本文選題：中風后焦慮障礙 + 通督安神�。� 參考：《黑龍江中醫(yī)藥大學》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后焦慮障礙的隨機對照研究,評價"通督安神"針刺法治療中風后焦慮障礙的臨床療效、起效時間和安全性。方法:將70名確診為中風后焦慮障礙的患者,隨機分為兩組(治療組和對照組),每組35例。治療組運用"通督安神"針刺法,選取穴位:百會、四神聰、神庭、印堂、水溝、膻中、神門(雙側)、內關(雙側),平補平瀉,每日針刺1次,療程共4周。對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治療,包括腦中風疾病基礎藥物治療和改善肢體功能的常規(guī)體針治療(不取神門、內關穴)。觀察指標:1.于治療1w、2w、4w,采用漢密爾頓焦慮量表(HAMA)和Zung氏焦慮自評量表(SAS),評價治療組和對照組治療中風后焦慮障礙的臨床療效和治療起效時間。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)評分來細化針刺治療組的優(yōu)勢所在。3.兩組患者在治療后均采用副反應量表(TESS)評分測評治療組與對照組的安全性。結果:1.臨床療效評價(1)兩組患者治療前、治療4周后HAMA量表評分比較:兩組患者在治療前HAMA量表評分無差異,P0.05,具有可比性。治療4周后,兩組患者HAMA評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,治療組與對照組間HAMA評分無統(tǒng)計學差異(P0.05),兩組療效相當。(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%,對照組的總有效率為80.0%,差異無統(tǒng)計學意義,P0.05,兩組療效相當。(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量。治療4周后,治療組與對照組間HAMA精神焦慮因子和睡眠因子評分無明顯差異(P0.05),無統(tǒng)計學意義,兩組在改善精神焦慮癥狀和睡眠質量方面療效相當。而治療4周后,治療組與對照組HAMA軀體性焦慮因子評分有明顯差異(P0.05),治療組在改善軀體性焦慮癥狀方面優(yōu)于對照組。(4)兩組患者在治療前、治療4周SAS量表評分比較:兩組患者SAS量表評分治療前無差異,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,治療組與對照組間SAS評分無統(tǒng)計學差異(P0.05),兩組療效相當。2.起效時間評價(1)治療組治療1周后,HAMA、SAS評分即較療前有明顯下降,差異有統(tǒng)計學意義(P0.05),說明治療組在治療1周后,即對PSAD有明顯療效。而對照組在治療1周后,兩量表評分較療前也有所降低,但差異不顯著,沒有統(tǒng)計學意義,P0.05。治療2周后,對照組HAMA、SAS評分才較療前有明顯降低,差異有統(tǒng)計學意義,P0.05,表明對照組在治療2周后才起效,提示治療組抗焦慮障礙較對照組起效快。(2)治療組在治療1周后,軀體性焦慮因子評分相比治療前具有顯著性差異(P0.05),在治療2周時呈現出極顯著差異性,且與對照組相比較有統(tǒng)計學差異(P0.05),提示治療組在改善軀體焦慮的方面1周時便起效,相比對照組有優(yōu)勢。兩組患者在精神性焦慮因子、睡眠因子等方面均在治療2周時相比治療前評分呈現顯著性差異(P0.05),提示兩組治療方法均在治療兩周時起效,且療效相當(P0.05)。3.安全性評價藥物對照組在治療過程中,有2例患者出現口干、1例患者出現頭暈、3例患者出現便秘、1例出現嗜睡,出現副反應人數占對照組的20%。針刺治療組沒有出現副反應,僅有1例出現皮下血腫,但未出現暈針、滯針、斷針、感染等其他針刺異常情況發(fā)生。結論:1."通督安神"針刺法治療中風后焦慮障礙與西藥對照組療效相當,兩者均能明顯改善中風后焦慮障礙患者的焦慮癥狀。2."通督安神"針刺法治療中風后焦慮障礙起效較西藥對照組起效迅速。3."通督安神"針刺法和西藥對照組均能明顯改善中風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間上優(yōu)于西藥對照組。4."通督安神"針刺法的安全性要優(yōu)于西藥對照組。
[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.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6

【相似文獻】

相關期刊論文 前10條

1 ;全國焦慮障礙學術會議征文通知[J];中國心理衛(wèi)生雜志;2009年05期

2 ;第二屆全國焦慮障礙學術會議征文通知[J];精神醫(yī)學雜志;2010年01期

3 ;第二屆全國焦慮障礙學術會議征文通知[J];臨床精神醫(yī)學雜志;2010年02期

4 ;第二屆全國焦慮障礙學術會議征文通知[J];中國民康醫(yī)學;2010年05期

5 ;第二屆全國焦慮障礙學術會議第二輪征文通知[J];精神醫(yī)學雜志;2010年03期

6 趙瑋琳;;談談焦慮障礙的簡易治療方法[J];人事天地;2012年11期

7 薛瑩;楊蘊萍;;門診焦慮障礙患者的成人依戀類型研究[J];中國臨床心理學雜志;2013年01期

8 薛瑩;楊蘊萍;;門診焦慮障礙患者的自我分化水平研究[J];精神醫(yī)學雜志;2013年03期

9 傅茂筍，王伯軍，，李蘭香;職業(yè)中學學生焦慮障礙及其危險因素[J];中國行為醫(yī)學科學;1995年02期

10 ;第六屆全國焦慮障礙學術會議第一輪征文通知[J];四川精神衛(wèi)生;2014年03期

相關會議論文 前10條

1 許晉川;謝方道;丁關慶;;281例焦慮障礙臨床研究[A];第七屆全國老年醫(yī)學學術會議暨海內外華人老年醫(yī)學學術會議論文匯編[C];2004年

2 陸崢;;《中國焦慮障礙防治指南》總論[A];2011年浙江省神經病學學術年會論文匯編[C];2011年

3 楊洪;;焦慮障礙心理機制及干預[A];中國心理衛(wèi)生協會殘疾人心理衛(wèi)生分會第五屆學術交流會論文集[C];2004年

4 李惠春;;抑郁和焦慮障礙共病模型[A];2006年浙江省精神病學學術會議論文匯編[C];2006年

5 劉肇瑞;黃悅勤;黃瑩;程輝;羅曉敏;陳曦;;焦慮障礙相關危險因素的病例對照研究[A];中華醫(yī)學會精神病學分會第九次全國學術會議論文集[C];2011年

6 王磊;劉志芬;段慧君;任燕;劉瑋偉;向玉仙;李素萍;張克讓;;住院焦慮障礙患者的腦電超慢漲落圖分析[A];中華醫(yī)學會精神病學分會第九次全國學術會議論文集[C];2011年

7 白炳清;;焦慮障礙新進展[A];中國中西醫(yī)結合學會精神疾病專業(yè)委員會第十一屆學術年會論文匯編[C];2012年

8 吳傳東;李志蕓;;焦慮障礙的臨床分析[A];中華醫(yī)學會第十次全國精神醫(yī)學學術會議論文匯編[C];2012年

9 李練;史麗麗;洪霞;趙曉暉;魏鏡;;綜合醫(yī)院門診患者出現睡眠問題時應高度警惕焦慮障礙[A];中國睡眠研究會第六屆學術年會論文匯編[C];2010年

10 莊麗頻;史堯勝;陳佩珍;房聰俠;夏穎;;急性焦慮障礙患者睡眠特征及其相關因素分析[A];睡眠醫(yī)學與精神衛(wèi)生研討會（中國科協2005年學術年會第50分會場）論文匯編[C];2005年

相關重要報紙文章 前10條

1 駐京記者 賈巖;探索焦慮障礙治療新路[N];醫(yī)藥經濟報;2010年

2 周婷玉　李寧;逾90%焦慮障礙患者,未得到治療[N];新華每日電訊;2009年

3 本報記者 連漪;焦慮障礙是真實的、嚴重的疾病[N];健康報;2012年

4 首都醫(yī)科大學附屬北京安定醫(yī)院 許克勤;形形色色的焦慮障礙[N];健康報;2007年

5 王蘇平;近兩成門診患者有抑郁/焦慮障礙[N];健康報;2007年

6 記者羅剛;九成多焦慮障礙患者未得到治療[N];健康報;2009年

7 健康時報記者 沙瓊;別小看了焦慮障礙[N];健康時報;2009年

8 本報記者 李陽和;焦慮障礙：知之者少,求治者更少[N];健康報;2012年

9 記者 王丹;大學新生職場新人焦慮障礙高發(fā)[N];健康報;2012年

10 本報記者 靖九江;高校新生、職場新人當心焦慮障礙[N];中國醫(yī)藥報;2012年

相關博士學位論文 前2條

1 盧靜;綜合醫(yī)院門診患者抑郁/焦慮障礙現況調查[D];中國協和醫(yī)科大學;2008年

2 劉軍;電針焦慮方治療中風后焦慮障礙的臨床療效評價[D];中國中醫(yī)科學院;2012年

相關碩士學位論文 前10條

1 王敏;焦慮障礙患者依戀模式的相關關系研究[D];安徽醫(yī)科大學;2015年

2 肖輝;帕金森病患者伴發(fā)焦慮障礙的相關因素分析[D];昆明醫(yī)科大學;2015年

3 董瑞賓;女性癲癇患者合并抑郁焦慮障礙的相關影響因素分析[D];天津醫(yī)科大學;2015年

4 陳玉狀;丁元慶教授治療焦慮障礙臨床總結與規(guī)律探討[D];山東中醫(yī)藥大學;2015年

5 孟欣;“通督安神”針刺法治療中風后焦慮障礙的臨床觀察[D];黑龍江中醫(yī)藥大學;2017年

6 張曉南;大連市焦慮障礙患病率及相關因素研究[D];大連醫(yī)科大學;2010年

7 陳光美;焦慮障礙的人格特征與蛋白組學的相關性研究[D];瀘州醫(yī)學院;2011年

8 王靜怡;成人癲癇伴發(fā)焦慮障礙的調查分析[D];暨南大學;2011年

9 王威;沈陽市綜合醫(yī)院內科門診焦慮障礙患病率與醫(yī)生識別率現狀調查[D];中國醫(yī)科大學;2007年

10 薛瑩;門診焦慮障礙患者的成人依戀和自我分化的關系研究[D];首都醫(yī)科大學;2013年

本文編號：1927786