目的：观察安神解郁穴位按摩法联合高频重复经颅磁刺激（rTMS） 治疗脑卒中后抑郁的疗效。方法：选取180 例脑卒中后抑郁患者，按随机数字表法分为对照组与观察组各90 例。2 组均进行基础治疗及综合康复训练，对照组采用高频rTMS 治疗，观察组采用安神解郁穴位按摩法联合高频rTMS 治疗。7 d 为1 个疗程，2 组共治疗8 个疗程。比较2 组治疗前后抑郁程度［汉密顿抑郁量表（HAMD）］、焦虑程度［汉密顿焦虑量表（HAMA）］、睡眠质量［匹兹堡睡眠质量指数量表（PSQI）］、心理韧性［心理韧性量表（CD-RISC）］以及神经功能［神经元烯醇化酶（NSE）、脑源性神经营养因子（BDNF）、多巴胺（DA）］变化。结果：治疗后，2 组HAMD、HAMA 及PSQI 评分均较治疗前降低，观察组上述3 项评分均低于对照组，差异均有统计学意义（P＜0.05）。治疗后，2 组自强、坚韧、乐观评分均较治疗前升高，观察组上述3 项评分均高于对照组，差异均有统计学意义（P＜0.05）。治疗后，2 组BDNF、DA 水平均较治疗前上升，NSE 水平均较治疗前下降；观察组BDNF、DA 水平均高于对照组，NSE 水平低于对照组，差异均有统计学意义（P＜0.05）。结论：安神解郁穴位按摩法联合高频rTMS 治疗脑卒中后抑郁患者，可有效缓解患者焦虑、抑郁症状，改善神经功能，提升睡眠质量。
Abstract：Objective：To observe the curative effect of point massage therapy of tranquilizing and resolving depression combined with high- frequency repetitive transcranial magnetic stimulation(rTMS) on post- stroke depression. Methods： A total of 180 patients with post-stroke depression were selected and divided into the control group and the observation group according to the random number table method，with 90 cases in each group. Both groups were given basic treatment and comprehensive rehabilitation training. The control group was treated with high- frequency rTMS，and the observation group was treated with point massage therapy of tranquilizing and resolving depression combined with high-frequency rTMS. Both groups were treated for eight courses，seven days being a course. Before and after treatment，the changes of depression in the two groups were compared by Hamilton Rating Scale for Depression(HAMD)，anxiety by Hamilton Anxiety Rating Scale (HAMA)，sleep quality by Pittsburgh Sleep Quality Index(PSQI)，resilience by Connor-Davidson Resilience Scale(CD-RISC)， and neurological function by neuron- specific enolase(NSE)， brain- derived neurotrophic factor(BDNF) and dopamine(DA). Results：After treatment，the scores of HAMD，HAMA and PSQI in the two groups were decreased when compared with those before treatment，and the above three scores in the observation group were lower than those in the control group，the differences being significant(P＜0.05). After treatment，the scores of self-improvement，perseverance and optimism in the two groups were increased when compared with those before treatment， and the above three scores in the observation group were higher than those in the control group， differences being significant(P＜0.05). After treatment， the levels of BDNF and DA in the two groups were increased when compared with those before treatment，and the levels of NSE were decreased；the levels of BDNF and DA in the observation group were higher than those in the control group，and the level of NSE was lower，differences being significant(P＜0.05). Conclusion：The application of point massage therapy of tranquilizing and resolving depression combined with high-frequency rTMS for patients with post-stroke depression can effectively relieve the symptoms of anxiety and depression and improve the neurological function and sleep quality.