【摘要】：目的觀察生物反饋療法對(duì)老年原發(fā)性高血壓和老年Ⅱ型糖尿病患者的心理生理反應(yīng)的調(diào)節(jié)效果,并探討生物反饋療法對(duì)老年原發(fā)性高血壓和老年Ⅱ型糖尿病的治療效果,從而為治療老年高血壓和老年糖尿病提供一定的實(shí)踐和理論依據(jù)。方法2016年5月-6月于四川省宜賓市某鄉(xiāng)鎮(zhèn)選取符合世界衛(wèi)生組織建議的高血壓診斷標(biāo)準(zhǔn)的原發(fā)性高血壓患者以及符合糖尿病診斷標(biāo)準(zhǔn)的Ⅱ型糖尿病患者。根據(jù)入組標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),選取40名老年高血壓患者按照隨機(jī)數(shù)字表法分為高血壓治療組和高血壓對(duì)照組,同時(shí)選取40名老年糖尿病Ⅱ型糖尿病患者按照隨機(jī)數(shù)字表法分為糖尿病治療組和糖尿病對(duì)照組,每組各20例。實(shí)驗(yàn)方法與步驟:(1)采用自制一般信息調(diào)查表收集研究對(duì)象的基本情況(包括年齡、性別、受教育程度等)。(2)分別測量高血壓治療組與對(duì)照組血壓值以及糖尿病治療組與對(duì)照組血糖值并作為初始值記錄。(3)選用生物反饋儀(spirit-8)壓力訓(xùn)練中指導(dǎo)語放松訓(xùn)練模塊對(duì)高血壓治療組和糖尿病治療組患者進(jìn)行治療,患者在指導(dǎo)語的引導(dǎo)下漸進(jìn)性地進(jìn)行放松,每次25分鐘,每周2次,一共實(shí)施8次。治療結(jié)束后高血壓治療組測量右臂血壓作為結(jié)束值并記錄,糖尿病治療組測取指尖血測試血糖值并記錄。(4)治療組所有成員完成生物反饋治療后,分別采集治療組和對(duì)照組的血壓以及血糖值。結(jié)果1、高血壓治療組在接受治療后血壓呈下降趨勢,八次治療后收縮壓(t=5.65,p=0.00)、舒張壓(t=3.18,p=0.00)以及脈壓差(t=4.87,p=0.00)與第一次治療前相比有明顯的降低,差異有統(tǒng)計(jì)學(xué)意義。2、糖尿病治療組在接受治療后血糖呈下降趨勢,八次治療后血糖與第一次治療前相比有明顯的降低,差異有統(tǒng)計(jì)學(xué)意義(t=2.02,p=0.04)。3、高血壓治療組經(jīng)過八次生物反饋治療后,左腦θ波(t=2.29,p=0.03)在第八次治療后明顯低于治療前的基線水平,治療后的rmssd值(t=-3.12,p=0.00)和sdnn值(t=-2.6,p=0.02)均明顯高于治療前的基線水平,差異有統(tǒng)計(jì)學(xué)意義。4、糖尿病治療組經(jīng)過八次生物反饋治療后,右腦θ波(t=-2.12,p=0.00)、左腦θ波(t=-2.20,p=0.04)和心率(t=-2.71,p=0.01)在第八次治療后明顯低于治療前的基線水平,治療后的皮溫(t=5.94,p=0.00)、rmssd值(t=2.44,p=0.03)和sdnn值(t=2.25,p=0.04)均明顯高于治療前的基線水平,差異有統(tǒng)計(jì)學(xué)意義。5、治療組血壓血糖的改善情況與性別、年齡、婚姻狀況、文化程度、家庭住址、居住情況、與配偶關(guān)系、有幾個(gè)孩子以及與子女關(guān)系均不具有相關(guān)性(p均0.05)。6、對(duì)高血壓治療組治療前后和隨訪3個(gè)月與6個(gè)月收縮壓(f=6.69,p=0.00)、舒張壓(f=4.91,p=0.00)和脈壓差(f=4.19,p=0.00)進(jìn)行單因素方差分析,分析結(jié)果表明有明顯組間效應(yīng),采用事后檢驗(yàn)的lsd方法可知,高血壓治療組收縮壓治療后與治療前相比明顯降低(p=0.001),與治療后相比明顯降低(p=0.010),隨訪6個(gè)月與治療前相比收縮壓明顯降低(p=0.031),與治療后相比收縮壓明顯降低(p=0.027);舒張壓治療后與治療前相比明顯降低(p=0.002),隨訪3個(gè)月與治療前相比明顯降低(p=0.007),隨訪6個(gè)月與治療前相比明顯降低(p=0.002),組脈壓差治療后與治療前相比明顯降低(p=0.003),差異均具有統(tǒng)計(jì)學(xué)意義。對(duì)糖尿病治療組治療前后和隨訪3個(gè)月與6個(gè)月隨機(jī)血糖值進(jìn)行單因素方差分析,分析結(jié)果表明有明顯組間效應(yīng)(f=7.44,p=0.00),采用事后檢驗(yàn)的lsd方法可知,隨訪3個(gè)月與治療前相比明顯降低(p=0.001),隨訪6個(gè)月與治療前相比明顯降低(p=0.001),差異均具有統(tǒng)計(jì)學(xué)意義。結(jié)論1、本研究表明生物反饋治療對(duì)老年原發(fā)性高血壓和老年Ⅱ型糖尿病的輔助治療有一定效果。2、采用輔助的生物反饋的治療方法,老年高血壓患者左腦θ波波幅明顯下降,sdnn、rmssd值顯著提高,老年Ⅱ型糖尿病患者左右腦θ波波幅與心率明顯下降,SDNN、RMSSD值顯著提高,由此可以推測,生物反饋治療有利于抑制老年高血壓與老年糖尿病患者的交感神經(jīng)興奮性,起到降低血壓血糖的作用。3、患者血壓血糖的改善情況不受性別、年齡、婚姻狀況、文化程度等人口因素的影響,如能按照治療要求掌握正確的方法并堅(jiān)持放松訓(xùn)練,均可以得到比較好的治療效果。4、生物反饋治療對(duì)老年原發(fā)性高血壓患者的血壓和老年Ⅱ型糖尿病患者的隨機(jī)血糖都具有較為長期的調(diào)控作用。
[Abstract]:Objective To observe the effect of biofeedback therapy on the psychological and physiological responses of elderly patients with primary hypertension and elderly type 2 diabetes, and to explore the therapeutic effect of biofeedback therapy on elderly primary hypertension and elderly type 2 diabetes, so as to provide some practical and theoretical basis for the treatment of elderly hypertension and senile diabetes. Methods in May 2016 -6 months in a township in Yibin, Sichuan Province, a primary hypertension patient and a diabetic patient who met the diagnostic criteria of the WHO recommended by the WHO were selected as the criteria for diabetes. According to the criteria for the entry and the exclusion criteria, 40 elderly hypertensive patients were selected according to the random number table method. At the same time, 40 patients with diabetes type II diabetes were divided into diabetes treatment group and diabetes control group, with 20 cases in each group. The experimental methods and steps: (1) a self-made general information questionnaire was used to collect the basic information of the research subjects (including age, sex, education. (2) the blood pressure of the hypertension treatment group and the control group, the blood glucose value of the diabetes treatment group and the control group were recorded and the initial value was recorded. (3) the guidance language relaxation training module of the biofeedback (spirit-8) training was used to treat patients with hypertension treatment group and diabetes treatment group, and the patients were guided in the guidance language. Take a gradual relaxation, 25 minutes each time, 2 times a week and 8 times. After the treatment, the hypertension treatment group measured the right arm blood pressure as the end value and recorded the blood glucose in the fingertip blood test. (4) all the members of the treatment group completed the biofeedback treatment and collected the blood pressure of the treatment group and the control group respectively. Results 1, 1, the blood pressure of the hypertension treatment group decreased after the treatment, the eight times after treatment, the systolic pressure (t=5.65, p=0.00), the diastolic pressure (t=3.18, p=0.00) and the pulse pressure (t=4.87, p=0.00) had a significant decrease compared with the first treatment, the difference was statistically significant.2, the diabetes treatment group had a lower blood sugar after receiving treatment. After eight times of treatment, the blood sugar was significantly lower than that before the first treatment. The difference was statistically significant (t=2.02, p=0.04).3. After eight times of biofeedback treatment, the left brain theta wave (t=2.29, p=0.03) was significantly lower than the baseline level before treatment, and the RMSSD value (t=-3.12, p=0.00) and SDNN after treatment. The values (t=-2.6, p=0.02) were significantly higher than the baseline levels before treatment, and the difference was statistically significant.4. After eight times of biofeedback therapy, the right brain (t=-2.12, p=0.00), left brain Bo (t=-2.20, p=0.04) and heart rate (t=-2.71, p=0.01) were significantly lower than the baseline levels of the treatment group after eight times of biofeedback treatment, and the skin temperature after treatment (t=5.9). 4, p=0.00), the value of RMSSD (t=2.44, p=0.03) and SDNN (t=2.25, p=0.04) were significantly higher than the baseline levels before treatment. The difference was statistically significant.5. The improvement of blood pressure in the treatment group was related to sex, age, marital status, educational level, family address, residence, relationship with spouses, several children and their relationship with their children. (P 0.05).6, the single factor analysis of variance was carried out between before and after treatment and 3 months and 6 months of systolic blood pressure (f=6.69, p=0.00), diastolic pressure (f=4.91, p=0.00) and pulse pressure difference (f=4.19, p=0.00) before and after treatment in the treatment group of hypertension. The results showed that there were obvious inter group effects. Compared with the treatment significantly decreased (p=0.001) before treatment (p=0.010), the systolic pressure decreased significantly (p=0.031) compared with that before treatment (p=0.031), and the systolic pressure was significantly lower than that of the treatment (p=0.027); diastolic pressure was significantly lower than before treatment (p=0.002), and the follow-up was significantly lower than that before treatment (p=0.007). The follow-up period of 6 months was significantly lower than that before treatment (p=0.002). The difference was significantly lower than before treatment (p=0.003), and the difference was statistically significant. The results showed that there were significant inter group effects (f=7.44, p=0.0). 0), the LSD method of post examination showed that the follow-up 3 months was significantly lower than that before treatment (p=0.001), and the follow-up 6 months was significantly lower than before treatment (p=0.001), and the difference was statistically significant. Conclusion 1. This study showed that biofeedback therapy has some effect on the adjuvant treatment of elderly primary hypertension and type 2 diabetes. .2, with the aid of biofeedback therapy, the amplitude of theta wave in the left brain of the elderly patients with hypertension was significantly decreased, and the value of SDNN and RMSSD increased significantly. The amplitude and heart rate of the left and right brain theta wave and heart rate of the elderly patients with type II diabetes were significantly decreased, and the values of SDNN and RMSSD were significantly improved. Therefore, it is possible to speculate that biofeedback therapy is beneficial to the inhibition of elderly hypertension and old sugar. The sympathetic excitability of the patients with urinary disease plays a role in reducing blood pressure and blood sugar.3. The improvement of blood pressure in patients is not affected by the influence of sex, age, marital status, and educational level, such as the ability to master the correct methods and adhere to the relaxation training according to the requirements of treatment, and get better therapeutic effect,.4, biofeedback. Treatment has a long-term regulatory effect on blood pressure in elderly patients with essential hypertension and random glucose in elderly patients with type 2 diabetes.
【學(xué)位授予單位】：成都醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R544.1;R587.1

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