【摘要】：目的： 本課題采用臨床科研方法學,進行隨機對照研究,以針藥結(jié)合耳穴貼壓和中西藥結(jié)合治療為對照,觀察針藥結(jié)合耳穴貼壓治療肝腎陰虛型多動癥患兒的臨床療效,旨在探討針藥結(jié)合耳穴貼壓、中西藥結(jié)合兩種療法治療肝腎陰虛型多動癥患兒的臨床療效的差異及其作用機理,為臨床治療小兒多動癥提供依據(jù)。 方法： 2011年11月至2013年1月期間臺灣明師中醫(yī)診所(經(jīng)臨床診斷為兒童多動癥且符合納入病例標準)的患兒63例,男性35例,女性28例。按1：1的比例隨機分配至針藥結(jié)合耳穴貼壓組和中西藥,其其中32例作為治療組(針灸中藥結(jié)合耳穴貼壓治療),31例作為對照組(中西藥治療)。西醫(yī)診斷標準參照美國精神病學會制定的《精神障礙診斷和統(tǒng)計手冊,DSM—IV》第四版,具體診斷標準所制定的有關兒童注意缺陷多動障礙的診斷標準,中醫(yī)診斷標準采用參照《全國中醫(yī)學會ADD研究協(xié)作組評分量表》制訂的“中醫(yī)虛證辨證參考標準”等有關小兒多動癥內(nèi)容制定肝腎陰虛辨證標準進行診斷。所有符合納入標準病例按設計要求觀察、治療。療程兩個月。針刺：每周針刺3次,共治療兩個月；耳穴貼壓：一周貼壓三次,共治療兩個月；中藥治療：周5次,周末停服,共治療兩個月；西藥(哌醋甲酯緩釋片)：開始每次口服5mg,1日2次,共治療兩個月。療效觀察具體項目包括：全國中醫(yī)學會ADD研究協(xié)作組評分量表》中肝腎陰虛證中醫(yī)證候評分標準、Achenbach兒童行為量表Conners兒童行為量表、文測驗聯(lián)合型(Combined Raven's Test, CRT)。療效評定標準主要照《全國中醫(yī)學會ADD研究協(xié)作組評分量表》中中醫(yī)證候療效判定標準及《最新國內(nèi)外疾病診療標準》中制定的注意缺陷與多動障礙癥狀的臨床療效標準及Conners量表的減分率。 數(shù)據(jù)分析采用統(tǒng)計軟件SPSS17.0。計量資料用均數(shù)±標準差((?)±S)表示,計數(shù)資料用構(gòu)成比(%)表示；計量資料組間比較采用t檢驗,自身前后比較用配對t檢驗或Wilcoxon配對秩和檢驗。分類資料組間比較采用X2檢驗,等級資料組間比較采用Ridit分析。假設檢驗統(tǒng)一使用雙側(cè)檢驗,給出檢驗統(tǒng)計量及其對應的P值,以P≤0.05有統(tǒng)計學意義,P≤0.01有顯著性統(tǒng)計學意義。 結(jié)果： 治療前針藥結(jié)合耳穴貼壓組、中西藥組的性別、年齡、年齡構(gòu)成、病程、中醫(yī)癥狀積分、CBCL兒童行為量表總評分、多動指數(shù)評分、智力測定(瑞文測驗聯(lián)合型)評分得分經(jīng)分析均無統(tǒng)計學意義,說明兩組之間的臨床基線資料具有可比性。療效觀察指標及療效評定結(jié)果總結(jié)如下： ①中醫(yī)癥狀各項評分 針藥結(jié)合耳穴貼壓組治療前后各中醫(yī)癥狀積分除面色、自汗外,其余各項得分相比較差異有統(tǒng)計學意義(P0.05),其中在改善肝腎陰虛型多動癥患兒多動不寧、學習效率低、少睡多夢及夜驚、手足心熱、盜汗方面療效顯著(P0.01)；中西藥組療前后各中醫(yī)癥狀積分相比較,多動不寧、注意力不集中、學習效率低、心悸頭暈、口干差異有統(tǒng)計學意義(P0.05)。 ②中醫(yī)癥狀總積分 治療一個療程后,針藥結(jié)合耳穴貼壓組的中醫(yī)癥狀總積分比中西藥組得分減少,差異有統(tǒng)計學意義(P0.05)；兩個療程后,兩組之間的肝腎陰虛型中醫(yī)癥狀總積分比較仍有統(tǒng)計學意義(P0.01)。無論在短期療效還是長期療效方面,針藥結(jié)合耳穴貼壓對于改善肝腎陰虛型多動癥患兒的中醫(yī)癥狀的臨床效果比中西藥治療更為顯著。 ③CBCL兒童行為量表評分 治療一個療程后,針藥結(jié)合耳穴貼壓組CBCL兒童行為量表評分值比治療前提高(P0.05),治療兩個療程后患兒的行為情況得到明顯改善(P0.01)中西藥組方面,治療一療程后行為量表評分數(shù)值雖有提升,但無統(tǒng)計學差異,治療兩個療程后患兒的行為情況可得到一定程度的好轉(zhuǎn)(P0.05)。經(jīng)兩個療程的治療后,兩組對于改善肝腎陰虛型多動癥患兒的CBCL兒童行為量表評分均有一定療效,但以針藥結(jié)合耳穴貼壓治療的效果最為顯著。 兩個療程治療后,兩組病例在CBCL兒童行為量表的各項社會能力部分比較方面,對于改善肝腎陰虛型多動癥患兒的活動情況,針藥結(jié)合耳穴貼壓組比中西藥組的得分明顯提高,兩組差異有顯著統(tǒng)計學意義(P0.01)；社交情況、學校情況方面,兩組得分相比較,差異不明顯。 ④多動指數(shù)評分 治療一療程后,在改善肝腎陰虛型多動癥患兒的多動指數(shù)方面,中西藥組的多動指數(shù)評分雖比針藥結(jié)合耳穴貼壓組有所減少,但差異無統(tǒng)計學意義(P0.05)。治療兩療程后,針藥結(jié)合耳穴貼壓組的多動指數(shù)明顯比中西藥組減少,差異具有統(tǒng)計學意義。從遠期療效來看,在改善肝腎陰虛型多動癥患兒的多動指數(shù)方面,針藥結(jié)合耳穴貼壓治療比中西藥結(jié)合治療效果較佳。 ⑤智力測定(瑞文測驗聯(lián)合型)評分 一個療程的治療后,針藥結(jié)合耳穴貼壓組、中西藥組智力測定(瑞文測驗聯(lián)合型)評分無明顯差異(P0.05)；兩個療程的治療后,針藥結(jié)合耳穴貼壓組與中西藥結(jié)合組比較智力情況評分改善幅度較大(P0.01)。對于改善肝腎陰虛型注意缺陷多動障礙患兒的智力情況方面,短期治療兩種療法差異不明顯,治療兩個療程后,針藥結(jié)合耳穴貼壓治療對于改善注意缺陷多動障礙患兒的智力效果比中西藥結(jié)合治療效果較佳。 ⑥中醫(yī)證候療效 針藥結(jié)合耳穴貼壓組臨床控制人數(shù)4人、占12.50%,顯效人數(shù)17人、占53.13%,有效人數(shù)9人、占28.12%,無效人數(shù)2人,占6.25%,總有效人數(shù)30人,總效率為93.75%；中西藥組臨床控制人數(shù)1人、占3.23%,顯效人數(shù)10人、占32.26%,有效人數(shù)24人、占45.16%,無效人數(shù)6人,占19.35%,總有效人數(shù)25人,總效率為80.64%。提示：在改善缺肝腎陰虛型注意缺陷多動障礙患兒的中醫(yī)證候療效方面,針藥結(jié)合耳穴貼壓治療與中西藥治療相比較,臨床療效較佳,能夠較好改善注意缺陷多動障礙患兒多動不寧、注意力不集中、少睡多夢、夜驚、心悸頭暈、手足心熱、口干等中醫(yī)癥候。 ⑦注意缺陷與多動障礙癥狀療效 針藥結(jié)合耳穴貼壓組痊愈人數(shù)3人、占9.375%,顯效人數(shù)18人、占56.25%,有效人數(shù)8人、占25.00%,無效人數(shù)3人,占9.375%,總有效人數(shù)29人,總效率為90.63%；中西藥組痊愈人數(shù)2人、占6.45%,顯效人數(shù)9人、占29.03%,有效人數(shù)13人、占41.94%,無效人數(shù)7人,占22.58%,總有效人數(shù)24人,總效率為77.42%。提示：在改善缺肝腎陰虛型多動癥患兒注意缺陷與多動障礙癥狀療效方面,針藥結(jié)合耳穴貼壓治療與中西藥治療相比較,臨床療效較佳。 結(jié)論： 本研究旨在探討針藥結(jié)合耳穴貼壓、中西藥結(jié)合兩種療法治療肝腎陰虛型多動癥患兒的臨床療效的差異及其作用機理,為臨床治療小兒多動癥提供依據(jù)。研究結(jié)果針藥結(jié)合耳穴貼壓組和中西藥組對肝腎陰虛型多動癥患兒都有比較顯著的療效,能明顯改善患者的臨床癥狀方面,包括肝腎陰虛癥狀(少睡多夢及夜驚、手足心熱、盜汗、口感)、社會活動能力、多動指數(shù)、智力等；中西藥治療雖然對于改善患兒的多動指數(shù)、社會活動能力、自控力、學習理解能力等方面有一定療效,但短期治療效果效果不盡如人意。相比之下,針藥結(jié)合耳穴貼壓療法在肝腎陰虛型多動癥患兒的JCBCL兒童行為量表評分、多動指數(shù)評分及中醫(yī)癥候各項癥狀的等方面較中西藥治療、具有更大的優(yōu)勢。針藥結(jié)合耳穴貼壓治療小兒多動癥,臨床療效顯著,遠期療效明顯,患者容易接受,是一種有效、便捷、經(jīng)濟、療效持久、無毒副作用的治療方法。
[Abstract]:Objective:
This subject adopts clinical scientific research methodology, carries on the randomized controlled study, takes the acupuncture and medicine union auricular point sticking pressure and the Chinese and Western medicine union treatment as the contrast, observes the acupuncture and medicine union auricular point sticking pressure treatment liver kidney yin deficiency type hyperactivity sickness child's clinical curative effect, aims at discussing the acupuncture and medicine union auricular point sticking pressure, the Chinese and Western medicine union two kinds of treatment liver kidney yin deficiency type hyperactivity sickness sickness sickne The difference of clinical curative effect and the mechanism of action are the basis for clinical treatment of ADHD in children.
Method:
From November 2011 to January 2013, 63 children, 35 males and 28 females, were randomly assigned to the acupuncture-drug combination auricular point pressing group and the traditional Chinese and Western medicines group in a ratio of 1:1. Western diagnostic criteria refer to the American Psychiatric Society's Diagnostic and Statistical Manual for Mental Disorders, DSM-IV, Fourth Edition. Specific diagnostic criteria refer to the diagnostic criteria for attention deficit hyperactivity disorder in children. The Chinese diagnostic criteria refer to the National Association of Chinese Medicine's ADD Research Collaborative Group Score. Scale > the formulation of the "TCM deficiency syndrome differentiation reference standard" and other related content of children with ADHD liver and kidney yin deficiency syndrome differentiation standard for diagnosis. Chinese medicine treatment: 5 times a week, weekend discontinuation, a total of two months; Western medicine (methylphenidate sustained-release tablets): each oral 5 mg, 2 times a day, a total of two months of treatment. The criteria for evaluating the efficacy of TCM syndromes and the criteria for evaluating the clinical efficacy of attention deficit and hyperactivity disorder symptoms and the Conners Scale were as follows: the criteria for evaluating the efficacy of TCM syndromes in the ADD Research Cooperative Group Scale of the National Society of Traditional Chinese Medicine; and the criteria for evaluating the clinical efficacy of attention deficit and hyperactivity disorder symptoms in the latest criteria for diagnosis and treatment of diseases at home and abroad. The reduction rate.
Statistical software SPSS17.0 was used to analyze the data. The mean (?) + standard deviation (?) + S was used to represent the measurement data, and the constituent ratio (%) was used to represent the counting data. Analysis. Assuming that the unifying use of bilateral test, test statistics and their corresponding P values were given, P < 0.05 was statistically significant, P < 0.01 was statistically significant.
Result:
Before treatment, there was no significant difference in gender, age, age composition, course of disease, score of TCM symptoms, total score of CBCL Child Behavior Scale, hyperactivity index score, intelligence test (Raven test combined type) score between the two groups. The indicators and curative effect evaluation results are summarized as follows:
Symptom scores of TCM
Acupuncture combined with auricular point pressing group before and after treatment, except complexion, sweat, the other scores were statistically significant (P 0.05), which in the improvement of liver and kidney Yin Deficiency Hyperactivity in children with restlessness, learning efficiency is low, less sleep and night terror, hand, foot, heart fever, night sweat significant effect (P 0.01); The scores of symptoms of TCM before and after treatment were significantly higher than those before treatment (P 0.05).
The total score of TCM symptoms
After one course of treatment, the total score of TCM symptoms of acupuncture combined with auricular point pressing group was significantly lower than that of traditional Chinese medicine group (P 0.05); after two courses of treatment, the total score of TCM symptoms of liver-kidney Yin deficiency type between the two groups was still statistically significant (P 0.01). Whether in the short-term or long-term efficacy, acupuncture combined with auricular acupuncture combined with Chinese medicine was still statistically significant. The clinical effect of acupoint sticking and pressing on improving the symptoms of children with hyperactivity of liver and kidney yin deficiency is more significant than that of traditional Chinese and Western medicine.
CBCL Child Behavior Scale score
After one course of treatment, the score of CBCL children's behavior scale in the Acupuncture-medicine combined with auricular point pressing group was higher than that before treatment (P 0.05). After two courses of treatment, the behavior of the children was significantly improved (P 0.01). Behavior can be improved to a certain extent (P 0.05). After two courses of treatment, two groups of children with hyperactivity of liver and kidney yin deficiency type CBCL behavior scale scores have a certain effect, but acupuncture combined with auricular plaster therapy is the most significant effect.
After two courses of treatment, the two groups of patients in CBCL children's behavior scale of various social ability comparison, for improving the activity of children with liver and kidney yin deficiency ADHD, acupuncture and medicine combined with auricular point pressing group than the Chinese and Western medicine group, the score was significantly higher, the two groups had significant statistical significance (P 0.01); social situation, school situation, school situation, and so on. The difference between the two groups was not obvious.
Hyperactivity index score
After one course of treatment, the scores of hyperactivity index in the Chinese and Western medicine group were lower than those in the acupuncture combined with auricular point pressing group, but there was no significant difference (P 0.05). After two courses of treatment, the hyperactivity index in the acupuncture combined with auricular point pressing group was significantly lower than that in the Chinese and Western medicine group. From the long-term effect point of view, in improving the hyperactivity index of children with liver-kidney Yin Deficiency Hyperactivity syndrome, acupuncture combined with auricular plaster therapy is better than traditional Chinese and Western medicine.
IQ (Raven test combined) score
After one course of treatment, there was no significant difference in intelligence score between the two groups (P 0.05); after two courses of treatment, the intelligence score of acupuncture combined with Auricular Acupoint Plaster group was improved more than that of the combination group (P 0.01). In terms of intelligence, there was no significant difference between the two short-term treatments. After two courses of treatment, the effect of acupuncture combined with Auricular Point Plaster Therapy on improving intelligence of children with attention deficit hyperactivity disorder was better than that of integrated Chinese and Western medicine.
Curative effect of TCM Syndrome
There were 4 clinical controllers (12.50%), 17 markedly effective (53.13%), 9 effective (28.12%), 2 ineffective (6.25%), 30 effective (93.75%) and 10 effective (32.26%), 24 effective (45.16%) and 6 ineffective (6.75%) in the acupuncture-drug-auricular plaster group, respectively. The total effective rate was 80.64%. It suggested that acupuncture combined with Auricular Acupoint Plaster Therapy had better clinical effect than traditional Chinese and Western medicine in improving the effect of TCM syndrome in children with ADHD of deficiency of liver and kidney yin. Less sleep, more dreams, night terrors, palpitations, dizziness, heat of hands and feet, dry mouth and other TCM symptoms.
Attention deficit hyperactivity disorder symptoms
The total effective rate was 90.63%. The total effective rate was 9.375%. The effective rate was 56.25%. The effective rate was 8%. The ineffective rate was 9.375%. The total effective rate was 90.63%. The total effective number was 24, the total effective rate was 77.42%.
Conclusion:
The purpose of this study is to explore the difference of clinical efficacy and mechanism of acupuncture combined with auricular point sticking therapy and combination of Chinese and Western medicine in treating children with hyperactivity disorder of liver and kidney yin deficiency, and to provide evidence for clinical treatment of children with hyperactivity disorder. The curative effect can obviously improve the clinical symptoms, including liver and kidney yin deficiency symptoms (less sleep and more sleep and night terror, hand and foot heat, night sweat, taste), social activity, hyperactivity index, intelligence, etc. Compared with traditional Chinese and Western medicine, acupuncture combined with auricular point sticking therapy has more advantages in JCBCL children's behavior scale score, hyperactivity index score and symptoms of TCM syndrome. It is an effective, convenient, economical, long-term, non-toxic and side-effect treatment method.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2013
【分類號】：R246.4

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