耳穴压丸配合认知行为疗法对耳鸣的临床疗效观察及相关证型分析

发布时间：2018-06-12 22:47

本文选题：耳鸣 + 耳穴压丸　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：观察耳穴压丸配合认知行为疗法对耳鸣的疗效并分析其相关证型,探讨耳穴压丸配合认知行为治疗耳鸣在临床中发挥的作用,并分析耳鸣疗效与相关因素的关系,寻求一种简易、经济、有效、低风险的耳鸣治疗方式,为耳鸣的治疗提供更多的临床依据。方法：对符合纳入标准的以耳鸣为第一主诉的35例患者予以耳穴压丸配合认知行为治疗。压丸穴位以神门、交感、皮质下、内耳、外耳为主穴,辨证取穴：风邪外侵加肺、大肠；肝郁气滞,肝火上扰者加肝、心；脾虚下陷,肾精不足者加脾、内分泌、肾；痰火郁结加三焦、大肠、脾。随症取穴：耳鸣忽轻忽重加耳背肾；因睡眠不佳而加重加耳背心；血脂高、血管硬化加内分泌。嘱患者每日自行按压(揉)3-5次,每次每穴50至80次,以出现酸、胀、热、麻为度,每次贴患耳(单侧或双侧),保留3日,休息1天,一周2次,5次为1个疗程,共2个疗程,在1个疗程和2个疗程结束后评价。治疗期间同时配合认知行为疗法。1个疗程、2个疗程分别观察患者耳鸣积分及生存质量等,记录相关数据,应用SPASS19.0统计软件对所得数据进行统计学处理。结果：经过统计分析软件处理,(1)总样本中治疗1个疗程后的有效率为51.4%,治疗2个疗程后的有效率为80%,P0.05,差异具有统计学意义。(2)总体样本中,THI评分在治疗1个疗程及2个疗程后,P0.05,差异具有统计学意义。(3)耳鸣在肝火上扰、痰火郁结、脾胃虚弱、肾精亏损这四型中分布及疗效无统计学差异。(4)疗效与病程、年龄、性别的关系,治疗1个疗程、2个疗程差异均无统计学意义。(5)经等级相关性检验,耳鸣严重程度分级与生存质量之间的关系呈正相关性,且随治疗周期增长,相关性越高。结论：(1)耳穴压丸配合行为认知行为治疗有助于耳鸣的缓解和提高相关的生活质量(尤其是情绪方面的和社会功能方面的)。(2)耳鸣的程度以及患者的耐受度与生活质量相互影响,尤其是睡眠障碍、烦躁、愤怒、抑郁方面。(3)耳鸣的宣教对患者正确认识耳鸣并接受耳鸣有极重要的作用,在排除重大疾病后,通过耳鸣的宣教及心理咨询,有部分患者表示可以不需要治疗。(4)本方案中性别、年龄、病程、证型、耳鸣能否匹配与疗效的关系并不明显。
[Abstract]:Objective: to observe the curative effect of auricular acupoint pressing pill combined with cognitive behavior therapy on tinnitus and analyze its related syndromes, explore the role of auricular acupoint pressing pill combined with cognitive behavior in the treatment of tinnitus, and analyze the relationship between the curative effect of tinnitus and related factors. To seek a simple, economical, effective and low risk tinnitus treatment, to provide more clinical basis for the treatment of tinnitus. Methods: 35 patients with tinnitus as the first complaint were treated with auricular pressing pill combined with cognitive behavior. The acupoints of pressure Pill are Shenmen, sympathetic, subcortical, inner ear and external ear. The main points are as follows: wind evil invades the lung and large intestine; liver and qi stagnation, liver fire is disturbed, liver, heart; spleen deficiency depression, kidney essence deficiency plus spleen, endocrine, kidney; Phlegm and fire stagnation plus tri-Jiao, large intestine, spleen. With the syndrome of acupoints: tinnitus light and heavy plus the back of the ear kidney; because of poor sleep aggravated plus ear vest; hyperlipidemia, vascular sclerosis plus endocrine. Patients were told to press themselves daily (kneading 3-5 times, 50 to 80 times each time) in order to appear acid, swelling, heat, hemp, sticking to the affected ears (unilateral or bilateral) for 3 days, rest for 1 day, 2 times a week for 5 times as a course of treatment, 2 courses of treatment, 2 times a week, 2 times a week for a course of treatment, 2 times a week for a course of treatment, a total of 2 courses of treatment. It was evaluated after one course of treatment and two courses of treatment. One course of treatment and two courses of treatment were used to observe the score of tinnitus and quality of life, to record the relevant data, and to use SPASS 19.0 statistical software to process the data. Results: the effective rate after one course of treatment was 51.4 in the total sample treated by statistical analysis software, and the effective rate was 80 P0.05 after two courses of treatment. The difference was statistically significant. After two courses of treatment, the difference was statistically significant (P 0.05). The tinnitus was disturbed on the liver fire. There was no significant difference in the distribution and efficacy of phlegm and fire stagnation, deficiency of spleen and stomach, deficiency of kidney essence. 4) the relationship between curative effect and course of disease, age, sex, treatment for one course of treatment, the difference of two courses of treatment were not statistically significant. There was a positive correlation between the severity of tinnitus and quality of life, and the higher the correlation was with the increase of treatment cycle. Conclusion1) combined with Behavioral Cognitive and Behavioral treatment, it is helpful to relieve tinnitus and improve the related quality of life (especially emotional and social function), as well as the influence of patient's tolerance and quality of life. In particular, sleep disorders, irritability, anger, depression and other aspects of tinnitus play a very important role in the patient's correct understanding of tinnitus and receiving tinnitus. Some patients indicated that there was no need for treatment.) the relationship between gender, age, course of disease, syndrome type, tinnitus matching and curative effect was not obvious.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R276.1

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