發(fā)布時間：2018-07-25 11:17

【摘要】：目的:本課題在針灸治療中風病的基礎上,針對中風后焦慮狀態(tài)以“心腦同治”為基本治療原則,采用情志針法(即以四神針、定神針、內關、神門、三陰交為主穴)配合徵調式樂曲與常規(guī)西藥治療作對照,觀察兩種方法對腦卒中后焦慮患者治療的臨床療效。方法:收集符合診斷標準中風后焦慮患者,采取患者單盲法,按就診順序隨機數(shù)字表法分為治療組、對照組。兩組均在中風病常規(guī)針灸治療基礎上進行干預,治療組予以情志針法(即以四神針、定神針、內關、神門、三陰交為主穴)配合徵調式樂曲療法,對照組采用口服西藥帕羅西汀,以漢密爾頓焦慮量表(HAMA)為主要觀察指標,輔以Zung氏焦慮自評量表(SAS)、生活自理能力評定Barthel指數(shù)(BI),來判定兩種干預方法治療中風后焦慮障礙的臨床療效,HAMA、SAS、BI在治療前、治療第2、4、6周末各評定一次;治療后3個月隨訪時,用HAMA、BI進行評定。運用TESS副反應量表在治療2、4、6周末各評定一次,觀察研究過程中的不良反應發(fā)生情況。結果:1.治療前兩組HAMD、SAS、BI評分差異無統(tǒng)計學意義(P0.05)。治療2周末兩組HAMD、SAS、BI評分和治療前比較,差異均有統(tǒng)計學意義(P0.01),組間比較HAMD、SAS、BI評分差異無統(tǒng)計學意義(P0.05);治療4周末兩組HAMD、SAS、BI評分和治療前比較,差異均有統(tǒng)計學意義(P0.01),組間比較HAMD、SAS、BI評分差異無統(tǒng)計學意義(P0.05);治療6周末兩組治療4周末HAMD、SAS、BI評分和治療前比較,差異均有統(tǒng)計學意義(P0.01),組間比較HAMD、SAS、BI評分差異無統(tǒng)計學意義(P0.05)。2.兩組HAMA三因子(精神性焦慮因子、軀體焦慮因子及睡眠因子)評分與治療前相比,差異均有統(tǒng)計學意義(P0.01),治療期間觀察兩組之間HAMD精神性焦慮因子、睡眠因子評分差異無統(tǒng)計學意義(P0.05)。治療第2周末至第4周末兩次組間軀體性焦慮因子評分差異無統(tǒng)計學意義(P0.05),治療6周末兩組間比較評分差異有統(tǒng)計學意義(P0.05)。3.以治療后HAMA減分率判定兩組療效,治療組的顯效率為55.17%,總有效率為89.66%;對照組的顯效率為33.33%,總有效率為85.61%。結果經非參數(shù)秩和檢驗統(tǒng)計學分析,治療組的總體療效和對照組相比較有統(tǒng)計學差異(Z=-1.968,P=0.0490.05),治療組的總體療效優(yōu)于對照組。4.兩組治療第2、4、6周末TESS分值有顯著性差異(P0.01),治療組與對照組相比副作用發(fā)生少。5.治療后3個月隨訪,兩組HAMA、BI評分比較,差異無統(tǒng)計學意義(P0.05)。兩組在精神性焦慮因子、睡眠因子方面均無顯著性差異(P0.05);而治療組軀體性焦慮因子得分低于對照組,有顯著性差異(P0.05)。結論:情志針法配合徵調式音樂治療中風后焦慮障礙的整體療效優(yōu)于口服西藥帕羅西汀,尤其針對軀體性焦慮優(yōu)勢明顯,同時副反應發(fā)生較西藥為少,且遠期療效穩(wěn)定。
[Abstract]:Objective: on the basis of acupuncture and moxibustion treatment of apoplexy, according to the basic treatment principle of "heart and brain treatment" in post-stroke anxiety state, the method of emotional acupuncture was adopted (that is, four mind acupuncture, fixed spirit acupuncture, Neiguan, Shenmen). Sanyinjiao (the main point) and the routine western medicine were used to observe the clinical efficacy of the two methods in the treatment of post-stroke anxiety patients. Methods: patients with post-stroke anxiety were collected and divided into treatment group and control group. On the basis of routine acupuncture and moxibustion treatment for apoplexy, the two groups were treated with emotional acupuncture (that is, four mind acupuncture, fixed mind acupuncture, Neiguan, Shenmen, Sanyinjiao as the main points) and the music therapy. The control group was treated with oral paroxetine and the Hamilton anxiety scale (HAMA) was used as the main observation index. The clinical efficacy of two intervention methods in the treatment of post-stroke anxiety disorder was evaluated with Zung's self-rating anxiety scale (SAS),) (SAS), self-care ability assessment Barthel index (BI),. Before treatment, at the end of the 2nd week of treatment, and at the end of the 6th week, the patients were followed up at 3 months after treatment. The evaluation was carried out with Hamamax BI. The side effects were assessed once at the end of 6 weeks by TESS's side effects scale. The adverse reactions were observed during the course of the study. The result is 1: 1. There was no significant difference between the two groups before treatment (P0.05). At the end of 2 weeks after treatment, there were significant differences between the two groups in the scores of HAMD-SASBI and before treatment (P0.01), but there was no significant difference in the scores of HAMD-SASBI between the two groups (P0.05), and at the end of 4 weeks, the scores of HAMD-SASBI in the two groups were compared with those before treatment. The differences were statistically significant (P0.01), there was no significant difference in the scores of HAMD-SASBI between groups (P0.05), the scores of HAMD-SASBI at the end of 6 weeks and before treatment were all statistically significant (P0.01), and there was no significant difference in scores of HAMD-SASBI between groups (P0.05). 2. The scores of three factors of HAMA (mental anxiety factor, somatic anxiety factor and sleep factor) in the two groups were significantly different from those before treatment (P0.01). During the treatment period, the mental anxiety factor of HAMD was observed between the two groups. There was no significant difference in sleep factor score (P0.05). There was no significant difference in the scores of somatic anxiety between the two groups from the 2nd to 4th weekend (P0.05), but there was significant difference between the two groups at the end of 6 weeks (P0.05). The effective rate of the treatment group was 55.177.The total effective rate was 89.660.The effective rate of the control group was 33.333.The total effective rate was 85.61. Results by non-parametric rank sum test, the total curative effect of the treatment group was significantly different from that of the control group (Z ~ (-1.968) P ~ (0.049) 0.05), and the total curative effect of the treatment group was better than that of the control group. There was a significant difference in TESS scores between the two groups at the end of the 6th week (P0.01). The side effects in the treatment group were less than those in the control group. After 3 months follow-up, there was no significant difference between the two groups (P0.05). There was no significant difference in mental anxiety factor and sleep factor between the two groups (P0.05), while the score of somatic anxiety factor in the treatment group was lower than that in the control group (P0.05). Conclusion: the overall curative effect of emotion acupuncture combined with music therapy for post-stroke anxiety disorder is better than that of oral paroxetine, especially for somatic anxiety, and the side effects are less than those of western medicine, and the long-term curative effect is stable.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6

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