發(fā)布時間：2018-06-20 13:59

  本文選題：針感 + 原發(fā)性痛經(jīng)�。� 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:初步探究單純性肥胖病、原發(fā)性痛經(jīng)兩種不同性質(zhì)疾病患者的針感與臨床療效之間的關(guān)系;不同性質(zhì)疾病相同穴位的針感差異比較;為假針刺試驗設(shè)計方法提供思路。方法:納入單純性肥胖病患者30例,每周治療3次,隔日一次,每個療程治療10次,每次治療30min,每1Omin行針一次。2個療程后觀察患者體質(zhì)量(W)、肥胖度(A%)、體質(zhì)指數(shù)(BMI)、體脂百分率(F%)、胸圍(cm)、腰圍(cm)、髖圍(cm)、股圍(cm)的指標(biāo)變化。針感的記錄應(yīng)用改良的針刺刺激量的規(guī)則(M-QNS)以及針刺刺激量一效應(yīng)調(diào)查表(F-QNS-E),分別記錄左側(cè)上肢曲池穴、腹部天樞穴、下肢足三里穴每次治療行針一次時的"最強(qiáng)針感",內(nèi)容包括:①針感類型:局部針感(痛感或和非痛感)和循經(jīng)感傳,②針感強(qiáng)度:采用視覺模擬評分法(VAS)按0~10等級記錄針感強(qiáng)度。2個療程結(jié)束后,計算每位患者針感強(qiáng)度平均值、循經(jīng)感傳出現(xiàn)次數(shù)、痛感出現(xiàn)次數(shù),統(tǒng)計分析單純性肥胖病患者針感與臨床療效的關(guān)系。納入原發(fā)性痛經(jīng)患者30例,填寫痛經(jīng)主觀積分量表,予針灸持續(xù)治療2個月經(jīng)周期,在月經(jīng)來潮的第25-27天進(jìn)行,連續(xù)治療3~5天,第2個周期行經(jīng)結(jié)束時再次填寫痛經(jīng)主觀積分量表,采用尼莫地平法,計算減分率,判斷療效。針感記錄方法同單純性肥胖病患者,研究主穴取腹部關(guān)元、左側(cè)下肢足三里和三陰交。數(shù)據(jù)綜合處理后,統(tǒng)計分析原發(fā)性痛經(jīng)患者針感與臨床療效的關(guān)系。結(jié)果:針灸治療單純性肥胖病患者總有效率為90%,各項指標(biāo)較治療前均顯著下降,P㩳0.01。單純性肥胖病患者各穴非痛感強(qiáng)度比較中足三里、天樞差異有統(tǒng)計學(xué)意義,P㩳0.01;循經(jīng)感傳率中天樞與曲池、足三里比較均有統(tǒng)計學(xué)意義,P㩳0.01;痛感出現(xiàn)率中曲池與足三里間差異有統(tǒng)計學(xué)意義,P㩳0.01。曲池、天樞、足三里非痛感強(qiáng)度、循經(jīng)感傳率、痛感出現(xiàn)率與療效之間均無相關(guān)性,P㩳O.05。針灸治療原發(fā)性痛經(jīng)患者總有效率為90%。痛經(jīng)患者非痛感強(qiáng)度及循經(jīng)感傳率比較中足三里、三陰交與關(guān)元比較差異有統(tǒng)計學(xué)意義,均P㩳0.01;痛感出現(xiàn)率中,關(guān)元、三陰交與足三里差異有統(tǒng)計學(xué)意義,P㩳0.01。關(guān)元、足三里、三陰交穴非痛感強(qiáng)度、循經(jīng)感傳率、痛感出現(xiàn)率與療效之間均無相關(guān)性,P㩳0.05。足三里穴針感在原發(fā)性痛經(jīng)及單純性肥胖病患者中比較,非痛感強(qiáng)度、循經(jīng)感傳率均無差異,P㩳0.05;而原發(fā)性痛經(jīng)患者的足三里穴更易出現(xiàn)痛感,差異有統(tǒng)計學(xué)意義,P㩳0.01。結(jié)論:①尚未發(fā)現(xiàn)單純性肥胖病患者針感強(qiáng)弱(非痛感強(qiáng)度、循經(jīng)感傳率、痛感出現(xiàn)率)與療效有相關(guān)性;②尚未發(fā)現(xiàn)原發(fā)性痛經(jīng)患者針感強(qiáng)弱(非痛感強(qiáng)度、循經(jīng)感傳率、痛感出現(xiàn)率)與療效有相關(guān)性;③足三里在原發(fā)性痛經(jīng)患者針感中更易出現(xiàn)痛感;④關(guān)于假針刺試驗設(shè)計方法的啟示:本研究未發(fā)現(xiàn)針感強(qiáng)弱與療效間的相關(guān)性,既往研究予輕、淺刺激作為對照試驗設(shè)計的方法有待進(jìn)一步商榷。
[Abstract]:Objective: to explore the relationship between acupuncture sensation and clinical efficacy in patients with simple obesity and primary dysmenorrhea, to compare the difference of acupuncture sensation at the same acupoints of different diseases, and to provide ideas for the design of pseudoacupuncture test. Methods: 30 patients with simple obesity were treated 3 times a week, once every other day, 10 times per course of treatment. After two courses of treatment, we observed the changes of body weight, fat and fat, body mass index (BMI), body fat percentage (F), chest circumference (cm), waist circumference (cm), hip circumference (cm) and femoral circumference (cm). The acupuncture sensation was recorded by the modified regular acupuncture stimuli (M-QNSs) and the F-QNS-E5 by the questionnaire of acupuncture stimulation-effect. The points of the left upper limb were recorded, respectively, and the abdominal Tianshu points were recorded, respectively. The "strongest needling feeling" of Zusanli acupoint in the lower extremity, which includes the types of needle sensation: local acupuncture (pain or non-pain) and meridian transmission. (2) Needle intensity: visual analogue score was used to record the needling intensity according to grade 0 ~ 10. After two courses of treatment, the average needling intensity of each patient, the number of times of appearing along meridian sensation, the number of times of occurrence of pain, and the number of times of occurrence of pain were calculated. The relationship between acupuncture sensation and clinical efficacy in patients with simple obesity was analyzed statistically. Thirty patients with primary dysmenorrhea were enrolled in the study. The subjective integral scale of dysmenorrhea was filled out, and acupuncture was given for 2 menstrual cycles, which were performed on the 25-27 days of menstrual menorrhagia for 3 to 5 consecutive days. At the end of the second cycle, the subjective integral scale of dysmenorrhea was filled out again, and Nimodipine method was used to calculate the reduction rate and to judge the curative effect. The method of acupuncture recording was the same as simple obesity. The main points were collected from abdominal Guan Yuan, left leg Zusanli and Sanyinjiao. After comprehensive treatment, the relationship between acupuncture sensation and clinical efficacy in patients with primary dysmenorrhea was analyzed statistically. Results: the total effective rate of acupuncture and moxibustion in treating simple obesity patients was 90. Comparison of non-pain intensity at different acupoints in patients with simple obesity, there was significant difference in Tianshu between Zusanli and Zusanli, and there was a significant difference between Tianshu and Quchi along the meridian. There were significant differences between Zusanli and Zusanli in the incidence of pain, and the difference between Zusanli and Zusanli was statistically significant. Quchi, Tianshu, Zusanli non-pain intensity, along the meridian sensory transmission rate, the incidence of pain and curative effect were not correlated with P0. 05. The total effective rate of acupuncture and moxibustion in treating primary dysmenorrhea was 90. There was significant difference between Zusanli, Sanyinjiao and Guan Yuan in patients with dysmenorrhea (P < 0.01), but there was significant difference in the occurrence rate of pain between Guanyuan, Sanyinjiao and Zusanli in dysmenorrhea patients. There was no correlation between the non-pain intensity, the transmission rate along the meridian, the occurrence rate of pain and the curative effect of Guan Yuan, Zusanli and Sanyinjiao. There was no difference in the intensity of non-pain and the rate of transmission along meridians in patients with primary dysmenorrhea and simple obesity, while in patients with primary dysmenorrhea, pain was more likely to occur at Zusanli (P < 0.01). Conclusion there is no correlation between acupuncture intensity (non-pain intensity, transmission rate along meridian, occurrence rate of pain) and curative effect in patients with simple obesity. (2) there is no significant correlation between acupuncture intensity (non-pain intensity, transmission rate along meridian) and effect in primary dysmenorrhea patients. There is a correlation between the occurrence rate of pain and the curative effect. In patients with primary dysmenorrhea, pain is more likely to appear in the acupuncture sense. 4. The enlightenment of pseudoacupuncture test design method: this study has not found the correlation between the strength of acupuncture and the curative effect. Previous studies on light and shallow stimuli as a control trial design methods need to be further discussed.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246

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