本文關(guān)鍵詞：期待效應(yīng)對針刺治療1級原發(fā)性高血壓療效影響的臨床研究　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：評價針刺治療1級原發(fā)性高血壓的臨床療效；探討心理期待效應(yīng)對針刺降壓效應(yīng)的影響。方法：1.針刺治療1級原發(fā)性高血壓的臨床療效評價本研究為前瞻性、多中心、大樣本、隨機、對照臨床試驗。以原發(fā)性高血壓(1級)為研究載體,采用RCT試驗設(shè)計方法,將符合納入標(biāo)準(zhǔn)的319例EH患者,通過中央隨機系統(tǒng)分為經(jīng)穴組、非經(jīng)非穴組、等待治療組。按照治療方案,經(jīng)穴組和非經(jīng)非穴組予以1周3次針刺干預(yù),30min/次,共6周18次；等待治療組不予以針刺干預(yù)。研究周期共13周,基線1周,治療期6周,入組第9周、12周進行兩次隨訪,共4次訪視。主要療效評價指標(biāo)：治療結(jié)束后24h平均收縮壓、舒張壓及其改善值。2.心理期待效應(yīng)對針刺降壓效應(yīng)的影響本部分研究沿用第一部分研究中經(jīng)穴組及非經(jīng)非穴組研究方案。在入組前對受試者進行針灸期待值評估,并予以賦值統(tǒng)計,根據(jù)得分將患者期待值進行高低分層。血壓數(shù)據(jù)僅采集入組0周、入組6周兩組24h平均收縮壓及其血壓改善值。通過相關(guān)性分析及回歸分析,探討針灸高低期待值對針刺后24h平均收縮壓變化的影響。結(jié)果：1.針刺治療原發(fā)性高血壓的臨床療效評價(1)24h收縮壓變化情況：入組6周后,經(jīng)穴組24hMSBP呈現(xiàn)下降趨勢,至第9周時降至最低、第12周時趨于平穩(wěn)。入組6周、9周、12周,三個時間節(jié)點,經(jīng)穴組24hMSBP變化情況與非經(jīng)非穴組、等待治療組比較,差異均有統(tǒng)計學(xué)意義(P0.05)；非經(jīng)非穴組與等待治療組比較,差異均無統(tǒng)計學(xué)差異(P0.05)。(2)24h收縮壓改善值：入組6周后,經(jīng)穴組24hMSBP改善值大于5mmHg,且持續(xù)至入組12周。經(jīng)穴組24hMSBP改善值在入組6周、入組9周、入組12周時,與非經(jīng)非穴組、等待治療組比較,差異均有統(tǒng)計學(xué)意義(P0.05)；非經(jīng)非穴組與等待治療組比較,差異均無統(tǒng)計學(xué)意義(P0.05)。(3)24h舒張壓變化情況：入組6周后,經(jīng)穴組24hMDBP呈現(xiàn)下降趨勢,至12周時,下降約3mmHg。入組6周、9周、12周,3組間24hMDBP變化比較,差異均無統(tǒng)計學(xué)意義(P0.05)。但在入組6周時,經(jīng)穴組24hMDBP變化情況與非經(jīng)非穴組比較,差異具有統(tǒng)計學(xué)意義(P0.05)。(4)24h舒張壓改善值：24hMDBP改善值在入組6周后、入組12周時,經(jīng)穴組與等待治療組比較,差異有有統(tǒng)計學(xué)意義(P0.05)。非經(jīng)非穴組24hMDBP改善值在3個時間節(jié)點,與經(jīng)穴組、等待治療組比較,差異均無統(tǒng)計學(xué)意義(P0.05)。2.心理期待效應(yīng)對針刺降壓效應(yīng)的影響(1)在經(jīng)穴組、非經(jīng)非穴組組內(nèi),期待值高低分成后,高低期待值對針刺后24hMSBP變化及改善值影響,差異均無統(tǒng)計學(xué)意義(P0.05)(2)通過logistic回歸分析,結(jié)果顯示,在經(jīng)穴組和非經(jīng)非穴組組內(nèi),低期待值對比高期待值治療后24hMSBP變化情況及其改善值,隨著血壓升高1mmHg,低期待值的效應(yīng)優(yōu)于高期待值,但差異均無統(tǒng)計學(xué)意義(P0.05)。(3)通過對6個條目與24h血壓變化情況做相關(guān)性檢驗,結(jié)果顯示,經(jīng)穴組、非經(jīng)非穴組中條目1、2、3、4、6分別與24hMSBP變化及其改善值的相關(guān)性,差異均無統(tǒng)計學(xué)意義(P0.05)；期待值條目7中高低期待值與24hMSBP變化情況的相關(guān)性,差異均無統(tǒng)計學(xué)意義(P0.05)。而在經(jīng)穴組內(nèi),條目7中高低期待與24hMSBP的影響,差異有統(tǒng)計學(xué)意義(P0.05)；非經(jīng)非穴組中,差異則無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：1.從針刺降壓療效上而言,經(jīng)穴組血壓改善值優(yōu)于非經(jīng)非穴組、等待治療組,說明針刺經(jīng)穴降壓療效明顯,且針刺經(jīng)穴降壓療效在短期內(nèi)有持續(xù)效應(yīng)；2.從期待值分層與針刺療效上看,在經(jīng)穴組和非經(jīng)非穴組組內(nèi),高低期待值分層并未對血壓變化情況及改善值產(chǎn)生影響；從相關(guān)性上看,期待值高低與針刺后血壓改善情況不存在相關(guān)性,即說明心理期待效應(yīng)并不參與針刺起效。
[Abstract]:Objective: To evaluate the therapeutic effect of acupuncture for treatment of grade 1 hypertension; to explore the effect of psychological expectation on the effect of acupuncture antihypertensive effect. Methods: This study is a prospective, multi center, large sample, randomized 1. clinical curative effect of acupuncture treatment on grade 1 hypertension, the Zhaolin primary bed test. Hypertension (grade 1) as the research carrier, using the RCT design method, will meet the inclusion criteria of 319 Cases of EH patients, the central randomization system is divided into acupoint group and non acupoint group, for treatment group. According to the treatment plan, acupoint group and non acupoint group to 1 weeks of the 3 acupuncture intervention 30min/ times, 18 times for a total of 6 weeks; treatment group were not treated with acupuncture intervention. The research lasted for 13 weeks, 1 weeks of baseline, treatment period of 6 weeks in group ninth weeks, 12 weeks for the two follow-up, a total of 4 visits. The primary outcome measures: 24h after treatment the average systolic pressure. Diastolic blood pressure and To improve the value of.2. psychological expectation effect on acupuncture effect of this part of the study in the first part of the study used acupoints group and non acupoint group in the research program. Before entering the group of subjects performed acupuncture expected value assessment, and to be assigned according to the statistics, the expected value for patients with score level stratification. Blood pressure data only collected into the group of 0 weeks, 6 weeks in group two 24h mean systolic blood pressure and improve blood pressure value. Through correlation analysis and regression analysis, to explore the level of acupuncture expectations average systolic blood pressure change on the influence of acupuncture on 24h. Results: the clinical efficacy evaluation of 1. acupuncture treatment of primary high blood pressure (systolic blood pressure 1 24h) change: the group after 6 weeks, 24hMSBP meridian group declined to ninth weeks when the minimum, Twelfth weeks tended to be steady. Into the group of 6 weeks, 9 weeks, 12 weeks, three time nodes, the change of 24hMSBP in acupoints group and non acupoint group, waiting for 娌葷枟緇勬瘮杈，

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