本文選題：熱敏灸 + 腫瘤相關(guān)性��； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過前瞻性的臨床對(duì)照研究,觀察熱敏灸治療心脾兩虛型腫瘤相關(guān)性失眠的療效以及客觀指標(biāo)腫瘤壞死因子(TNF)的變化規(guī)律,并了解患者睡眠狀況及心脾兩虛的中醫(yī)癥狀改善的情況。方法:采用隨機(jī)對(duì)照試驗(yàn)研究方法,將在廣州市中醫(yī)醫(yī)院腫瘤科住院且符合納入標(biāo)準(zhǔn)的70例腫瘤患者,隨機(jī)分成治療組和對(duì)照組,各35例。治療組以熱敏灸療法聯(lián)合腫瘤科住院常規(guī)治療,對(duì)照組僅予腫瘤科住院常規(guī)治療。觀察時(shí)間為7天,分別在治療前及治療后記錄患者PSQI評(píng)分及心脾兩虛型中醫(yī)癥候積分,并抽血查腫瘤壞死因子客觀指標(biāo),最后進(jìn)行統(tǒng)計(jì)學(xué)處理并分析得出結(jié)論。結(jié)果:1.入組的70例患者基線資料:平均年齡為64.26± 10.02歲,男性患者33例(47.1%),女性患者37例(52.9%),肺癌17例(24.3%),鼻咽癌6例(8.6%),婦科腫瘤6例(8.6%),消化系腫瘤31例(44.3%),其他惡性腫瘤10例(14.3%),腫瘤臨床分期Ⅰ期3例,Ⅱ期5例,Ⅲ期20例,Ⅳ期42例,中晚期患者占88.6%;中醫(yī)癥候病情分級(jí)輕度1例,中度58例,重度11例,中重度占98.6%;失眠嚴(yán)重程度分級(jí)輕度9例,中度31例,重度30例,中重度患者占87.1%。治療組與對(duì)照組上述基線資料比較差異無統(tǒng)計(jì)學(xué)意義。2.PSQI失眠量表評(píng)分及心脾兩虛型中醫(yī)證候積分:與治療前比較,兩組患者治療后PSQI評(píng)分及中醫(yī)證候積分均有所降低(P0.001)。與對(duì)照組比較,治療組患者聯(lián)合熱敏灸治療后PSQI總評(píng)分7.71±3.064及中醫(yī)證候總積分11.06±4.820,分別低于對(duì)照組患者僅接受住院常規(guī)治療后的PSQI總評(píng)分11.56±2.439及中醫(yī)證候總積分16.12±4.721,差異有意義(P0.001)。提示熱敏灸治療能更明顯的緩解癥狀,療效更優(yōu)。3.PSQI失眠量表及心脾兩虛型中醫(yī)證候積分表各單項(xiàng)積分:在PSQI失眠量表各單項(xiàng)評(píng)分比較中,兩組患者治療后"睡眠質(zhì)量"、"入睡時(shí)間"、"睡眠時(shí)間"、"睡眠效率積分"、"睡眠障礙"、"催眠藥物"及"日間功能障礙"七個(gè)單項(xiàng)評(píng)分均低于兩組治療前各單項(xiàng)的評(píng)分(P0.001)。與對(duì)照組比較,治療組患者聯(lián)合熱敏灸治療后"睡眠質(zhì)量"、"入睡時(shí)間"、"睡眠時(shí)間"、"睡眠效率"、"睡眠障礙"及"日間功能障礙"六項(xiàng)評(píng)分降低,有顯著性差異(P0.05),而"催眠藥物"評(píng)分差異無統(tǒng)計(jì)學(xué)意義(P0.05)。在心脾兩虛型中醫(yī)證候積分表各單項(xiàng)比較中,兩組患者治療后,"失眠"、"心悸"、"神疲體倦"、"食納"、"多夢(mèng)"、"健忘"、"腹脹"、"便溏"、"面色"、"舌象"及"脈象"十一個(gè)單項(xiàng)積分均較治療前有所降低,有顯著性差異(P0.05)。與對(duì)照組比較,治療組患者聯(lián)合熱敏灸治療后"失眠"、"神疲體倦"、"多夢(mèng)"、"面色"及"脈象"五個(gè)癥狀改善程度更加明顯(P0.05),而兩組患者治療后"心悸"、"食納"、"健忘"、"腹脹"、"便溏"及"舌象"(P0.05)六項(xiàng)改善程度無明顯差異。4.失眠改善療效與中醫(yī)癥狀改善療效分析:治療組失眠改善療效總有效率82.86%,中醫(yī)癥狀改善療效總有效率達(dá)88.57%,對(duì)照組失眠改善療效總有效率20.59%,中醫(yī)癥狀改善療效總有效率67.65%,熱敏灸聯(lián)合住院常規(guī)治療在改善睡眠和心脾兩虛中醫(yī)癥狀方面,療效更優(yōu)(P0.01)。5.與對(duì)照組比較,治療組治療前、后TNF值均無顯著性差異(P0.05);與治療前比較,治療組與對(duì)照組患者治療后TNF值均無顯著性差異(P0.05)。結(jié)論:1.熱敏灸治療能有效提高患者睡眠質(zhì)量,縮短入睡時(shí)間,增長(zhǎng)睡眠時(shí)間,增加睡眠效率,減輕睡眠障礙及日間功能障礙,減少催眠藥物的使用。2.熱敏灸可改善失眠、神疲體倦、多夢(mèng)、健忘等精神癥狀,減輕心悸,增加食納,緩解腹脹、便溏,改善面色、舌脈象等心脾兩虛型癥狀。3.熱敏灸不能顯著影響心脾兩虛型腫瘤相關(guān)性失眠患者的腫瘤壞死因子水平。
[Abstract]:Objective: To observe the therapeutic effect of thermosensitive moxibustion on tumor associated insomnia of heart and spleen two deficiency and the objective index of tumor necrosis factor (TNF), and to understand the situation of the patients' sleep status and the improvement of TCM symptoms with the deficiency of heart and spleen two. Methods: a randomized controlled trial was used in this study. 70 tumor patients hospitalized in the oncology department of Guangzhou traditional Chinese medicine hospital were randomly divided into the treatment group and the control group, each with 35 cases. The treatment group was treated with the heat sensitive moxibustion combined with the oncology department for routine treatment. The control group was only hospitalized in the oncology department for 7 days. The PSQI score was recorded before and after the treatment. The score of TCM syndrome of the two deficiency of heart and spleen, and the objective index of TNF to find out the objective index of TNF. Finally, statistical processing and conclusion were made. Results: the baseline data of 70 patients in the 1. group were 64.26 + 10.02 years old, 33 cases (47.1%), 37 cases (52.9%), 17 cases (24.3%) of lung cancer, 6 cases of nasopharyngeal carcinoma (8.6%), gynecology. 6 cases (8.6%), 31 cases of digestive system tumor (44.3%), 10 cases of other malignant tumors (14.3%), tumor clinical stage I 3 cases, 5 cases in stage II, 20 cases in stage III, 42 cases in stage IV, 42 cases in stage IV, 88.6% in middle and late stage, mild 1 of TCM syndrome, moderate 58 cases, serious 11 cases, moderate severe cases, moderate cases and severe cases of insomnia. There was no significant difference in the baseline data between the 87.1%. treatment group and the control group in the.2.PSQI Insomnia Scale score and the TCM syndrome score of the heart and spleen two deficiency syndrome. Compared with the treatment before treatment, the scores of the PSQI scores and TCM syndrome scores in the two groups were reduced (P0.001). After the moxibustion treatment, the total score of PSQI was 7.71 + 3.064 and the total score of TCM syndrome was 11.06 + 4.820. The total score of PSQI in the control group was 11.56 + 2.439 and the total score of TCM syndrome was 16.12 + 4.721, respectively. The difference was significant (P0.001). It suggested that the thermosensitive moxibustion treatment could relieve the symptoms more obviously and the curative effect was better than that of the.3.PSQI Insomnia Scale. And each single score of TCM syndrome score table of "heart and spleen two" syndrome: in the comparison of the single item scores of the PSQI Insomnia Scale, the two groups of patients after treatment, "sleep quality", "sleep time", "sleep time", "sleep efficiency score", "sleep disorder", "hypnotic drugs" and "daytime dysfunction" were all lower than the scores of the two groups before treatment. P0.001). Compared with the control group, the six scores of "sleep quality", "sleep time", "sleep time", "sleep efficiency", "sleep disorder" and "daytime dysfunction" were reduced in the treatment group after the treatment of heat sensitive moxibustion, and there were significant differences (P0.05), but the difference of "hypnotic drugs" score was not statistically significant (P0.05). In the individual comparison, two groups of patients were treated with "insomnia", "palpitation", "fatigued fatigue", "feeding", "multi dream", "forgetfulness", "abdominal distention", "loose stool", "face", "tongue" and "pulse", which were lower than before treatment (P0.05). Compared with the control group, the treatment group combined with thermosensitive moxibustion treatment, "insomnia", "God tired", "God tired". Two groups of patients' heart palpitations, "heart palpitations", "appetite", "forgetfulness", "abdominal distention", "loose stools" and "tongue elephant" (P0.05), there was no obvious difference in the six improvement degree of.4. insomnia, and the curative effect of insomnia improvement and improvement of TCM symptoms improved: the total effective efficiency of insomnia in the treatment group was 82.86%. The total effective efficiency of insomnia in the treatment group was 82.86%. The total effective rate of TCM symptom improvement was 88.57%, the total effective rate of insomnia improved in the control group was 20.59%, the total effective rate of TCM symptom improvement was 67.65%. The curative effect was better than that of the control group (P0.01).5. and the control group. The TNF value of the treatment group was no significant before the treatment group. Sex difference (P0.05); compared with before treatment, there was no significant difference in TNF value between the treatment group and the control group (P0.05). Conclusion: 1. heat sensitive moxibustion can effectively improve the quality of sleep, shorten the time of sleep, increase the time of sleep, increase the efficiency of sleep, reduce the sleep and sleep disorders and daytime dysfunction, and reduce the use of.2. fever with hypnotic drugs. Moxibustion can improve insomnia, fatigue, dream, forgetfulness and other mental symptoms, reduce heart palpitations, increase food intake, relieve abdominal distention, loose stool, improve face color, tongue and pulse and other heart and spleen two deficiency symptoms.3. thermosensitive moxibustion can not significantly affect the level of tumor and death factor of patients with insomnia related insomnia related to the two deficiency of heart and spleen.
【學(xué)位授予單位】：廣州中醫(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)】：R246.5
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本文編號(hào)：1947059