本文關鍵詞： 卒中后睡眠障礙 針刺療法 通督治郁針法 帕羅西汀　出處：《安徽中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的根據中醫(yī)針灸理論,采用通督治郁針法治療PSSD伴抑郁癥狀。通過觀察針刺療法對卒中后睡眠障礙伴抑郁患者的匹茲堡睡眠質量指數量表(Pittsburgh Sleep Quality Indexs,PSQI)和漢密爾頓抑郁指數量表(Hamilton Depression Rating Scale,HAMD)評分的影響,來初步推斷通督治郁針法治療PSSD伴抑郁患者的效果,為中醫(yī)針刺治療PSSD伴抑郁的有效性和安全性提供臨床科學依據。方法從臨床收集符合PSSD伴抑郁診斷標準的病例60例。所有收集來的病例均按入組先后的順序隨機分為2組,把60例患者按就診先后順序隨機編為1~60號,通過隨機數字表法按1:1比例分為治療組30例和對照組30例。治療組采用針刺療法,以“通督治郁針法”為主要穴位,辨證配以疏肝理氣或寧心安神穴位。取穴:主穴取太沖、百會、神庭、人中、內關、印堂、神門、合谷。對照組采用西藥艾司唑侖1mg睡前半小時服用+帕羅西汀20mg一日一次,清晨頓服,時間共為4周。分別在治療前及治療后第2周和第4周予以采取靜脈血檢查血電解質、血常規(guī)、肝腎功能和心電圖檢查,并在治療前后分別觀察PSQI和HAMD評分的變化,分別與治療前做比較以及做組間的比較。計數資料均選用(—X±S)來表示,運用t檢驗,計量資料則采取X2檢驗。觀察結果,如果P0.05則表示相應的治療后有顯著性差異,倘若P0.01提示和治療前比較有非常顯著性差異,假如P0.05可以認為不存在顯著性差異。在治療過程中,同時觀察、記錄、分析臨床不良事件的發(fā)生。于治療的過程中,均予以兩組患者基礎疾病的常規(guī)性治療。包括調控血壓、血糖等等。結果(1)在治療后的第2周,治療組和對照組的PSQI評分較治療前比較均有顯著性差異(P0.05),而兩組間的相比較也有顯著性差異(P0.05);治療后的第4周,兩組的PSQI評分和治療前比較均有非常顯著性差異(P0.01),并且組間相比較也有非常顯著的差異(P0.01)。(2)在治療后的第2周,兩組的HAMD評分和治療前相比較,無顯著性差異(P0.05)而兩組之間相比較,也沒有顯著的差異(P0.05);治療后的第4周,兩組的HAMD表評分結果同治療前的量表相比較存在顯著的差異(P0.05),而兩組間之內相比,也呈現顯著的差異(P0.05)。(3)在治療后的第2周和第4周,電解質、血常規(guī)、肝腎功能和心電圖檢查結果,分別與治療前相比較,兩者均無顯著性差異(P0.05)。(4)治療期間,在治療組出現的不良反應有3例,在對照組出現的不良反應有11例,有統(tǒng)計學差異(P0.05)。結論以“通督治郁針法”為主治療卒中后睡眠障礙,能夠明顯的改善卒中后睡眠障礙患者的失眠癥狀,療效優(yōu)于單純口服艾司唑。以“通督治郁針法”為主治療卒中后睡眠障礙伴抑郁,也能夠有效改善卒中后睡眠障礙患者的抑郁情況,為其治療卒中后睡眠障礙也能提供幫助。
[Abstract]:Objective according to the acupuncture and moxibustion theory of TCM. The Pittsburgh Sleep quality Index (Pittsburgh Sleep quality Index) scale for patients with post-stroke sleep disorder and depression was observed by using Tongdu treatment of depression acupuncture in treating PSSD patients with depressive symptoms. Pittsburgh Sleep Quality Indexs. PSQI and Hamilton Depression Rating scale (Hamd) score. To preliminarily infer the effect of Tongdu treatment of depression in patients with PSSD combined with depression. To provide clinical scientific basis for the efficacy and safety of acupuncture in the treatment of PSSD with depression. Methods 60 cases of PSSD with depression were collected from the clinic. All the collected cases were classified into the group. The sequence was randomly divided into two groups. 60 patients were randomly divided into treatment group (n = 30) and control group (n = 30) according to the proportion of 1: 1 by random digital table. The treatment group was treated with acupuncture. "Tongdu treatment of depression needling method" as the main acupoints, syndrome differentiation to soothe the liver or calm the heart Anshen acupoints. Acupoints: the main point to take Taishong, Baihui, Shenting, people, Neiguan, Yin Tang, Shenmen. The control group received paroxetine 20mg once in the morning on 1st. The blood electrolytes, blood routine, liver and kidney function and electrocardiogram were examined before treatment and 2 and 4 weeks after treatment. The changes of PSQI and HAMD scores were observed before and after treatment, and compared with those before treatment and between groups. The metrological data were taken X2 test. Observation results, if P0.05 means that the corresponding treatment has significant difference, if P0.01 hint and treatment before there is a very significant difference. If P0.05 can be considered there is no significant difference. In the treatment process, observe, record, analyze the occurrence of clinical adverse events. In the course of treatment. Both groups were given routine treatment for basic diseases, including regulating blood pressure, blood sugar and so on. Results 1) 2 weeks after treatment. The PSQI scores of the treatment group and the control group were significantly higher than those of the control group (P 0.05), and the difference between the two groups was also significant (P 0.05). At the 4th week after treatment, the PSQI scores of the two groups were significantly different from those before treatment (P 0.01). There was also a significant difference between the two groups (P 0.01). At the second week after treatment, the HAMD scores of the two groups were compared with those before treatment. There was no significant difference between the two groups (P0.05) and there was no significant difference between the two groups. At the 4th week after treatment, there was a significant difference between the two groups in HAMD scale scores compared with the pre-treatment scale (P0.05), and within the two groups, there was a significant difference between the two groups. There was also a significant difference (P 0.05). The results of electrolyte, blood routine, liver and kidney function and electrocardiogram were compared before and after treatment at the 2nd and 4th week after treatment. There was no significant difference between the two groups during the treatment period, there were 3 cases of adverse reactions in the treatment group and 11 cases in the control group. There is a statistical difference (P 0.05). Conclusion "Tongdu treatment of depression acupuncture" treatment of post-stroke sleep disorders, can significantly improve the insomnia symptoms of patients with post-stroke sleep disorders. The curative effect is better than the simple oral Estrazole. "Tongdu treatment of depression" is the main treatment of post-stroke sleep disorders with depression, but also can effectively improve the depression of patients with post-stroke sleep disorders. It can also be helpful for the treatment of sleep disorders after stroke.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.6

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1 高井亮;通督治郁針法治療PSSD伴抑郁患者臨床療效觀察[D];安徽中醫(yī)藥大學;2016年

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