發(fā)布時間：2018-06-05 22:22

  本文選題：失眠 + 心腎不交型　； 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：本課題采用小樣本隨機對照的研究方法,通過與普通針刺治療為對照組的比較,觀察方氏頭皮針治療心腎不交型失眠的臨床療效。旨在探討方氏頭皮針治療心腎不交型失眠的臨床療效及可能作用機理,為臨床針灸療法治療心腎不交型失眠提供新臨床思路和嚴(yán)謹(jǐn)?shù)目蒲匈Y料,并在廣度和深度上進(jìn)一步挖掘和擴(kuò)展方氏頭皮針的功效和適用范圍。方法：本研究課題病例主要是來自廣東省中醫(yī)院病房和門診以及廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院門診在2014年12月至2015年12月期間就診的病人,根據(jù)本研究的病例選擇標(biāo)準(zhǔn)納入60例研究病例,將合格病例按照隨機分配原則平均分配至治療組(方氏頭皮針結(jié)合體針組)和對照組(普通針刺組),治療組和對照組的病例分別都是30例,對照組參照王啟才主編的《針灸治療學(xué)》中失眠的治療處方選取相關(guān)穴位進(jìn)行常規(guī)針刺,治療組則參照方云鵬的《頭皮針》進(jìn)行飛針針刺治療,并加上對照組的常規(guī)針刺。方氏頭皮針結(jié)合體針治療組和普通針刺對照組的患者均接受每天1次的治療,一周5次,2周為1個療程,整個研究要求共4周,即兩個療程的治療。本研究的臨床總療效標(biāo)準(zhǔn)采用現(xiàn)今可信度及效度較高的匹茲堡睡眠質(zhì)量指數(shù)(PSQI)評定量表的評分自擬,根據(jù)患者治療前及治療后的PSQI評分利用減分率方式進(jìn)行計算后,根據(jù)得出的結(jié)果進(jìn)行評定治療前后患者的臨床總療效,同時對兩組患者的中醫(yī)證候療效進(jìn)行比較。臨床總療效和中醫(yī)證候療效在第一療程治療后、第二療程治療后、兩個療程治療結(jié)束后1個月的隨訪時對兩組的病例進(jìn)行評估,運用SPSS20.0對研究的數(shù)據(jù)進(jìn)行統(tǒng)計分析。結(jié)果：本課題根據(jù)病例選取標(biāo)準(zhǔn)納入的病例數(shù)為60例,納入研究的全部心腎不交型失眠患者均接受了足夠的治療療程,最后納入統(tǒng)計學(xué)分析的病例數(shù)為60例,治療組與對照組各30例。1、治療前納入方氏頭皮針結(jié)合體針治療組和普通針刺對照組的心腎不交型失眠癥患者中,所有病例的基線資料如性別、年齡、病程、治療前中醫(yī)證候積分、治療前PSQI各成分積分及總分進(jìn)行組間比較,結(jié)果提示P0.05,說明兩組基線特征差異均無統(tǒng)計意義,也就是說,在治療前,方氏頭皮針結(jié)合體針治療組和普通針刺對照組的心腎不交型失眠癥患者的基線特征具有可比性。2、臨床總療效的比較：比較治療組和對照組治療后的中醫(yī)證候療效,治療組總有效率為93.33%,其中痊愈9例,顯效9例,有效10例,無效2例。對照組總有效率為86.67%,其中痊愈4例,顯效5例,有效17例,無效4例。在總有效率上,經(jīng)秩和檢驗發(fā)現(xiàn)P值小于0.05,有統(tǒng)計學(xué)意義。比較治療組和對照組治療后的臨床療效,治療組總有效率為90%,其中痊愈10例,顯效13例,有效4例,無效3例。對照組總有效率為76.67%,其中痊愈5例,顯效6例,有效12例,無效7例。在總有效率上,經(jīng)秩和檢驗發(fā)現(xiàn)P值小于0.05,有統(tǒng)計學(xué)意義,結(jié)果說明方氏頭皮針結(jié)合體針治療組中醫(yī)證候療效和臨床療效高于普通針刺對照組。3、不同時段療效指標(biāo)的比較：分別將方氏頭皮針結(jié)合體針治療組和普通針刺對照組兩組的心腎不交型失眠患者在第一療程治療后、第二療程治療后、兩個療程治療后一個月隨訪時的3個不同時段的中醫(yī)證候總評分(包括失眠多夢、心煩、健忘、頭暈耳鳴、腰膝酸軟、五心煩熱、口干少津7項)、PSQI各成分積分(包括睡眠質(zhì)量、入睡時間、睡眠效率、睡眠時間、睡眠障礙、催眠藥物、日間功能障礙7項)及PSQI總分分別與治療前的中醫(yī)證候評分、PSQI各成分積分及總分作組內(nèi)比較；將方氏頭皮針結(jié)合體針治療組和普通針刺對照組的兩組患者在治療后的3個不同時段的中醫(yī)證候評分、PSQI各成分積分及總分作組間比較。方氏頭皮針結(jié)合體針治療組的組內(nèi)比較：統(tǒng)計結(jié)果表明方氏頭皮針結(jié)合體針治療組在第一療程治療后、第二療程治療后、兩個療程治療后一個月隨訪的不同時段的中醫(yī)證候評分、PSQI各成分積分及PSQI總分與治療前的中醫(yī)證候評分、PSQI各成分積分及PSQI總分相比均降低,經(jīng)獨立樣本t檢驗分析(P小于0.05),組內(nèi)差異具有統(tǒng)計學(xué)意義,研究結(jié)果表明,經(jīng)過治療,方氏頭皮針結(jié)合體針治療組在改善患者的中醫(yī)證候評分、PSQI各成分積分及PSQI總分方面均有效。普通針刺對照組的組內(nèi)比較：統(tǒng)計結(jié)果表明普通針刺對照組在第一療程治療后、第二療程治療后、兩個療程治療后一個月隨訪的不同時段的中醫(yī)證候評分、PSQI各成分積分及PSQI總分與治療前的中醫(yī)證候評分、PSQI各成分積分及PSQI總分相比均降低,經(jīng)獨立樣本t檢驗分析(P小于0.05),組內(nèi)差異具有統(tǒng)計學(xué)意義,研究結(jié)果表明,經(jīng)過治療,普通針刺對照組在改善患者的中醫(yī)證候評分、PSQI各成分積分及PSQI總分方面均有一定的療效。方氏頭皮針結(jié)合體針治療組和普通針刺對照組兩組的組間比較：治療前方氏頭皮針結(jié)合體針治療組和普通針刺對照組的中醫(yī)證候總評分、PSQI各成分積分及PSQI總分,經(jīng)統(tǒng)計分析,P大于0.05,差異不具有統(tǒng)計學(xué)意義；方氏頭皮針結(jié)合體針治療組和普通針刺對照組兩組的中醫(yī)證候總評分在第一療程治療后、第二療程后、兩個療程治療后一個月隨訪的3個不同時段的組間差異經(jīng)統(tǒng)計分析具有統(tǒng)計學(xué)意義,P小于0.05；方氏頭皮針結(jié)合體針治療組和普通針刺對照組兩組的PSQI總分在第-療程治療后、第二療程后、兩個療程治療后一個月隨訪的不同時段的組間差異經(jīng)統(tǒng)計分析可以具有統(tǒng)計學(xué)意義,P小于0.05；方氏頭皮針結(jié)合體針治療組和普通針刺對照組兩組的PSQI各成分積分在第一療程治療后PSQI評分量表中的睡眠障礙和催眠藥物經(jīng)統(tǒng)計分析,差異不具有統(tǒng)計學(xué)意義,P大于0.05,說明第一療程治療后兩組患者在改善睡眠障礙和催眠藥物方面不具有可比性,也就是說第一療程治療后兩組患者在改善睡眠障礙和催眠藥物方面的療效相當(dāng)；第一療程治療后PSQI評分量表中的其他成分(包括睡眠質(zhì)量、入睡時間、睡眠時間、睡眠效率日間功能障礙5項)經(jīng)統(tǒng)計學(xué)分析,差異具有統(tǒng)計學(xué)意義,P小于0.05；方氏頭皮針結(jié)合體針治療組和普通針刺對照組在第二療程治療后、兩個療程治療后一個月隨訪時的PSQI評分量表中的各成分積分(包括睡眠質(zhì)量、入睡時間、睡眠效率、睡眠時間、睡眠障礙、催眠藥物、日間功能障礙7項)經(jīng)統(tǒng)計學(xué)分析,P均小于0.05,且各成分積分治療組均低于對照組,所以總體來說方氏頭皮針結(jié)合體針治療組療程結(jié)束后在改善心腎不交型失眠患者的睡眠質(zhì)量、入睡時間、睡眠效率、睡眠時間、睡眠障礙、催眠藥物、日間功能障礙方面優(yōu)于對照組,而相對來說在改善睡眠障礙和催眠藥物方面,兩組治療方法的起效時間偏慢一些。結(jié)論：方氏頭皮針結(jié)合體針治療組和普通針刺對照組治療方法對治療心腎不交型失眠均有一定臨床療效,但和普通針刺對照組的療法相比,方氏頭皮針結(jié)合體針治療組的臨床總療效更好,主要體現(xiàn)在對中醫(yī)證候的總評分、整體睡眠的改善和總有效率的差異,睡眠質(zhì)量、入睡時間、睡眠效率、睡眠時間、睡眠障礙、催眠藥物、日間功能障礙較對照組均改善明顯。方氏頭皮針結(jié)合體針治療心腎不交型失眠的臨床療效顯著,穩(wěn)定持久,臨床應(yīng)用安全有效,值得推廣應(yīng)用和進(jìn)行深入研究。
[Abstract]:Objective: To observe the clinical efficacy of Fang's scalp needle in the treatment of the heart and kidney non cross type insomnia by comparing the small sample randomized controlled study method and comparison with the common acupuncture treatment group. The purpose of this study is to explore the clinical curative effect and the mechanism of the effect of Fang's scalp needle in the treatment of the heart and kidney non cross type insomnia, and to treat the heart and kidney with clinical acupuncture and moxibustion therapy. Non cross type insomnia provides new clinical ideas and rigorous scientific research data, and further excavates and extends the efficacy and scope of the scalp needles in breadth and depth. Methods: the main cases of this study were from the Guangdong Province Traditional Chinese Medical Hospital ward and outpatient department and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2014 to 201. During the December period of 5 years, 60 cases of study were included in the case selection criteria of this study. The eligible cases were assigned to the treatment group (square scalp needle combined with body acupuncture group) and the control group (common acupuncture group) according to the principle of random distribution. The cases in both the treatment group and the control group were 30 cases respectively, and the control group referred to Wang Qicai's chief editor. The therapeutic prescriptions of insomnia in acupuncture and moxibustion therapy selected related acupoints for routine acupuncture, and the treatment group referred to Fang Yunpeng's scalp needle for needle acupuncture and the conventional acupuncture in the control group. The patients of the Fang's scalp needle combined with the body acupuncture group and the common acupuncture control group were treated with 1 times a day, 5 times a week and 1 weeks for 2 weeks. The whole study required a total of 4 weeks, that is, a total of 4 weeks, or two courses of treatment. The total clinical efficacy standard of this study was made up of the Pittsburgh sleep quality index (PSQI) rating scale with high reliability and validity. The results were calculated on the basis of the reduction rate before and after the treatment and the PSQI score after the treatment. The total clinical curative effect of the patients before and after treatment was evaluated. At the same time, the curative effect of the TCM syndrome in the two groups was compared. After the first course of treatment, after the first course of treatment, the second course of treatment, and the follow-up of the two courses of treatment at the end of 1 months, the two groups of cases were evaluated, and the data of the study were carried out by SPSS20.0. Results: the number of cases included in this subject according to the case selection standard was 60 cases, and all the patients who were included in the study were treated with sufficient treatment course. The number of cases included in the statistical analysis was 60 cases, the treatment group and the control group were 30.1. The treatment group was included in the square scalp needle combined with the body acupuncture treatment group before treatment and the treatment group. In the common acupuncture control group, the baseline data such as sex, age, course of disease, TCM syndrome score before treatment, integral and total score of PSQI components before treatment were compared in all cases. The results showed P0.05, indicating that there was no statistical significance between the two groups of baseline characteristics, that is to say, before treatment, the scalp of Fang's scalp. The baseline characteristics of the patients with non cross type insomnia in the acupuncture group and the common acupuncture control group had comparable.2, and the total clinical effect was compared: the total effective rate of the treatment group was 93.33% compared with the treatment group and the control group. 9 cases were cured, 9 cases were markedly effective, 10 cases were effective and 2 cases were invalid. The total effective of the control group was effective. The rate was 86.67%, of which 4 cases were cured, 5 cases were markedly effective, 17 cases were effective and 4 cases were invalid. In total efficiency, the P value was less than 0.05 by rank sum test. Compared with the treatment group and the control group, the total effective rate was 90%, including 10 cases, 13 effective, 4 effective and 3 cases. The total effective rate of the control group was 76.67. %, of which 5 cases were cured, 6 cases were markedly effective, 12 cases were effective and 7 cases were invalid. In total efficiency, the P value was less than 0.05 by rank sum test. The results showed that the curative effect and clinical effect of traditional Chinese medicine syndrome of Fang's scalp needle combined with body acupuncture group were higher than that of ordinary acupuncture control group.3, and the comparison of curative effect indexes at different time periods: the square scalp needle respectively After the first course of treatment, after the first course of treatment combined with the two groups of the body acupuncture treatment group and the common acupuncture control group, the total score of TCM Syndromes of 3 different periods of two courses of treatment after the two course of treatment (including insomnia, annoyance, forgetfulness, dizziness tinnitus, low waist and knee soft, five heart irritated heat, and dry oral atrazine, 7 items) The scores of PSQI components (including sleep quality, sleep time, sleep efficiency, sleep time, sleep disorder, hypnotic drug, day dysfunction 7) and PSQI total scores were compared with the TCM syndrome scores before treatment, the integral and total score of PSQI were compared in groups, and the square scalp needle was combined with the body acupuncture treatment group and the common acupuncture control group of two. The score of TCM syndrome in 3 different periods after treatment, the scores of PSQI components and the total score were compared. The comparison of the group in the group with the square scalp needle combined with the body acupuncture group: the statistical results showed that after the first course of treatment, the square scalp needle combined with the body acupuncture treatment group was treated with the second course of treatment, and the two course of treatment was followed up for one month after the treatment. The score of TCM syndrome in different periods of time, the score of PSQI components and PSQI total score and the score of TCM syndrome before treatment, the scores of each component of PSQI and the total score of PSQI were reduced, and the independent sample t test analysis (P was less than 0.05), the difference in the group was statistically significant. The results of the study showed that after treatment, the scalp needle combined with the body acupuncture group was in the treatment group. The TCM syndrome score of the patients was improved, the integral of PSQI and the total score of PSQI were all effective. The comparison of the group in the common acupuncture control group: the statistical results showed that after the first course of treatment in the ordinary acupuncture control group, after the second course of treatment, the TCM Syndrome score of the different period of the two course of treatment after one month of treatment, and the integral of each component of PSQI was integrated. The total score of PSQI and the score of TCM syndrome before treatment, the score of each component of PSQI and the total score of PSQI were reduced, and the independent sample t test was analyzed (P is less than 0.05). The difference in the group was statistically significant. The results of the study showed that after treatment, the common acupuncture control group was improved in the score of TCM syndrome, the integral of PSQI components and the total score of PSQI. The comparison between the two groups of the two groups of Fang's scalp acupuncture combined with the body acupuncture treatment group and the common acupuncture control group: the total score of TCM syndrome in the front of the scalp needle combined with the body acupuncture treatment group and the common acupuncture control group, the integral and PSQI score of PSQI components and the statistical analysis, the difference is not statistically significant; the difference is not statistically significant. After the first course of treatment, the total score of TCM syndrome in two groups of two groups of the scalp needle combined with the body acupuncture group and the common acupuncture control group, after the second course of treatment, the difference between the 3 different periods after the two course of treatment was statistically significant, and the difference was less than 0.05; the square scalp needle combined with the body acupuncture treatment group and the common needle. After the second course of treatment, the total score of PSQI in the two groups of the acupuncture control group was statistically significant, and the P was less than 0.05 after two courses of treatment. The integral of the PSQI components in the two groups of the square scalp acupuncture combined with the body acupuncture group and the common acupuncture group were treated with the first treatment course. The difference of sleep disorders and hypnotic drugs in the PSQI scale was not statistically significant, P was greater than 0.05, indicating that the two groups were not comparable in improving sleep disorders and hypnotic drugs after the first course of treatment, that is, two groups of patients after the first course of treatment were improving sleep disorders and hypnotic drugs. The other components in the PSQI scale after the first course of treatment (including 5 items of sleep quality, sleep time, sleep time, and sleep efficiency day dysfunction) were statistically analyzed, the difference was statistically significant and P was less than 0.05; the square scalp needle combined with the body acupuncture treatment group and the common acupuncture control group in second courses of treatment. After two courses of treatment, the scores of all components in the PSQI scale (including sleep quality, sleep time, sleep efficiency, sleep time, sleep time, sleep disorder, hypnotic drug, and daytime dysfunction 7) were statistically analyzed, all of which were less than 0.05, and all the components of the integral treatment group were lower than those of the control group, so the overall head of Fang's head was in general. The skin needle combined with body acupuncture treatment group was better than the control group in improving sleep quality, sleep time, sleep time, sleep time, sleep disorder, hypnotic drugs and daytime dysfunction in improving the sleep quality of the patients with heart and kidney uncross type insomnia, while the two groups were relatively slow in the onset time of the treatment methods in improving sleep disorders and hypnotic drugs. Conclusion: the treatment of square scalp acupuncture combined with body acupuncture group and common acupuncture control group has a certain clinical effect on the treatment of non heart and kidney type insomnia, but compared with the common acupuncture control group, the total clinical effect of the square scalp needle combined with the body acupuncture treatment group is better, and the main should be reflected in the total score of TCM syndromes and the overall sleep. The difference of improvement and total efficiency, sleep quality, sleep time, sleep time, sleep time, sleep disorder, hypnotic drug, and daytime dysfunction are better than those of the control group. The clinical efficacy of Fang's scalp needle combined with body acupuncture in the treatment of heart and kidney failure insomnia is significant, stable and lasting, the clinical application is safe and effective, it is worth popularizing and carrying out. Study in depth.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 吳捷;耳針、體針治療呃逆療效比較[J];江蘇中醫(yī);1996年04期

2 郭會敏;點刺加體針治療厭食癥30例[J];現(xiàn)代中西醫(yī)結(jié)合雜志;1999年04期

3 孟仕貴;吹灸結(jié)合體針治療中耳炎所致耳鳴療效觀察[J];河北中醫(yī);2000年03期

4 王朝輝;常見胃病體針治療近況概述[J];通化師范學(xué)院學(xué)報;2002年02期

5 王會來,付淑文;耳針為主配合體針治療小兒急性扁桃體炎76例療效觀察[J];針灸臨床雜志;2003年03期

6 詹光宗;;體針治療婦女更年期綜合征療效觀察[J];西南軍醫(yī);2007年06期

7 相永梅;王健;;電耳針結(jié)合體針治療失眠80例療效觀察[J];遼寧中醫(yī)雜志;2007年12期

8 宋輝;李登科;;耳針配合體針治療呃逆65例[J];四川中醫(yī);2008年05期

9 顧玉娟;;多功能美容針加體針治療痤瘡45例[J];中國中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2011年10期

10 謝才軍;王謙;韓富;黃濤;張志強;;耳針結(jié)合體針治療椎基底動脈供血不足性眩暈的臨床觀察[J];醫(yī)學(xué)信息(上旬刊);2011年06期

相關(guān)會議論文 前10條

1 許健鵬;肖淑杰;郭華珍;;頭部圍針加體針治療偏癱認(rèn)知障礙的臨床觀察[A];第四次全國中西醫(yī)結(jié)合神經(jīng)系統(tǒng)疾病學(xué)術(shù)研討會論文集[C];2002年

2 田永萍;;耳針配合體針治療帶狀皰疹45例臨床觀察[A];第12屆全國耳穴診治學(xué)術(shù)研討會論文匯編[C];2009年

3 秦宏;東貴榮;;耳針結(jié)合體針治療肱骨外上髁炎[A];中國針灸學(xué)會2009學(xué)術(shù)年會論文集（下集）[C];2009年

4 史佳;唐南淋;李丹丹;李向榮;石學(xué)慧;嚴(yán)杰;吳清明;;頭針結(jié)合體針治療腦卒中后肩手綜合征臨床觀察[A];2010湖南省針灸學(xué)術(shù)年會資料匯編[C];2010年

5 王民集;張磊;孫滿長;王飛;吉云鵬;;耳針為主配合體針治療血管性癡呆60例[A];2011中國針灸學(xué)會年會論文集（摘要）[C];2011年

6 周薇;周仲瑜;;頭針加體針治療血管性癡呆的臨床觀察[A];2011中國針灸學(xué)會年會論文集（摘要）[C];2011年

7 周薇;周仲瑜;;頭針加體針治療血管性癡呆的臨床觀察[A];中國針灸學(xué)會臨床分會全國第十九屆針灸臨床學(xué)術(shù)研討會論文集[C];2011年

8 齊曉靜;蔡宗升;;頭針聯(lián)合體針治療中風(fēng)偏癱60例[A];中國康復(fù)醫(yī)學(xué)會療養(yǎng)康復(fù)專業(yè)委員會2008年學(xué)術(shù)會議論文匯編[C];2008年

9 徐向昱;巨劍玲;;翳風(fēng)穴位注射配合體針治療面神經(jīng)炎療效觀察[A];中國中醫(yī)藥學(xué)會基層中醫(yī)藥會議�？痆C];1997年

10 馬文珠;張藝萌;陳蓓琪;;針刺減肥的處方規(guī)律的探討[A];2011中國針灸學(xué)會年會論文集（摘要）[C];2011年

相關(guān)重要報紙文章 前1條

1 本報實習(xí)記者 王輝;四法結(jié)合治偏癱[N];健康時報;2004年

相關(guān)博士學(xué)位論文 前3條

1 許祥發(fā);頭針配合體針治療腦卒中偏癱的臨床研究[D];廣州中醫(yī)藥大學(xué);2015年

2 沈家興;方氏頭皮針結(jié)合體針治療心腎不交型失眠的臨床療效觀察[D];廣州中醫(yī)藥大學(xué);2016年

3 白鵬;頭穴電刺激聯(lián)合體針治療急性期重度Bell麻痹的臨床研究[D];北京中醫(yī)藥大學(xué);2007年

相關(guān)碩士學(xué)位論文 前10條

1 錢箐箐;腹針結(jié)合體針治療肝郁氣滯型黃褐斑的臨床療效觀察[D];浙江中醫(yī)藥大學(xué);2015年

2 程巖;眼針配合體針治療心脾兩虛型失眠的臨床研究[D];長春中醫(yī)藥大學(xué);2015年

3 呂窈;平衡針聯(lián)合體針治療急性冠脈綜合征的臨床研究[D];廣州中醫(yī)藥大學(xué);2013年

4 許美珍;平衡針配合普通體針治療肩周炎的臨床研究[D];廣州中醫(yī)藥大學(xué);2010年

5 王雪嬌;平衡針配合體針治療肝陽上亢證偏頭痛的臨床研究[D];長春中醫(yī)藥大學(xué);2012年

6 周薇;頭針加體針治療血管性癡呆的臨床觀察[D];湖北中醫(yī)學(xué)院;2009年

7 林俊一;頭針配合體針治療中風(fēng)偏癱臨床研究[D];廣州中醫(yī)藥大學(xué);2013年

8 劉彥廷;腹針療法結(jié)合體針治療中風(fēng)后呃逆的臨床觀察[D];遼寧中醫(yī)藥大學(xué);2012年

9 秦亞冰;頭針配合體針治療心脾兩虛型抑郁癥的臨床觀察[D];黑龍江中醫(yī)藥大學(xué);2013年

10 張慧蘭;耳壓聯(lián)合體針治療椎動脈型頸椎病的理論與臨床研究[D];南京醫(yī)科大學(xué);2007年

，

本文編號：1983621