【目的】 观察加味补阳还五汤联合宁心解郁电针法治疗卒中后抑郁（PSD）患者的临床疗效，并探讨其可能的作用机制。 【方法】 选取2021年10月到2023年10月陕西省中医医院病房及门诊收治的120例明确诊断为PSD的患者为研究对象。按随 机数字表将患者随机分为观察组和对照组，每组各60例。2组患者均给予常规治疗，对照组在常规治疗的基础上，给予草酸 艾司西酞普兰片口服。观察组在对照组治疗的基础上，给予加味补阳还五汤联合宁心解郁电针法治疗。2组均治疗4周。治 疗1个月后，评价2组临床疗效。观察2组患者治疗前后24项汉密尔顿抑郁量表评分（HAMD-24）和美国国立卫生院神经功能 缺损评分（NIHSS）的变化情况，以及脑血容量及脑血流量的情况。比较2组患者治疗前后神经递质指标包括血清去甲肾上腺 素（NE）、多巴胺（DA）、5-羟色胺（5-HT）水平，以及炎症因子指标包括白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）水平 的变化情况。【结果】（1）治疗后，2组患者的HAMD-24评分和NIHSS评分明显改善（P＜0.05），且观察组在改善HAMD-24评 分和NIHSS评分方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2组患者的脑血流量与脑血容量均明显改善 （P＜0.05），且观察组在改善脑血流量与脑血容量方面明显优于对照组，差异有统计学意义（P＜0.05）。（3）治疗后，2组患者的血清NE、DA、5-HT水平明显改善（P＜0.05），且观察组在改善血清 NE、DA、5-HT 水平方面明显优于对照组，差异有 统计学意义（P＜0.05）。（4）治疗后，2组患者的血清 TNF-α和 IL-6水平明显改善（P＜0.05），且观察组在改善血清 TNF-α和 IL-6 水平方面明显优于对照组，差异有统计学意义（P＜0.05）。（5）观察组总有效率为 93.33%（56/60），对照组为 76.67% （46/60）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。【结论】 加味补阳还五汤联合宁心解郁电针法能有效改善 PSD患者的抑郁症状，提高神经功能及脑血管灌注量，其作用机制可能与调节神经递质、炎症因子水平有关。

Objective To evaluate the clinical efficacy of Modified Buyang Huanwu Decoction combined with Ningxin Jieyu Electroacupuncture in treating post-stroke depression（PSD） and explore its potential mechanisms. Methods A total of 120 PSD patients diagnosed at Shaanxi Provincial Hospital of Traditional Chinese Medicine （inpatient and outpatient departments） from October 2021 to October 2023 were enrolled and randomly divided into an observation group and a control group using a random number table，with 60 cases in each group. Both groups received conventional therapy. The control group additionally received oral administration of Escitalopram Oxalate Tablets， while the observation group underwent Modified Buyang Huanwu Decoction combined with Ningxin Jieyu Electroacupuncture. Both groups were treated for 4 weeks. The clinical efficacy，24-item Hamilton Depression Scale（HAMD-24） scores，National Institutes of Health Stroke Scale（NIHSS） scores，cerebral blood volume（CBV）， cerebral blood flow（CBF）， serum neurotransmitter levels [norepinephrine（NE）， dopamine （DA），5-hydroxytryptamine（5-HT）]，and inflammatory cytokines [interleukin-6（IL-6），tumor necrosis factor- α（TNF-α）] were evaluated after one-month treatment. Results（1） After treatment，the HAMD-24 scores and NIHSS scores of patients in the two groups significantly improved（P＜0.05）， and the observation group was significantly superior to the control group in improving the HAMD-24 scores and NIHSS scores，and the difference was statistically significant（P＜0.05）.（2） After treatment，the cerebral blood flow and cerebral blood volume of patients in the two groups were significantly improved（P＜0.05）， and the observation group was significantly superior to the control group in improving cerebral blood flow and cerebral blood volume， with statistically significant differences（P＜0.05）（. 3） After treatment，the serum NE，DA，and 5-HT levels of patients in the two groups were significantly improved（P＜0.05），and the observation group was significantly superior to the control group in improving serum NE， DA， and 5-HT levels， with statistically significant differences（P＜0.05）. （4）After treatment，the serum TNF-α and IL-6 levels of patients in the two groups were significantly improved （P＜0.05），and the observation group was significantly superior to the control group in improving serum TNF-α and IL-6 levels，with statistically significant differences（P＜0.05）（. 5） The total effective rate was 93.33%（56/60） in the observation group and 76.67%（46/60） in the control group. The efficacy of the observation group was superior to that of the control group， and the difference was statistically significant（P＜0.05）. Conclusion Modified Buyang Huanwu Decoction combined with Ningxin Jieyu Electroacupuncture effectively alleviates depressive symptoms，enhances neurological function，and improves cerebrovascular perfusion in PSD patients. The therapeutic mechanism may involve modulation of neurotransmitter levels and inflammatory cytokines.

R246.9

国家自然科学基金资助项目（编号：81904193）；陕西省重点研发计划资助项目（编号：2018ZDXM-SF-013）