针刺“四关穴”治疗焦虑症的临床疗效观察

发布时间：2018-04-22 07:14

本文选题：焦虑症 + 四关穴　；参考：《南京中医药大学》2017年博士论文

【摘要】：研究目的:本研究充分分析目前国内外的研究进展,发现焦虑症患者临床症状的发生和病情反复可能是由于在肝失疏泄的基础上,出现脏腑、气血、阴阳失调引起,并且睡眠障碍亦是引起病变发生和复发的因素。因此本研究创新性选用常规治疗急重热证、痛症以及癫狂痫症的四关穴来治疗慢性神志疾病,进一步探讨针刺治疗焦虑症的临床疗效,及睡眠障碍与焦虑症的相关性,以作为针灸临床治疗焦虑症提供参考。研究方法:采用SAS9.3统计学软件,利用程序参数按照1:1:1比例,随机产生90个随机数字,按照患者就诊顺序,随机将符合标准的患者分为治疗组、观察组和对照组,每组患者各30例,其中治疗组患者予以针刺"四关"穴联合常规取穴,观察组患者予以常规针刺联合安神定志丸,对照组患者单独采取常规针刺治疗,3组患者共治疗4周,治疗结束后观察每组患者焦虑自评量表(self-Rating Anxiety Scales SAS)评分、匹兹堡睡眠质量指数(PSQI)、生活质量评价量表SF-36及临床疗效。研究结果:1.三组患者治疗前SAS量表评分比较,均符合正态性分布和方差齐性,行单因素方差分析结果显示,三组患者治疗前SAS量表评分比较无差异,具有可比性(P0.05)。经4周治疗后,三组患者SAS量表评分同样符合方差齐性和正态性分布,使用单因素方差分析结果显示三组患者SAS评分不全相同,采用SNK法对三组患者两两比较分析发现,治疗组患者治疗后SAS评分与观察组比较差异具有统计学意义(P0.05),与对照组患者评分比较,差异具有统计学意义(P0.05),而观察组患者治疗后SAS评分与对照组比较,差异无统计学意义(P0.05),两组患者SAS量表评分改善相当;2.三组患者治疗前PSQI量表评分比较,均符合正态性分布和方差齐性,行单因素方差分析结果显示,三组患者治疗前PSQI量表评分比较无差异(P0.05),具有可比性。经4周治疗后,三组患者PSQI量表评分同样符合方差齐性和正态性分布,三组患者PSQI各项评分及总分均较治疗前有明显改善(P0.05);使用单因素方差分析结果显示三组患者PSQI评分不全相同,采用SNK法对三组患者两两比较分析发现,治疗组患者在睡眠质量、入睡时间、睡眠效率、睡眠障碍、日间功能及PSQI总分比较改善方面均分别优于观察组和对照组,差异具有统计学意义(P0.05);但三组之间催眠药物评分比较,差异无统计学意义(P0.05)。观察组患者在睡眠时间改善方面由于对照组,差异具有统计学意义(P0.05);但两组患者睡眠质量、入睡时间、睡眠效率、睡眠障碍、催眠药物、日间功能及PSQI评分比较方面,差异无统计意义(P0.05);3.三组患者治疗前SF-36量表评分比较,均符合正态性分布和方差齐性,行单因素方差分析结果显示,三组患者治疗前SF-36量表评分比较无差异(P0.05),具有可比性。经4周治疗后,三组患者SF-36量表评分同样符合方差齐性和正态性分布,三组患者SF-36量表各项评分及总分均较治疗前有明显改善(P0.05);使用单因素方差分析结果显示三组患者SF-36量表评分不全相同,采用SNK法对三组患者两两比较分析发现,治疗组患者在生理职能、躯体疼痛、活力、总体健康、情感职能、情感健康及SF-36总分比较改善方面均分别优于观察组和对照组,差异具有统计学意义(P0.05);但三组之间生理功能和生活功能评分比较,差异无统计学意义(P0.05)。观察组患者在精神健康改善方面由于对照组,差异具有统计学意义(P0.05);但两组患者生理职能、社会功能、生理职能、躯体疼痛、活力、总体健康、情感职能及SF-36评分比较方面临床改善相当,差异无统计意义(P0.05);4.治疗结束时,治疗组患者治愈4例、显效13例、有效9例、无效4例,临床总有效率86.6%,观察组中治愈2例、显效7例、有效13例、无效8例,临床总有效率73.3%,对照组中治愈1例、显效8例、有效12例、无效9例,临床总有效率70%,三组患者临床总有效率比较具有统计学差异(P0.05),其中治疗组患者临床总有效率优于观察组和对照组,而观察组与对照组患者临床疗效相当;5.SAS评分与PSQI评分均符合正态性分布,采用Person积差相关分析,发现SAS评分与PSQI评分呈正相关(Person相关系数0.78,P=0.01),说明SAS评分越高,患者睡眠障碍越严重。结论:1.睡眠障碍与焦虑症成正相关性,睡眠障碍越严重的患者临床焦虑评分越高;2.针刺"四关穴"能够明显改善患者临床焦虑症状评分、PSQI评分及提高焦虑症患者生活质量。
[Abstract]:Objective: to fully analyze the current research progress at home and abroad, and find that the occurrence and recurrence of the clinical symptoms and symptoms of anxiety patients may be caused by the loss of liver, the appearance of Zang Fu, Qi and blood, yin and Yang disorder, and the sleep disorder is also the cause of the occurrence and recurrence of the disease. Treatment of acute severe heat syndrome, pain and eclampsia by four points in the treatment of chronic mental disease, further explore the clinical efficacy of acupuncture treatment of anxiety, and the correlation between sleep disorders and anxiety, as a reference for clinical treatment of anxiety disorders. Research methods: SAS9.3 statistical software, the use of program parameters according to 1:1:1 In proportion, 90 random numbers were randomly produced. According to the patient's order, the patients were randomly divided into the treatment group, the observation group and the control group, 30 cases in each group. The patients in the treatment group were treated with acupuncture "four Guan" points combined with conventional acupoints, and the patients in the observation group were treated with conventional acupuncture combined with Anshen Ding Zhi pill, and the control group took a separate routine. The 3 groups of patients were treated with acupuncture for 4 weeks. After the treatment, the self-Rating Anxiety Scales SAS score, Pittsburgh sleep quality index (PSQI), the quality of life assessment scale SF-36 and the clinical efficacy were observed. The results of the study were in 1. three groups of patients before the treatment of SAS scale, all in line with normal distribution and prescription. The results of single factor variance analysis showed that there was no difference between the three groups of patients before treatment and there was no difference (P0.05). After 4 weeks of treatment, the SAS scale score of the three groups was also consistent with the homogeneity of variance and normal distribution. The single factor variance analysis showed that the SAS score was not the same in the three groups, and the SNK method was used. Three groups of patients 22 comparative analysis found that the treatment group after the treatment of SAS score compared with the observation group had a statistically significant difference (P0.05), and compared with the control group, the difference was statistically significant (P0.05), and the observation group after the treatment of SAS score compared with the control group, the difference was not statistically significant (P0.05), the two group of SAS scale The score improvement was equal. 2. three groups of patients were compared with normal distribution and Fang Chaqi sex before treatment, and the results of single factor variance analysis showed that there was no difference (P0.05) between the three groups of patients before treatment (P0.05). After 4 weeks of treatment, the score of the PSQI scale in the three groups was also consistent with the homogeneity of variance and normality. Distribution, the scores and total scores of PSQI in the three groups were significantly improved (P0.05). The results of single factor variance analysis showed that the PSQI score of the three groups was not the same. The SNK method was used to compare the three groups of patients with sleep quality, sleep time, sleep efficiency, sleep disorder, daytime function and PSQI. The total score was better than the observation group and the control group, the difference was statistically significant (P0.05), but the difference between the three groups was not statistically significant (P0.05). The difference of the sleep time in the observation group was statistically significant (P0.05) in the improvement of sleep time, but the quality of sleep in the two groups, and the sleep time. The difference of sleep efficiency, sleep disorder, hypnotic drug, day function and PSQI score was not statistically significant (P0.05). 3. the three groups were compared with normal distribution and homogeneity of variance before treatment, and the results of single factor variance analysis showed that there was no difference between the three groups before the treatment of the SF-36 scale (P0.05). After 4 weeks of treatment, the SF-36 scale score in the three groups was also consistent with the homogeneity of variance and normal distribution. The scores and total scores of the SF-36 scales in the three groups were significantly improved (P0.05). The results of the single factor variance analysis showed that the SF-36 scale score of the three groups was not the same, and the SNK method was used in the three group of patients 22. The comparative analysis found that the patients in the treatment group were superior to the observation group and the control group in the physiological function, body pain, vitality, overall health, emotional function, emotional health and SF-36 total score, and the difference was statistically significant (P0.05), but there was no statistical difference between the three groups (P0.05). The difference in the mental health improvement of the patients in the observation group was statistically significant (P0.05), but the two groups of patients' physiological functions, social functions, physiological functions, somatic pain, vitality, overall health, emotional function and SF-36 score compared with the clinical improvement, the difference was not statistically significant (P0.05); at the end of 4. treatment, the treatment group patients 4 cases were cured, 13 cases were effective, 9 cases were effective, 4 cases were invalid, the total effective rate was 86.6%, 2 cases were cured in the observation group, 7 cases were cured, 13 cases were effective, 8 cases were invalid, the total clinical effective rate was 73.3%, 1 cases were cured in the control group, significant effective 8 cases, effective 12 cases, invalid 9 cases, clinical total effective efficiency compared with statistical difference (P0.05) The clinical efficacy of the patients in the treatment group was better than that of the observation group and the control group, while the clinical efficacy of the observation group was similar to the control group. Both the 5.SAS score and the PSQI score were in accordance with the normal distribution. The SAS score was positively correlated with the PSQI score (0.78, P=0.01), indicating that the higher the SAS score, the higher the SAS score, the sleep of the patients. The more serious the obstacles were. Conclusion: 1. the sleep disorder is positively correlated with anxiety, the higher the clinical anxiety score of the patients with the more severe sleep disorders, the 2. acupuncture "four points" can obviously improve the patient's clinical anxiety symptom score, PSQI score and improve the quality of life of the patients with anxiety.

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.6

【参考文献】