本文選題：焦慮癥 + 四關(guān)穴��； 參考：《南京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：研究目的:本研究充分分析目前國內(nèi)外的研究進展,發(fā)現(xiàn)焦慮癥患者臨床癥狀的發(fā)生和病情反復(fù)可能是由于在肝失疏泄的基礎(chǔ)上,出現(xiàn)臟腑、氣血、陰陽失調(diào)引起,并且睡眠障礙亦是引起病變發(fā)生和復(fù)發(fā)的因素。因此本研究創(chuàng)新性選用常規(guī)治療急重?zé)嶙C、痛癥以及癲狂癇癥的四關(guān)穴來治療慢性神志疾病,進一步探討針刺治療焦慮癥的臨床療效,及睡眠障礙與焦慮癥的相關(guān)性,以作為針灸臨床治療焦慮癥提供參考。研究方法:采用SAS9.3統(tǒng)計學(xué)軟件,利用程序參數(shù)按照1:1:1比例,隨機產(chǎn)生90個隨機數(shù)字,按照患者就診順序,隨機將符合標準的患者分為治療組、觀察組和對照組,每組患者各30例,其中治療組患者予以針刺"四關(guān)"穴聯(lián)合常規(guī)取穴,觀察組患者予以常規(guī)針刺聯(lián)合安神定志丸,對照組患者單獨采取常規(guī)針刺治療,3組患者共治療4周,治療結(jié)束后觀察每組患者焦慮自評量表(self-Rating Anxiety Scales SAS)評分、匹茲堡睡眠質(zhì)量指數(shù)(PSQI)、生活質(zhì)量評價量表SF-36及臨床療效。研究結(jié)果:1.三組患者治療前SAS量表評分比較,均符合正態(tài)性分布和方差齊性,行單因素方差分析結(jié)果顯示,三組患者治療前SAS量表評分比較無差異,具有可比性(P0.05)。經(jīng)4周治療后,三組患者SAS量表評分同樣符合方差齊性和正態(tài)性分布,使用單因素方差分析結(jié)果顯示三組患者SAS評分不全相同,采用SNK法對三組患者兩兩比較分析發(fā)現(xiàn),治療組患者治療后SAS評分與觀察組比較差異具有統(tǒng)計學(xué)意義(P0.05),與對照組患者評分比較,差異具有統(tǒng)計學(xué)意義(P0.05),而觀察組患者治療后SAS評分與對照組比較,差異無統(tǒng)計學(xué)意義(P0.05),兩組患者SAS量表評分改善相當;2.三組患者治療前PSQI量表評分比較,均符合正態(tài)性分布和方差齊性,行單因素方差分析結(jié)果顯示,三組患者治療前PSQI量表評分比較無差異(P0.05),具有可比性。經(jīng)4周治療后,三組患者PSQI量表評分同樣符合方差齊性和正態(tài)性分布,三組患者PSQI各項評分及總分均較治療前有明顯改善(P0.05);使用單因素方差分析結(jié)果顯示三組患者PSQI評分不全相同,采用SNK法對三組患者兩兩比較分析發(fā)現(xiàn),治療組患者在睡眠質(zhì)量、入睡時間、睡眠效率、睡眠障礙、日間功能及PSQI總分比較改善方面均分別優(yōu)于觀察組和對照組,差異具有統(tǒng)計學(xué)意義(P0.05);但三組之間催眠藥物評分比較,差異無統(tǒng)計學(xué)意義(P0.05)。觀察組患者在睡眠時間改善方面由于對照組,差異具有統(tǒng)計學(xué)意義(P0.05);但兩組患者睡眠質(zhì)量、入睡時間、睡眠效率、睡眠障礙、催眠藥物、日間功能及PSQI評分比較方面,差異無統(tǒng)計意義(P0.05);3.三組患者治療前SF-36量表評分比較,均符合正態(tài)性分布和方差齊性,行單因素方差分析結(jié)果顯示,三組患者治療前SF-36量表評分比較無差異(P0.05),具有可比性。經(jīng)4周治療后,三組患者SF-36量表評分同樣符合方差齊性和正態(tài)性分布,三組患者SF-36量表各項評分及總分均較治療前有明顯改善(P0.05);使用單因素方差分析結(jié)果顯示三組患者SF-36量表評分不全相同,采用SNK法對三組患者兩兩比較分析發(fā)現(xiàn),治療組患者在生理職能、軀體疼痛、活力、總體健康、情感職能、情感健康及SF-36總分比較改善方面均分別優(yōu)于觀察組和對照組,差異具有統(tǒng)計學(xué)意義(P0.05);但三組之間生理功能和生活功能評分比較,差異無統(tǒng)計學(xué)意義(P0.05)。觀察組患者在精神健康改善方面由于對照組,差異具有統(tǒng)計學(xué)意義(P0.05);但兩組患者生理職能、社會功能、生理職能、軀體疼痛、活力、總體健康、情感職能及SF-36評分比較方面臨床改善相當,差異無統(tǒng)計意義(P0.05);4.治療結(jié)束時,治療組患者治愈4例、顯效13例、有效9例、無效4例,臨床總有效率86.6%,觀察組中治愈2例、顯效7例、有效13例、無效8例,臨床總有效率73.3%,對照組中治愈1例、顯效8例、有效12例、無效9例,臨床總有效率70%,三組患者臨床總有效率比較具有統(tǒng)計學(xué)差異(P0.05),其中治療組患者臨床總有效率優(yōu)于觀察組和對照組,而觀察組與對照組患者臨床療效相當;5.SAS評分與PSQI評分均符合正態(tài)性分布,采用Person積差相關(guān)分析,發(fā)現(xiàn)SAS評分與PSQI評分呈正相關(guān)(Person相關(guān)系數(shù)0.78,P=0.01),說明SAS評分越高,患者睡眠障礙越嚴重。結(jié)論:1.睡眠障礙與焦慮癥成正相關(guān)性,睡眠障礙越嚴重的患者臨床焦慮評分越高;2.針刺"四關(guān)穴"能夠明顯改善患者臨床焦慮癥狀評分、PSQI評分及提高焦慮癥患者生活質(zhì)量。
[Abstract]:Objective: to fully analyze the current research progress at home and abroad, and find that the occurrence and recurrence of the clinical symptoms and symptoms of anxiety patients may be caused by the loss of liver, the appearance of Zang Fu, Qi and blood, yin and Yang disorder, and the sleep disorder is also the cause of the occurrence and recurrence of the disease. Treatment of acute severe heat syndrome, pain and eclampsia by four points in the treatment of chronic mental disease, further explore the clinical efficacy of acupuncture treatment of anxiety, and the correlation between sleep disorders and anxiety, as a reference for clinical treatment of anxiety disorders. Research methods: SAS9.3 statistical software, the use of program parameters according to 1:1:1 In proportion, 90 random numbers were randomly produced. According to the patient's order, the patients were randomly divided into the treatment group, the observation group and the control group, 30 cases in each group. The patients in the treatment group were treated with acupuncture "four Guan" points combined with conventional acupoints, and the patients in the observation group were treated with conventional acupuncture combined with Anshen Ding Zhi pill, and the control group took a separate routine. The 3 groups of patients were treated with acupuncture for 4 weeks. After the treatment, the self-Rating Anxiety Scales SAS score, Pittsburgh sleep quality index (PSQI), the quality of life assessment scale SF-36 and the clinical efficacy were observed. The results of the study were in 1. three groups of patients before the treatment of SAS scale, all in line with normal distribution and prescription. The results of single factor variance analysis showed that there was no difference between the three groups of patients before treatment and there was no difference (P0.05). After 4 weeks of treatment, the SAS scale score of the three groups was also consistent with the homogeneity of variance and normal distribution. The single factor variance analysis showed that the SAS score was not the same in the three groups, and the SNK method was used. Three groups of patients 22 comparative analysis found that the treatment group after the treatment of SAS score compared with the observation group had a statistically significant difference (P0.05), and compared with the control group, the difference was statistically significant (P0.05), and the observation group after the treatment of SAS score compared with the control group, the difference was not statistically significant (P0.05), the two group of SAS scale The score improvement was equal. 2. three groups of patients were compared with normal distribution and Fang Chaqi sex before treatment, and the results of single factor variance analysis showed that there was no difference (P0.05) between the three groups of patients before treatment (P0.05). After 4 weeks of treatment, the score of the PSQI scale in the three groups was also consistent with the homogeneity of variance and normality. Distribution, the scores and total scores of PSQI in the three groups were significantly improved (P0.05). The results of single factor variance analysis showed that the PSQI score of the three groups was not the same. The SNK method was used to compare the three groups of patients with sleep quality, sleep time, sleep efficiency, sleep disorder, daytime function and PSQI. The total score was better than the observation group and the control group, the difference was statistically significant (P0.05), but the difference between the three groups was not statistically significant (P0.05). The difference of the sleep time in the observation group was statistically significant (P0.05) in the improvement of sleep time, but the quality of sleep in the two groups, and the sleep time. The difference of sleep efficiency, sleep disorder, hypnotic drug, day function and PSQI score was not statistically significant (P0.05). 3. the three groups were compared with normal distribution and homogeneity of variance before treatment, and the results of single factor variance analysis showed that there was no difference between the three groups before the treatment of the SF-36 scale (P0.05). After 4 weeks of treatment, the SF-36 scale score in the three groups was also consistent with the homogeneity of variance and normal distribution. The scores and total scores of the SF-36 scales in the three groups were significantly improved (P0.05). The results of the single factor variance analysis showed that the SF-36 scale score of the three groups was not the same, and the SNK method was used in the three group of patients 22. The comparative analysis found that the patients in the treatment group were superior to the observation group and the control group in the physiological function, body pain, vitality, overall health, emotional function, emotional health and SF-36 total score, and the difference was statistically significant (P0.05), but there was no statistical difference between the three groups (P0.05). The difference in the mental health improvement of the patients in the observation group was statistically significant (P0.05), but the two groups of patients' physiological functions, social functions, physiological functions, somatic pain, vitality, overall health, emotional function and SF-36 score compared with the clinical improvement, the difference was not statistically significant (P0.05); at the end of 4. treatment, the treatment group patients 4 cases were cured, 13 cases were effective, 9 cases were effective, 4 cases were invalid, the total effective rate was 86.6%, 2 cases were cured in the observation group, 7 cases were cured, 13 cases were effective, 8 cases were invalid, the total clinical effective rate was 73.3%, 1 cases were cured in the control group, significant effective 8 cases, effective 12 cases, invalid 9 cases, clinical total effective efficiency compared with statistical difference (P0.05) The clinical efficacy of the patients in the treatment group was better than that of the observation group and the control group, while the clinical efficacy of the observation group was similar to the control group. Both the 5.SAS score and the PSQI score were in accordance with the normal distribution. The SAS score was positively correlated with the PSQI score (0.78, P=0.01), indicating that the higher the SAS score, the higher the SAS score, the sleep of the patients. The more serious the obstacles were. Conclusion: 1. the sleep disorder is positively correlated with anxiety, the higher the clinical anxiety score of the patients with the more severe sleep disorders, the 2. acupuncture "four points" can obviously improve the patient's clinical anxiety symptom score, PSQI score and improve the quality of life of the patients with anxiety.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R246.6

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