發(fā)布時(shí)間：2018-05-24 05:04

  本文選題：中風(fēng)后焦慮障礙 + 通督安神��； 參考：《黑龍江中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過"通督安神"針刺法與西藥帕羅西汀治療中風(fēng)后焦慮障礙的隨機(jī)對(duì)照研究,評(píng)價(jià)"通督安神"針刺法治療中風(fēng)后焦慮障礙的臨床療效、起效時(shí)間和安全性。方法:將70名確診為中風(fēng)后焦慮障礙的患者,隨機(jī)分為兩組(治療組和對(duì)照組),每組35例。治療組運(yùn)用"通督安神"針刺法,選取穴位:百會(huì)、四神聰、神庭、印堂、水溝、膻中、神門(雙側(cè))、內(nèi)關(guān)(雙側(cè)),平補(bǔ)平瀉,每日針刺1次,療程共4周。對(duì)照組給予口服西藥鹽酸帕羅西汀片,每日1次,每次10mg,4天后加量,每日1次,每次20mg,療程共4周。兩組患者均給予基礎(chǔ)治療,包括腦中風(fēng)疾病基礎(chǔ)藥物治療和改善肢體功能的常規(guī)體針治療(不取神門、內(nèi)關(guān)穴)。觀察指標(biāo):1.于治療1w、2w、4w,采用漢密爾頓焦慮量表(HAMA)和Zung氏焦慮自評(píng)量表(SAS),評(píng)價(jià)治療組和對(duì)照組治療中風(fēng)后焦慮障礙的臨床療效和治療起效時(shí)間。2.于治療1w、2w、4w采用HAMA三因子(包含精神性焦慮因子、軀體性焦慮因子和睡眠因子)評(píng)分來細(xì)化針刺治療組的優(yōu)勢(shì)所在。3.兩組患者在治療后均采用副反應(yīng)量表(TESS)評(píng)分測(cè)評(píng)治療組與對(duì)照組的安全性。結(jié)果:1.臨床療效評(píng)價(jià)(1)兩組患者治療前、治療4周后HAMA量表評(píng)分比較:兩組患者在治療前HAMA量表評(píng)分無差異,P0.05,具有可比性。治療4周后,兩組患者HAMA評(píng)分均較療前明顯下降(P0.05),兩種療法均可明顯改善PSAD患者的焦慮癥狀。且治療4周后,治療組與對(duì)照組間HAMA評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05),兩組療效相當(dāng)。(2)兩組患者治療4周后總療效比較:治療組總有效率為82.9%,對(duì)照組的總有效率為80.0%,差異無統(tǒng)計(jì)學(xué)意義,P0.05,兩組療效相當(dāng)。(3)兩組患者治療前和治療4周HAMA三因子比較:兩組患者治療前HAMA三因子評(píng)分無差異,P0.05,具有可比性。治療4周后HAMA精神焦慮因子、睡眠因子和軀體焦慮因子評(píng)分均較療前明顯下降(P0.05),說明兩種療法均可明顯改善PSAD患者的精神焦慮癥狀、軀體焦慮癥狀和睡眠質(zhì)量。治療4周后,治療組與對(duì)照組間HAMA精神焦慮因子和睡眠因子評(píng)分無明顯差異(P0.05),無統(tǒng)計(jì)學(xué)意義,兩組在改善精神焦慮癥狀和睡眠質(zhì)量方面療效相當(dāng)。而治療4周后,治療組與對(duì)照組HAMA軀體性焦慮因子評(píng)分有明顯差異(P0.05),治療組在改善軀體性焦慮癥狀方面優(yōu)于對(duì)照組。(4)兩組患者在治療前、治療4周SAS量表評(píng)分比較:兩組患者SAS量表評(píng)分治療前無差異,P0.05,具有可比性。治療4周后,兩組患者SAS評(píng)分均較療前明顯下降(P0.05),兩種療法均可明顯改善PSAD患者的焦慮癥狀。且治療4周后,治療組與對(duì)照組間SAS評(píng)分無統(tǒng)計(jì)學(xué)差異(P0.05),兩組療效相當(dāng)。2.起效時(shí)間評(píng)價(jià)(1)治療組治療1周后,HAMA、SAS評(píng)分即較療前有明顯下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),說明治療組在治療1周后,即對(duì)PSAD有明顯療效。而對(duì)照組在治療1周后,兩量表評(píng)分較療前也有所降低,但差異不顯著,沒有統(tǒng)計(jì)學(xué)意義,P0.05。治療2周后,對(duì)照組HAMA、SAS評(píng)分才較療前有明顯降低,差異有統(tǒng)計(jì)學(xué)意義,P0.05,表明對(duì)照組在治療2周后才起效,提示治療組抗焦慮障礙較對(duì)照組起效快。(2)治療組在治療1周后,軀體性焦慮因子評(píng)分相比治療前具有顯著性差異(P0.05),在治療2周時(shí)呈現(xiàn)出極顯著差異性,且與對(duì)照組相比較有統(tǒng)計(jì)學(xué)差異(P0.05),提示治療組在改善軀體焦慮的方面1周時(shí)便起效,相比對(duì)照組有優(yōu)勢(shì)。兩組患者在精神性焦慮因子、睡眠因子等方面均在治療2周時(shí)相比治療前評(píng)分呈現(xiàn)顯著性差異(P0.05),提示兩組治療方法均在治療兩周時(shí)起效,且療效相當(dāng)(P0.05)。3.安全性評(píng)價(jià)藥物對(duì)照組在治療過程中,有2例患者出現(xiàn)口干、1例患者出現(xiàn)頭暈、3例患者出現(xiàn)便秘、1例出現(xiàn)嗜睡,出現(xiàn)副反應(yīng)人數(shù)占對(duì)照組的20%。針刺治療組沒有出現(xiàn)副反應(yīng),僅有1例出現(xiàn)皮下血腫,但未出現(xiàn)暈針、滯針、斷針、感染等其他針刺異常情況發(fā)生。結(jié)論:1."通督安神"針刺法治療中風(fēng)后焦慮障礙與西藥對(duì)照組療效相當(dāng),兩者均能明顯改善中風(fēng)后焦慮障礙患者的焦慮癥狀。2."通督安神"針刺法治療中風(fēng)后焦慮障礙起效較西藥對(duì)照組起效迅速。3."通督安神"針刺法和西藥對(duì)照組均能明顯改善中風(fēng)后焦慮障礙患者的精神性焦慮癥狀、軀體性焦慮癥狀和睡眠癥狀,但在改善軀體性焦慮癥狀療效和起效時(shí)間上優(yōu)于西藥對(duì)照組。4."通督安神"針刺法的安全性要優(yōu)于西藥對(duì)照組。
[Abstract]:Objective: To evaluate the clinical efficacy, time and safety of "Tong Du Anshen" acupuncture method for the treatment of post apoplectic anxiety disorder through a randomized controlled study of "Tong Du Anshen" acupuncture and paroxetine in the treatment of post apoplectic anxiety disorder. Methods: 70 patients with apoplexy after apoplexy were randomly divided into two groups (the treatment group and the control group). There were 35 cases in each group. The treatment group, using the acupuncture method of "Tong Du and God", selected acupoints: Baihui, Si Shen Cong, God's court, printing hall, ditch, mutton (bilateral), Neiguan (bilateral), flat filling and diarrhea, 1 times a day for 4 weeks. The control group was given oral western medicine Paroxetine Hydrochloride Tablets, 1 times a day, 4 days plus dose, 1 times a day, each time, course of treatment, 20mg, treatment course, each time, treatment course. A total of 4 weeks. The two groups were given basic treatment, including basic medication for cerebral apoplexy and routine body acupuncture treatment to improve limb function (not taking the Shen gate, Neiguan point). 1. in the treatment of 1W, 2W, 4W, the Hamilton Anxiety Scale (HAMA) and Zung's anxiety self rating scale (SAS) were used to evaluate the treatment group and the control group in the treatment of post apoplectic anxiety The clinical efficacy of the disorder and the onset time of treatment was.2. in the treatment of 1W, 2W, 4W using HAMA three factors (including mental anxiety factors, somatic anxiety factors and sleep factors) to refine the advantages of the acupuncture treatment group.3. two patients were treated with the side reaction scale (TESS) score after treatment to evaluate the safety of the treatment group and the control group. Results: 1. clinical efficacy evaluation (1) two groups of patients before treatment, 4 weeks after the HAMA scale score comparison: two groups of patients before treatment HAMA scale score no difference, P0.05, comparable. After 4 weeks of treatment, two groups of patients with HAMA scores were significantly lower than before treatment (P0.05), and two treatments can significantly improve the anxiety symptoms of patients with PSAD, and after the treatment for 4 weeks after the treatment, There was no significant difference in HAMA score between the treatment group and the control group (P0.05). (2) the total curative effect of the two groups of patients after 4 weeks was compared: the total effective rate of the treatment group was 82.9%, the total effective rate of the control group was 80%, the difference was not statistically significant, P0.05, and the two groups had the equivalent effect. (3) the two group patients were compared with the 4 weeks before and 4 weeks: two group, two group. The scores of HAMA three factors were no difference before treatment, and P0.05 was comparable. After 4 weeks of treatment, the scores of HAMA mental anxiety factors, sleep factors and somatic anxiety factors were significantly lower than those before treatment (P0.05), indicating that the two treatments could obviously improve the mental anxiety symptoms, somatic anxiety symptoms and sleep quality of PSAD patients. After 4 weeks treatment, the treatment group was treated. There was no significant difference in the scores of HAMA mental anxiety and sleep factors (P0.05) between the control group and the control group (P0.05). The two groups had the same effect on improving mental anxiety and sleep quality. And after 4 weeks of treatment, the score of HAMA somatic anxiety factor in the treatment group and the control group was significantly different (P0.05). The treatment group was improving somatic anxiety symptoms. (4) two groups of patients before treatment, 4 weeks of SAS scale score comparison: the two group of patients with no difference before the SAS scale treatment, P0.05, comparable. After 4 weeks of treatment, the two groups were significantly lower than before the treatment (P0.05), two treatments can significantly improve the anxiety of PSAD patients. After 4 weeks, treatment group, treatment group There was no significant difference in SAS score between the control group and the control group (P0.05), the two groups were equivalent to.2. time evaluation (1) after 1 weeks of treatment in the treatment group, HAMA, the SAS score was significantly lower than before the treatment, the difference was statistically significant (P0.05), indicating that the treatment group had a significant effect on PSAD after the treatment, and the control group was compared with the two scale after 1 weeks of treatment. The difference was not significant, but the difference was not statistically significant. After 2 weeks of P0.05. treatment, the control group HAMA, SAS score was significantly lower than before the treatment, the difference was statistically significant, P0.05, indicating that the control group was only effective after 2 weeks of treatment, suggesting that the anti anxiety disorder in the treatment group was faster than the control group. (2) the treatment group was somatic anxiety after 1 weeks of treatment. There was a significant difference in factor score before treatment (P0.05), which showed significant difference at 2 weeks and compared with the control group (P0.05), suggesting that the treatment group was effective at 1 weeks in improving physical anxiety and compared with the control group. The two groups were in the aspects of mental anxiety factors, sleep factors and so on. There was a significant difference between the 2 weeks before treatment (P0.05), suggesting that two groups of treatment methods were all effective at two weeks, and the curative effect was equivalent (P0.05).3. safety evaluation of the drug control group in the treatment process, there were 2 patients with dry mouth, 1 patients with dizziness, 3 patients with constipation, 1 cases of somnolence, and side effects. The 20%. acupuncture treatment group of the control group had no side effects, only 1 cases had subcutaneous hematoma, but there were no needles, stagnation needles, broken needles, infection and other abnormal conditions. Conclusion: 1. "Tong Du Anshen" acupuncture treatment of anxiety disorder after apoplexy is equivalent to the western medicine control group, both can obviously improve the anxiety disorder after apoplexy. .2. "Tong Du Anshen" acupuncture method for the treatment of post apoplectic anxiety disorder is more effective than the western medicine control group, which can improve the mental anxiety symptoms, somatic anxiety symptoms and sleep symptoms in the patients with anxiety disorder after apoplexy, but it can improve the effect of somatic anxiety symptoms. And the onset time was better than that of Western medicine control group. The safety of.4. "Tong Du Anshen" acupuncture method was better than that of Western medicine control group.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.6

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