本文選題：中風(fēng)后抑郁 + 十三鬼穴�。� 參考：《廣州中醫(yī)藥大學(xué)》2016年博士論文

【摘要】：目的：通過與常規(guī)針刺治療為對照組的比較,觀察“針刺十三鬼穴”治療中風(fēng)后抑郁的臨床療效,初步探討針刺十三鬼穴治療中風(fēng)后抑郁的中醫(yī)治療機(jī)理,為臨床中運(yùn)用針灸療法治療中風(fēng)后抑郁提供新思路。方法：本研究課題病例主要是在2014年12月至2015年12月期間至廣東省中醫(yī)院、廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院的就診的門診病人以及住院病人,嚴(yán)格按照納入標(biāo)準(zhǔn)的要求納入60例中風(fēng)后抑郁患者,并按照1：1的比例隨機(jī)分為兩組,分別為針刺十三鬼穴治療組與常規(guī)針刺對照組。針刺十三鬼穴治療組與常規(guī)針刺組對照組兩組中風(fēng)后抑郁患者患者在接受針刺治療前統(tǒng)一接受一定的基礎(chǔ)治療,在此基礎(chǔ)上,針刺十三鬼穴治療組的中風(fēng)后抑郁病例的針刺主穴選用唐代著名醫(yī)家孫思邈的經(jīng)驗(yàn)穴“十三鬼穴”基礎(chǔ)并剔除臨床實(shí)際操作穴位選取不便及患者接受難易程度的海泉及會陰兩穴,并按特定的鬼穴針刺順序進(jìn)行針刺。常規(guī)針刺對照組則參照王華主編的《針灸學(xué)》中有關(guān)郁證的治療處方選取相關(guān)穴位進(jìn)行常規(guī)針刺。針刺十三鬼穴組治療組與常規(guī)針刺組對照組的中風(fēng)后抑郁患者每天接受的針刺治療的次數(shù)為1次,連續(xù)完成10次針刺治療為1個療程,整個研究所有中風(fēng)后抑郁病例需完成2個療程的治療,在治療前后對針刺十三鬼穴治療組與常規(guī)針刺對照組兩組的中風(fēng)后抑郁患者采用不同療效指標(biāo)對抑郁狀態(tài)、神經(jīng)功能缺損,日常生活能力三個方面的的改善情況進(jìn)行測評。其中24項(xiàng)漢密爾頓抑郁量表(HAMD)評估針刺十三鬼穴療法和常規(guī)針刺療法各自對中風(fēng)后抑郁患者抑郁狀態(tài)的改善程度；改良愛丁堡-斯堪的那維亞神經(jīng)功能缺損評分量表(MESSS)評估針刺十三鬼穴療法和常規(guī)針刺療法各自對中風(fēng)后抑郁患者神經(jīng)功能缺損方面的改善程度；日常生活活動能力量表(BI)評估針刺十三鬼穴療法和常規(guī)針刺療法各自對中風(fēng)后抑郁患者日常生活能力方面的改善程度。本研究的臨床總療效標(biāo)準(zhǔn)參照《精神科評定量表手冊》有關(guān)中風(fēng)后抑郁的療效評定標(biāo)準(zhǔn),在本研究中,所有的研究的數(shù)據(jù)都采用SPSS20.0統(tǒng)計軟件進(jìn)行處理及統(tǒng)計分析。結(jié)果：1.治療前針刺十三鬼穴治療組與常規(guī)針刺對照組的病例兩組間的基本資料(性別、年齡、病程、中風(fēng)類別、HAMD、MESSS、BI評分量表評分)經(jīng)統(tǒng)計學(xué)統(tǒng)計分析比較,差異無統(tǒng)計學(xué)意義(P0.05)。表面治療前針刺十三鬼穴組與常規(guī)針刺組的病例兩組間的基本資料具有可比性。2.完成了2個療程的治療后,我們將針刺十三鬼穴治療組與常規(guī)針刺對照組兩組治療后的HAMD、MESSS、BI評分量表評分與治療前的評定結(jié)果分別進(jìn)行組內(nèi)比較發(fā)現(xiàn),差異有統(tǒng)計學(xué)意義(P0.05),且針刺十三鬼穴治療組與常規(guī)針刺對照組治療后HAMD、MESSS評分量表中的總積分比治療前總積分有所下降,BI評分量表中的總積分較治療前總積分有所上升,研究結(jié)果表明針刺十三鬼穴療法和常規(guī)針刺療法各自對中風(fēng)后抑郁患者的抑郁狀態(tài)、神經(jīng)功能缺損以及日常生活能力方面均有一定的改善作用。3.完成了2個療程的治療后,我們將針刺十三鬼穴治療組與常規(guī)針刺對照組治療后的HAMD、MESSS、BI評分量表總的評分進(jìn)行組間比較發(fā)現(xiàn),差異具有統(tǒng)計學(xué)意義(P0.05),針刺十三鬼穴治療組治療后HAMD、MESS評分量表的總分低于常規(guī)針刺對照組的HAMD、MESSS評分量表的總分；針刺十三鬼穴治療組治療后BI評分量表的總分高于常規(guī)針刺對照組的BI評分量表的總分,研究結(jié)果表明在對中風(fēng)后抑郁患者的抑郁狀態(tài)、神經(jīng)功能缺損以及日常生活能力方面的改善方面,針刺十三鬼穴療法的改善效果優(yōu)于常規(guī)針刺療法的改善效果。4.完成了2個療程的治療后,我們將針刺十三鬼穴治療組與常規(guī)針刺對照組兩組臨床療效進(jìn)行統(tǒng)計分析,結(jié)果顯示針刺十三鬼穴治療組臨床總有效率為86.67%,其中針刺十三鬼穴治療組的痊愈的病例數(shù)為4例,顯效的病例數(shù)為15例,有效的病例數(shù)為7例,無效的病例數(shù)為4例；常規(guī)針刺對照組臨床總有效率為70.00%,其中常規(guī)針刺對照組的痊愈的病例數(shù)為3例,顯效的病例數(shù)為7例,有效的病例數(shù)為11例,無效的病例數(shù)為9例；針刺十三鬼穴組與常規(guī)針刺組兩組的臨床療效的差異有統(tǒng)計學(xué)意義(P0.05),研究結(jié)果表明針刺十三鬼穴療法治療中風(fēng)后抑郁的總臨床療效優(yōu)于常規(guī)針刺治療中風(fēng)后抑郁的總臨床療效。結(jié)論：針刺十三鬼穴治療組和常規(guī)針刺對照組治療中風(fēng)后抑郁都有一定臨床療效,但針刺十三鬼穴組治療中風(fēng)后抑郁的臨床總療效比常規(guī)針刺組更佳,而且在改善抑郁狀態(tài)、神經(jīng)功能缺損,提高日常生活能力方面,針刺十三鬼穴治療組優(yōu)于常規(guī)針刺組,故針刺十三鬼穴是臨床治療中風(fēng)后抑郁有效的療法之一,值得臨床推廣。
[Abstract]:Objective: To observe the clinical effect of "acupuncture thirteen ghost point" on the treatment of post apoplectic depression by comparison with the conventional acupuncture treatment group, and discuss the mechanism of TCM treatment of acupuncture at thirteen ghost points for the treatment of post apoplectic depression, and provide new ideas for the treatment of post apoplectic depression in clinical practice. Method: the subject of this study is the main case. 60 cases of post apoplectic depression were included in Guangdong Province Traditional Chinese Medical Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the hospitalized patients at the First Affiliated Hospital of Guangzhou University of Chinese Medicine in the period from December 2014 to December 2015. The patients were randomly divided into two groups according to the proportion of 1:1, respectively, the acupuncture thirteen ghosts treatment group and the routine treatment group. The acupuncture control group. The two groups of post apoplectic depression patients in the thirteen ghosts treatment group and the conventional acupuncture group received a certain basic treatment before receiving the acupuncture treatment. On this basis, the acupuncture main points of the post apoplectic post apoplectic depression cases in the thirteen ghosts acupoint treatment group were selected by the famous doctor Sun Simiao in the Tang Dynasty "thirteen points". Hai Quan and two points of the perineum, which are inconvenient to select the acupoints in clinical practice, are removed from the clinical practice, and the patients receive two points of the perineum, which are difficult and easy to accept. The number of acupuncture treatment for post apoplectic depression patients in group treatment group and routine acupuncture group was 1 times a day, and 10 consecutive acupuncture treatments were 1 courses. The whole study of all postapoplectic depression cases needed 2 courses of treatment. Before and after treatment, two groups of acupuncture thirteen ghosts treatment group and conventional acupuncture control group were treated. The patients with depression were evaluated with three aspects of depression, nerve function defect and daily living ability with different therapeutic targets. 24 Hamilton Depression Scale (HAMD) was used to evaluate the improvement of the depressive state of the patients with post apoplectic depression by acupuncture thirteen ghosts and conventional acupuncture. DDF - Scandinavian nerve function defect scale (MESSS) was used to evaluate the improvement of nerve function defects in patients with post apoplectic depression by acupuncture thirteen ghosts and conventional acupuncture. The daily living ability scale (BI) assessed the thirteen ghosts and conventional acupuncture treatments for post apoplectic depression. The degree of improvement in daily living ability. The standard of clinical total efficacy of this study was referred to the psychiatric rating scale manual for the evaluation of the efficacy of post apoplectic depression. In this study, all the data were processed and statistically analyzed by SPSS20.0 software. Results: 1. pre treatment acupuncture thirteen ghosts acupoint treatment group The basic data (sex, age, course of disease, stroke category, HAMD, MESSS, BI score scale) between the two groups of the conventional acupuncture control group were not statistically significant (P0.05). The basic data between the two groups of the thirteen ghosts and the conventional acupuncture groups before the surface treatment were comparable to the.2. completion After 2 courses of treatment, we found that the HAMD, MESSS, BI score of the acupuncture thirteen ghosts and the conventional acupuncture control group were compared with the evaluation results before the treatment, and the difference was statistically significant (P0.05), and the acupuncture group in the acupuncture group and the conventional acupuncture control group were HAMD, MESSS after the treatment. The total integral in the score scale was lower than the total integral before the treatment. The total integral in the BI scale was higher than that before the treatment. The results showed that the acupuncture thirteen ghost point therapy and the conventional acupuncture treatment had certain changes in the depressive state of the patients with post apoplectic depression, the loss of nerve function and the daily living ability. After 2 courses of treatment were completed by.3., we compared the total score of HAMD, MESSS and BI score in the acupuncture thirteen ghosts treatment group and the conventional acupuncture control group. The difference was statistically significant (P0.05), and the total score of the MESS score was lower than that of the conventional acupuncture at the thirteen ghosts treatment group, and the total score of the MESS score was lower than that of the conventional acupuncture. The total score of the HAMD and MESSS score in the control group; the total score of the BI score in the acupuncture thirteen ghosts treatment group was higher than the total score of the BI score in the conventional acupuncture control group. The results showed that the depressive state of the patients with post apoplectic depression, the impairment of nerve function and the daily living ability were improved, and the thirteen ghosts were needled. The effect of acupoint therapy is better than the improvement effect of conventional acupuncture. After 2 courses of treatment completed by.4., the clinical curative effect of two groups of acupuncture thirteen ghosts treatment group and conventional acupuncture control group is statistically analyzed. The results show that the total effective rate of acupuncture at thirteen ghosts acupoint treatment group is 86.67%, of which the acupuncture thirteen ghosts acupoint treatment group is in the treatment group. The number of cured cases was 4 cases, the number of effective cases was 15 cases, the number of effective cases was 7 cases and the number of invalid cases was 4 cases. The total clinical effective rate of the conventional acupuncture control group was 70%, of which 3 cases were cured in the conventional acupuncture control group, 7 cases were markedly effective cases, the effective cases were 11 cases, the number of invalid cases was 9 cases, and the number of invalid cases was 9 cases. Thirteen the difference between the thirteen ghosts group and the two groups of the conventional acupuncture group has a significant difference (P0.05). The results of the study show that the total clinical effect of acupuncture thirteen ghosts therapy on post apoplectic depression is better than that of the conventional acupuncture treatment for post apoplectic depression. Conclusion: the treatment group of acupuncture at thirteen ghosts and the routine acupuncture control group are treated with acupuncture. Depression after wind has a certain clinical effect, but the clinical curative effect of acupuncture thirteen ghosts group is better than that of the conventional acupuncture group in the treatment of post apoplectic depression, and the acupuncture thirteen ghost acupoint treatment group is better than the conventional acupuncture group in improving the depression state, nerve function defect and improving the daily living ability. Therefore, acupuncture at thirteen ghost points is a clinical treatment after apoplexy. One of the effective therapies for depression is worthy of clinical promotion.
【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

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