in the treatment of depression by conducting a randomized controlled clinical study.Methods1.Literature researchThrough the computer and manual retrieval,comprehensive collection of SSRI drugs and acupuncture compared to improve the quality of life of the relevant literature.Search time from October 1996 to February 2017.The search library includes Chinese biomedical literature database CBM,CNKI,Wanfang,Weipu VIP,Pubmed database.A randomized controlled study was conducted by reading the title and abstract.The data were extracted by excel,and the meta-analysis was performed by Revman5.3 to evaluate acupuncture and SSRI drugs of improving the quality of life of patients with depression.2.clinical research(1)the object of studyPatients with mild to moderate depression were recruited from the acupuncture outpatient of Guangdong Province Traditional Chinese Medical Hospital,from February 2016 to February 2017.(2)type of studyThe patients who were eligible for inclusion in the standard 105 patients were randomly divided into three groups according to the ratio of 1:1:1,the integrated group(acupuncture and moxibustion group),drug group(paroxetine group)and placebo group(placebo acupuncture and moxibustion group).And the blind method was used in the efficacy evaluation and data analysis.(3)Interventions? integrated acupuncture groupAcupuncture:Baihui,Yintang,Shuigou,Neiguan,Hegu,TaichongMethod of operation:0.35×25mm needle,filiform needle acupuncture,d isinfection before acupuncture.fistly,needle Hegu and Taichong,the nee dle was inserted vertically to a depth of 10-12mm,then needle Baihui and Yintang,the needle was inserted obliquely at 15 °with a depth of 10-12m m,then needle Shuigou and Neiguan,the needle was inserted vertically to a depth of 10-12mm.The above points are taken to uniform twist until De qi.The needle is left in acupoint place for 30 minutes,with needling on ce per 10 minutes,mild reinforcing-reducing method.Abdominal needle:Yin Qi Gui Yuan(Zhongwan,Xiawan,Qihai,Guanyuan)Operation:the patient was placed in the prone position,0.35×25mm n eedle after regular disinfect,needle points vertically to a depth of 10-12mm without Deqi,retaining the needle for 30 minutes.Moxibustion:Sihua points(Geshu,Danshu)(Moxa cone specifications:such as sesame size,column height 0.2cm,bottom diameter of about 0.1cm,burning time of about 2-3s.)Operation:use a cotton swab to dip the amount of Dieda Wanhua oil,which is coated on the bonding point with moxa made as above specifications,then ignite moxa with medical incense.When patients feel hot pain,the operator will quickly hand moxa burning away,each acupoint Moxibustion 2 times.Intradermal needle:Xinshu,GanshuOperation:acupuncture points after the use of granular intradermal needle,with tweezers to clamp the needle handle,the needle toward the spine direction,along the subcutaneous transverse piercing acupuncture points;needle penetration depth of 5-8mm,so that the needle handle retained in the skin,First with medical tape(0.5×0.5cm)attached to the needle under the metal ring on the skin,and then above it with medical tape(1.5 X 1.5cm)paste fixed,each needle retaining 2-3 days,until the next treatment Side out.? Paroxetine Hydrochloride GroupOral administration of paroxetine hydrochloride(initial dose of 20mg/qd,taking 2-3 weeks after the reaction according to the patient can be increased by 10mg per week,the maximum daily amount of not more than 50mg,taking a total of 8 weeks.)? placebo acupuncture and moxibustion groupplacebo acupuncture and placebo abdominal needle:The acupoints were the same as the acupuncture group.Operation:the viscous care ring fixed in the acupuncture points,with 1 inch blunt needle piercing through the care ring surface of the skin,even mention inserted twist 3 times,but not puncture the skin,do not get Deqi,And the operation and time were the same as the acupuncture group.placebo moxibustion:Selection of acupuncture points and moxa cone specifications with the integration of acupuncture group.Operation:use a cotton swab to dip the amount of Dieda Wanhua oil,which is coated on the bonding point with moxa made as above specifications,then ignite moxa with medical incense.When the moxa is ignited for only ls without feeling hot pain,the operator will quickly hand moxa burning away,each acupoint Moxibustion 2 times.placebo intradermal needle:Operation:use the blunt scalp needle,the operation with the integrated acupuncture group,but the blunt scalp needle is not buried in the skin.(4)treatmentAcupuncture treatment twice a week,each treatment interval ? 48h,4 weeks for a course of treatment,a total of 2 courses,a total of 16 treatment;each needle for 30 minutes;paroxetine hydrochloride daily breakfast or after dinner,Take a total of 8 weeks.After the end of the treatment,follow-up for 4 weeks.(5)Evaluation indicatorsThe main indicators:HAMD-17The Secondary indicators:SF-36 scale(6)other indicators? adverse reaction records:SER adverse reaction scale of the drug does not evaluate the negative,acupuncture adverse reactions by the acupuncture adverse reaction scale to evaluate.? patient compliance evaluation? laboratory indicators:tests of the liver and kidney functions,routine urinalysis,and 12-lead ECG.(7)evaluation of efficacyHAMD-17 Depression ScaleAccording to the reduction rate of HAMD-17,the curative effect was evaluated at the 8th week of treatment,and the changes were compared at each time point and follow-up period.Obviously Effective:50%?HAMD-17 Reduction rate<75%;Effective:25%?HAMD-17 Reduction rate<50%;Invalid:HAMD-17 Reduction rate<25%SF-36 Quality of Life ScalePF(Physical function),RP(physical function),BP(physical pain),GH(general health),VT(vitality),SF(social function),RE(emotional function)and MH(mental health),A total of eight dimensions were used to evaluate the performance of patients with depression before and after treatment.(8)Statistical analysisStatistics software using excel to collect and import,with SPSS17.0 statistics.Measurement data and counting material using a chi-square test.Comparison in grups with multiple time points using the single factor analysis of variance or paired t test,comparison between groups using multiple variance analysis or nonparametric test(non-normal distribution).LSD was used to analyze the count data and the measurement data.Bilateral tests were performed using conservative estimates,with a level = 0.05.result:1.literature researchSeven of the nine studies included are high-quality literatures,six of which included follow-up,but most of the follow-up period was only 4 weeks.Only one article was followed for one year.Basing on improving in short-term quality of life In the case of meta-analysis of the present study,it was concluded that the use of electroacupuncture or verum acupuncture combined with SSRI drugs was superior in improving patients' physiology and psychology domain compared with SSRI drugs alone;in the social domain,verum acupuncture combined with SSRIs was better than SSRI drugs alone while electroacupuncture combined with SSRI drugs had the same effience as SSRI drugs alone;in the environmental domain,electroacupuncture or verum acupuncture combined with SSRI drugs was the same as SSRIs alone.In the case of total survival and total health assessment and analysis of the combined scores of different scales,it was found that electroacupuncture or verum acupuncture combination of SSRIs was superior to SSRIs alone.2.clinical researchBaseline comparison:There was no significant difference in age,sex,occupation,course of disease,whether or not acupuncture treatment,HAMD-17 and SF-36.? HAMD-17 comparison resultsComparison between groupsThree groups of patients in the fourth week of HAMD-17 comparison between the two groups using wilcoxon rank sum test,the use of adjusted P value.There was no significant difference between integrated group and drug group(P>0.05).There was significant difference between the integrated group and placebo group(P<0.05),and there was significant difference between the drug group and placebo group(P<0.05).Three groups of patients treated for 8 weeks HAMD-17 compared between the two groups were compared using wilcoxon rank sum test,the use of adjusted P value.There was no significant difference between integrated group and drug group(P>0.05).There was significant difference between the integrated group and placebo group(P<0.05),and there was significant difference between drug group and placebo group(P<0.05).Three groups of patients were followed up for 12 weeks HAMD-17,compared between the two groups using wilcoxon rank sum test,the use of adjusted P value.There was no significant difference between integrated group and placebo group(P>0.05).There was significant difference between the integrated group and placebo group(P<0.05),and there was significant difference between the drug group and placebo group(P<0.05).Group comparisonThe comparison of determination values before and after administration was evaluated by repeated measure variance analysis.There was statistically significant in each group at each time point,compared with before treatment(integrated group,F =63.268,P<0.001;drug group,F=14.194,P<0.001;placebo group,F = 16.451,P<0.001).The integrated group:Compared with before treatment,the scores of the patients were significantly decreased at each time point;compared wi th the 4th weeks after treatment,the scores were significantly decreased at the 8th and 12th weeks(P<0.001);compared with the 8th week,the sco re decreased at 12th weeks,the difference was statistically significant(P<0.001).The drug group:Compared with before treatment,the scores of the pa tients were significantly decreased at each time point;compared with the 4th weeks after treatment,the scores were significantly decreased at th e 8th and 12th weeks(P<0.001);compared with the 8th week,the score dec reased at 12th weeks,the difference was statistically significant(P<0.001).The placebo group:Compared with before treatment,the scores of the patients were decreased at each time point,but there was no significanc e at the 4th weeks(P>0.05);compared with the 4th weeks after treatment,the scores were significantly decreased at the 8th weeks(P<0.001)and w ithout significance at the 12th weeks(P>0.05);compared with the 8th wee k,the score increased,but the difference was statistically significant(P<0.005).?SF-36 comparison results Group comparisonIn the integrated group,the RP,BP,GH,VT,SF,RE,MH dimension were higher than those before treatment,the difference was statistically significant(P<0.05),while the difference of PF dimension was not statistically significant(P)0.05).In the drug group,The physiological function,the RP,BP,GH,VT,SF,RE,MH dimension were higher than those before treatment,the difference was statistically significant(P<0.05),while the difference of PF dimension was not statistically significant(P>0.05).In the placebo group,the RE and MH were higher than those before treatment,the difference was statistically significant(P<0.05),the PF,RP,BP,GH,VT and SF dimension were higher than those before treatment,but the difference was not statistically significant(P>0.05).Comparison between groupsAt 4 weeks of treatment,the integrated group compared with the placebo group,the RP,BP,GH,VT,SF,RE,MH dimension were significant(P<0.05),there was no significant difference in the PF dimension(P>0.05);the integrated group compared with the drug group,the RP,BP,GH,VT,SF,RE dimension were significant(P<0.05),there was no significant difference in the PF and MH dimension(P>0.05);the drug group compared with the placebo group,the RP dimension was significant(P<0.05),there was no significant difference in the PF,BP,GH,VT,SF,RE and MH dimension(P>0.05).At 8 weeks of treatment,the integrated group compared with the placebo group,the PF,RP,BP,GH,VT,SF and MH dimension were significant(P<0.05),there was no significant difference in the RE dimension(P>0.05);the integrated group compared with the drug group,the BP,GH,SF,MH dimension were significant(P<0.05),there was no significant difference in the PF,RP,VT and RE dimension(P>0.05);the drug group compared with the placebo group,the RP,VT,RE,MH dimension were significant(P<0.05),there was no significant difference in the PF,BP,GH and SF dimension(P>0.05).At 12 weeks of treatment,the integrated group compared with the placebo group,the RP,BP,GH,VT,SF,RE,MH dimension were significant(P<0.05),there was no significant difference in the PF dimension(P>0.05);05);the integrated group compared with the drug group,the RP,GH,VT,MH dimension were significant(P<0.05),there was no significant difference in the PF,RP,SF and RE dimension(P>0.05);the drug group compared with the placebo group,the RP,SF,RE and MH dimension were significant(P<0.05),there was no significant difference in the PF,BP,GH and VT dimension(P>0.05).? safety analysisThe integration group had 1 cases of hematoma,4 cases of blisters.The hematoma was found after getting back home,prompting the operator should take careful examination to make sure whether the patient was uncomfortable after removing the needles.Blisters were all caused by fine moxibustion,they were so small that resumpted by their own without any special treatment,suggesting that the operator should be careful to avoid unnecessary burns to the patient.The Drug group had 4 cases of palpitations,7 cases of dry mouth,2 cases of loss of appetite,1 case od fingers cut,4 cases of dizziness,2 cases of constipation,although there were adverse effects,they were all mild,without giving special treatment.It is important to note that one patient was suffering from a finger hurt with dizziness,which might be caused by side effects of the drug,suggesting that taking paroxetine early may need to be careful to avoid doing fine work.There were no adverse events related to the operation in the comfort group.In general,the integration of acupuncture and drug treatment are safe.? the total effective rate at the 8th weekComparison of the three groups of total efficiency,the integrated group was 84.3%,the drug group was 86%,the placebo group was 42%.Comparison between the three groups,and the P value was corrected for the three groups,and the integration group and the drug group were bteer than the placebo group(P<0.001),but there was no statistical significance between the integrated group and the drug group(P>0.05).conclusion1.Literature researchAcupuncture combined with SSRI drugs on the quality of life of patients with depression in all areas are better than the use of SSRI drugs alone,embodied in the physiological field,psychological field,social field,environmental field,etc.Although the study included most of the literature Quality is high,but the number is not enough,indicating that more high-quality literature support is still needed.2.Clinical researchBy observing the changes of HAMD-17 scale,SF-36 scale and adverse reactions in the three groups,The conclusion is as follows:Three groups can improve the depressive symptoms of patients with mild to moderate depression,and the effect can be maintained after stopping treatment.But the efficacy of the placebo group was significantly lower than the integration group and drug group.Three groups were able to reduce the total score of HAMD-17 scale,the integration group and the drug group began to show the effect after the first 4 weeks of treatment,the placebo group began to show the effect at the 8 weeks.At the 12 weeks follow-up,the score of drug group and placebo group appeared small rebound,while the integrated group continued to decline.At the 8th week,the integrated group had the same effect as the drug group,while the placebo group had a significant effect,but was significantly lower than the integrated group and the drug group.Conclusion:literature Research:Acupuncture combined with SSRI drugs on the quality of life of patients with depression in all areas are better than the use of SSRI drugs alone,specifically reflected in the physiological field,psychological field,social field,environmental field,etc.Although most of the literature included in this study Quality is high,but the number is small,more high-quality documentary evidences are needed.Clinical research:By observing the changes of HAMD-17 scale,SF-36 scale and adverse reactions in the three groups,acupuncture and moxibustion therapy can improve the depressive symptoms and quality of life of patients with mild to moderate depression,the integration of acupuncture and moxibustion has a certain placebo effect,integrated acupuncture group and paroxetine group are better than placebo integrated acupuncture group;in the quality of life of the physiological and psychological dimensions,integration acupuncture group is better than paroxetine.