本文選題：得氣 + HAMA量表�。� 參考：《北京中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的1.得氣與經(jīng)穴效應(yīng)關(guān)系研究：以寒濕凝滯證原發(fā)性痛經(jīng)(Primary dysmenorrhea,PD)患者為研究對(duì)象,通過(guò)隨機(jī)對(duì)照試驗(yàn)與得氣二次評(píng)價(jià)相結(jié)合的設(shè)計(jì),研究毫針不同刺法干預(yù)產(chǎn)生的得氣與不得氣對(duì)三陰交穴鎮(zhèn)痛效應(yīng)及緩解焦慮效應(yīng)的影響,了解得氣與經(jīng)穴效應(yīng)的關(guān)系,為臨床科學(xué)應(yīng)用和豐富得氣理論提供循證醫(yī)學(xué)依據(jù)。2.得氣部分機(jī)體影響因素研究：通過(guò)評(píng)價(jià)寒凝證PD患者非經(jīng)期時(shí)的植物神經(jīng)功能和焦慮狀態(tài),觀察痛經(jīng)發(fā)作時(shí)毫針不同刺法干預(yù)三陰交穴出現(xiàn)的得氣情況,初步探討患者非經(jīng)期時(shí)的生理功能和心理狀態(tài)對(duì)痛經(jīng)發(fā)作時(shí)針刺得氣的影響。方法納入68例寒凝證PD患者,以1：3的比例隨機(jī)分為期望得氣組17例和期望不得氣組51例,以毫針不同刺法作為兩組的區(qū)別點(diǎn),期望得氣組給予雙側(cè)三陰交穴粗針、深刺、施手法干預(yù),而期望不得氣組則給予雙側(cè)三陰交穴細(xì)針、淺刺、不施手法干預(yù)。于第一次月經(jīng)結(jié)束后3-7天內(nèi)上午8：00-11：00,對(duì)其進(jìn)行植物神經(jīng)功能檢查,根據(jù)公式計(jì)算植物神經(jīng)平衡指數(shù)(夕值)；并囑其回憶月經(jīng)前一周的焦慮狀態(tài),填寫(xiě)HAMA焦慮量表,計(jì)算HAMA總分。于第二次月經(jīng)痛經(jīng)發(fā)作當(dāng)天,以0-100mm的視覺(jué)模擬評(píng)價(jià)量表(VAS)測(cè)量其腹痛程度(VAS-P值),當(dāng)VAS-P值≥40mm時(shí),根據(jù)隨機(jī)方案對(duì)患者雙側(cè)三陰交穴進(jìn)行相應(yīng)的針刺干預(yù),留針30min后起針,并于針刺前、起針即刻、起針后10min、20min和30min分別以VAS量表測(cè)量其腹痛程度(VAS-P值)和焦慮程度(VAS-A值)。起針后,采用本課題組前期編寫(xiě),且經(jīng)過(guò)信度效度檢驗(yàn)的《受試者針感臨床評(píng)價(jià)量表》對(duì)患者實(shí)際得氣與否進(jìn)行二次評(píng)價(jià),根據(jù)評(píng)價(jià)結(jié)果,將期望得氣組患者二次分為實(shí)際得氣組(A組)和實(shí)際不得氣組(B組)、將期望不得氣組患者二次分為實(shí)際得氣組(C組)和實(shí)際不得氣組(D組)VAS值組內(nèi)比較采用配對(duì)樣本t檢驗(yàn)或非參數(shù)檢驗(yàn)；組間比較采用縱向數(shù)據(jù)回歸模型的邊際均數(shù)模型。根據(jù)植物神經(jīng)平衡指數(shù)夕值將患者二次分為植物神經(jīng)功能正常者組(E組),交感神經(jīng)功能增強(qiáng)或亢進(jìn)組(F組)和副交感神經(jīng)功能增強(qiáng)或亢進(jìn)者組(H組)；根據(jù)HAMA總分將患者二次分為可能焦慮或焦慮組(M組)和非焦慮組(N組),采用獨(dú)立樣本t檢驗(yàn)或非參數(shù)檢驗(yàn)對(duì)各組實(shí)際得氣總分進(jìn)行比較；采用卡方檢驗(yàn)對(duì)各組患者的實(shí)際得氣率進(jìn)行比較；實(shí)際得氣患者的植物神經(jīng)平衡指數(shù)夕值、HAMA總分與得氣總分的關(guān)系采用雙變量相關(guān)性分析方法。結(jié)果1.得氣與經(jīng)穴效應(yīng)關(guān)系研究：經(jīng)對(duì)數(shù)據(jù)進(jìn)行整理和分析,發(fā)現(xiàn)其中4例患者針刺前腹痛VAS-P值40mm,8例患者量表評(píng)價(jià)前后矛盾,故剔除這12例數(shù)據(jù),最終納入統(tǒng)計(jì)分析的有效樣本量共計(jì)56例：期望得氣組14例,期望不得氣組42例。其中,期望得氣組實(shí)際得氣者(A組)14例[14/14,100%],期望得氣組實(shí)際不得氣者(B組)0例,期望不得氣組實(shí)際得氣者(C組)25例[25/39,59.5%],期望不得氣組實(shí)際不得氣者(D組)17例[17/39,40.5%]。①基線比較：期望得氣組與期望不得氣組患者治療前年齡、經(jīng)期、月經(jīng)周期、發(fā)病病程以及針刺前VAS-P值和VAS-A值比較均未見(jiàn)明顯差異(P均0.05)。②組內(nèi)比較：B組因樣本量為0而未做統(tǒng)計(jì),期望得氣組、期望不得氣組、A組、C組以及D組起針即刻、起針后10、20、30min的VAS-P值及VAS-A值與針刺前相比均顯著降低,差異具有統(tǒng)計(jì)學(xué)意義(P均0.05)。③組間比較：根據(jù)得氣量表對(duì)得氣實(shí)際情況進(jìn)行二次評(píng)價(jià)后,期望得氣組的實(shí)際得氣率為100%,期望不得氣組的實(shí)際得氣率為59.5%,前者明顯高于后者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。期望得氣組患者腹痛VAS-P值顯著低于期望不得氣組,A組患者腹痛VAS-P值顯著低于D組,A+C組患者腹痛VAS-P值顯著低于B+D組,A組患者腹痛VAS-P值顯著低于C組,差異均具有統(tǒng)計(jì)學(xué)意義(P均0.05)；C組與D組患者腹痛VAS-P值的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。A組患者焦慮VAS-A值顯著低于D組,A+C組患者焦慮VAS-A值顯著低于B+D組,差異均具有統(tǒng)計(jì)學(xué)意義(P均0.05)；期望得氣與期望不得氣組、C組與D組、A組與C組患者焦慮VAS-A值的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P均0.05)。2.得氣部分機(jī)體影響因素研究：根據(jù)植物神經(jīng)平衡指數(shù)夕值將患者二次分為植物神經(jīng)功能正常者(E組)14例[14/56,25%],交感神經(jīng)功能增強(qiáng)或亢進(jìn)者(F組)0例,副交感神經(jīng)功能增強(qiáng)或亢進(jìn)者(H組)42例[42/56,75%]；根據(jù)HAMA焦慮總分將患者二次分為可能焦慮或焦慮者(M組)26例[26/56,46.4%],非焦慮者(N組)30例[30/56,53.6%]。①植物神經(jīng)功能：F組因樣本量為0而未作統(tǒng)計(jì),E組與H組得氣總分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)際得氣率的差異亦無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；各組植物神經(jīng)平衡指數(shù)y值與得氣總分亦無(wú)顯著相關(guān)性(P0.05)。②HAMA焦慮狀態(tài)：M組與N組患者得氣總分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)際得氣率的差異亦無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),各組HAMA.總分與得氣總分亦無(wú)顯著相關(guān)性(P0.05)。結(jié)論1.得氣與經(jīng)穴效應(yīng)關(guān)系的研究：①得氣與不得氣均能增強(qiáng)寒凝證PD患者三陰交穴的鎮(zhèn)痛和緩解焦慮效應(yīng),但得氣更佳；②在毫針粗針、深刺、施手法的綜合干預(yù)下,得氣率更高,得氣率高則鎮(zhèn)痛效應(yīng)和緩解效應(yīng)更佳。2.得氣部分機(jī)體影響因素的研究：非經(jīng)期時(shí)寒凝證PD患者的植物神經(jīng)功能和焦慮狀態(tài)具有一定的規(guī)律,但尚不能認(rèn)為二者是影響痛經(jīng)發(fā)作時(shí)針刺得氣的機(jī)體因素。
[Abstract]:Objective to study the relationship between 1. and the effect of acupoint effect: the patients of Primary dysmenorrhea (PD) with cold damp stagnation syndrome were used as the research object, and the effect of gas and no gas on the analgesic effect and relieving anxiety of the three yin points was studied by the combination of the randomized controlled trial and the two evaluation of gas. To understand the relationship between gas and acupoint effect, to provide evidence based medicine based on.2. for clinical scientific application and rich gas theory. By evaluating the autonomic nervous function and anxiety state of PD patients during the non menstrual period of cold coagulating syndrome, the effects of different prickly needles on the emergence of the three yin acupoints during the episodes of dysmenorrhea were observed. The effect of the physiological function and psychological state of the patients during non menstrual period on the spiny breath of dysmenorrhea was preliminarily investigated. Methods 68 cases of PD patients with cold coagulation syndrome were randomly divided into 17 cases of expectant gas group and 51 cases of expectant no gas group with the proportion of 1:3, with the difference point between the two groups with the different needles of the needles, and the expectant gas group was given bilateral three yin. Cross acupoint thick needles, deep prickles, and manipulation intervention, and expect no gas group to give two side three yin points fine needle, shallow puncture, no manipulation intervention. At 8:00-11:00 in the morning after the first period of the period, the plant nerve function examination, according to the formula calculation of plant nerve balance index (Eve value), and to recall the first week of the month of menstruation In the state of anxiety, the HAMA anxiety scale was filled in and the total score of HAMA was calculated. On the day of second menstrual menstrual dysmenorrhea, the degree of abdominal pain (VAS-P) was measured with the 0-100mm visual analogue scale (VAS). When the VAS-P value was more than 40mm, the corresponding acupuncture intervention was carried out on the patients' bilateral Sanyinjiao acupoints according to the random scheme, and the needle was left to 30min and before the acupuncture. Immediately after the needle, 10min, 20min and 30min were used to measure the degree of abdominal pain (VAS-P) and the degree of anxiety (VAS-A) with the VAS scale respectively. After the needle, the two evaluation was made by the subject group, which was written in the previous group, and the reliability and validity test was used to evaluate the patient's actual gas or not. The patients were divided into the actual gas group (group A) and the actual non gas group (group B). The patients were divided into the actual gas group (group C) and the actual non gas group (group D) with the actual gas group (group A) and the actual non gas group (Group D). The paired sample t test or non parametric test was used in the VAS group. The value of nerve balance index was divided into two times of the patient's group (group E) with normal autonomic nerve function (group F), group of sympathetic nerve function or hyperactivity (group F) and parasympathetic nerve function enhancement or hyperactivity group (group H). According to the total score of HAMA, the patients were divided into possible anxiety or anxiety group (group M) and non anxiety group (group N), using independent sample t test or non The actual gas score of each group was compared by the parameter test; the actual gas rate of each group was compared with the chi square test. The relationship between the total score of HAMA and the total gas score was analyzed by the method of bivariate correlation analysis. Results the relationship between gas and acupoint effect of 1. was studied: through the data After sorting and analyzing, 4 patients were found to have VAS-P value 40mm before acupuncture, and 8 patients were evaluated before and after the assessment. Therefore, the 12 cases were eliminated, and 56 cases were included in the statistical analysis: 14 cases in the expected gas group and 42 cases in the expectation of no gas group, of which 14 cases of [14/14100%] were expected in the expected gas group (group A). Expectation was expected. There were 0 cases (group B), 25 cases of [25/39,59.5%] in group C, and 17 cases of [17/39,40.5%]. (group D) in expectation of no gas group (group D), 17 cases of baseline comparison: the age, menstrual cycle, course of onset, VAS-P value and VAS-A value before acupuncture, the menstrual cycle, the course of onset, and the value of VAS-A. There was no significant difference (P 0.05). In group B, there was no statistics in group B because of the amount of sample, expected gas group, expecting no gas group, A group, C group and D group immediately, the VAS-P value and VAS-A value of 10,20,30min decreased significantly after the needle, and the difference was statistically significant (P 0.05). 3 The actual gas rate of the expected gas group was 100%, the actual gas yield of the expected gas group was 59.5%, the former was significantly higher than the latter, the difference was statistically significant (P0.05). The VAS-P value of abdominal pain in the patients of expected gas group was significantly lower than that of the expected gas group, and the VAS-P value of abdominal pain in group A patients was significant, and the value of abdominal pain in group A was significant. The VAS-P value of abdominal pain in group A+C was significantly lower than that of group B+D, and the VAS-P value of abdominal pain in group A was significantly lower than that in group C (P 0.05), and there was no significant difference between the C group and the D group (P, 0.05), and the anxiety value of the patients in the C group and the D group was significantly lower than that in the group. All of them were statistically significant (P 0.05); there was no statistical difference between group C and group D, group A and group C, and group A and C group (P all 0.05) the influence factors of the air part of.2., according to the night value of the plant nerve balance index, the patients were divided into two cases of normal autonomic nerve function (E group), 14 cases of [14/56,2. 5%], 0 cases of sympathetic nervous function or hyperactivity (group F), 42 cases of [42/56,75%] with enhanced parasympathetic nerve function or hyperactivity (group H); 26 cases of [26/56,46.4%], 30 cases of non anxiety (group N) [30 /56,53.6%]. (group N), 30 cases of [30 /56,53.6%]. (group N), and 30 cases of autonomic nervous function, according to the total score of anxiety and hyperfunction of parasympathetic nerve, and 30 cases of [30 /56,53.6%]. (group N): the F group was not made by the sample size of 0. Statistics showed that there was no significant difference in total gas score between group E and group H (P0.05), and there was no significant difference in the actual gas rate (P0.05), and there was no significant correlation between the y value of the plant nerve balance index and the total gas score (P0.05). (P0.05) HAMA anxiety state: there was no significant difference in the total gas score between the M group and the N group (P0.05), and the actual gas rate was found. There was no statistically significant difference (P0.05), and there was no significant correlation between the total score of HAMA. and the total gas score of each group (P0.05). Conclusion the study of the relationship between Qi and acupoint effect of 1. is that both qi and Qi can enhance the analgesic and relieving anxiety effects of the three Yin points of PD patients with cold coagulation, but get better gas; 2. Under the combined intervention, the results of higher gas rate, higher gas rate, higher gas rate and better effect of analgesia and relieving effect on the body influence factors of.2. were studied: the autonomic nervous function and anxiety state of PD patients in non menstrual period cold coagulating syndrome had certain regularity, but the two were not considered to be the body factors affecting the time needling of dysmenorrhea.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R246

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5 鄭暉;梁繁榮;李瑛;;經(jīng)穴效應(yīng)特異性研究的古代及現(xiàn)代認(rèn)識(shí)[A];中國(guó)針灸學(xué)會(huì)第九屆全國(guó)中青年針灸推拿學(xué)術(shù)研討會(huì)論文集[C];2010年

6 陳婷;謝西梅;蔡定均;周奇志;劉旭光;;經(jīng)穴效應(yīng)特異性研究的新視角——運(yùn)用神經(jīng)肌電圖技術(shù)研究經(jīng)脈體表特異性聯(lián)系[A];2011中國(guó)針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

7 石學(xué)敏;李雅潔;樊小農(nóng);王舒;;經(jīng)穴效應(yīng)特異性及針刺參數(shù)對(duì)效應(yīng)影響的研究——基于“水溝”穴治療腦梗死的研究[A];中國(guó)針灸學(xué)會(huì)2009學(xué)術(shù)年會(huì)論文集（上集）[C];2009年

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