期待效应对针刺治疗1级原发性高血压疗效影响的临床研究

发布时间：2018-01-03 22:17

  本文关键词：期待效应对针刺治疗1级原发性高血压疗效影响的临床研究　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 期待效应 针刺 原发性高血压 临床疗效

【摘要】：目的：评价针刺治疗1级原发性高血压的临床疗效；探讨心理期待效应对针刺降压效应的影响。方法：1.针刺治疗1级原发性高血压的临床疗效评价本研究为前瞻性、多中心、大样本、随机、对照临床试验。以原发性高血压(1级)为研究载体,采用RCT试验设计方法,将符合纳入标准的319例EH患者,通过中央随机系统分为经穴组、非经非穴组、等待治疗组。按照治疗方案,经穴组和非经非穴组予以1周3次针刺干预,30min/次,共6周18次；等待治疗组不予以针刺干预。研究周期共13周,基线1周,治疗期6周,入组第9周、12周进行两次随访,共4次访视。主要疗效评价指标：治疗结束后24h平均收缩压、舒张压及其改善值。2.心理期待效应对针刺降压效应的影响本部分研究沿用第一部分研究中经穴组及非经非穴组研究方案。在入组前对受试者进行针灸期待值评估,并予以赋值统计,根据得分将患者期待值进行高低分层。血压数据仅采集入组0周、入组6周两组24h平均收缩压及其血压改善值。通过相关性分析及回归分析,探讨针灸高低期待值对针刺后24h平均收缩压变化的影响。结果：1.针刺治疗原发性高血压的临床疗效评价(1)24h收缩压变化情况：入组6周后,经穴组24hMSBP呈现下降趋势,至第9周时降至最低、第12周时趋于平稳。入组6周、9周、12周,三个时间节点,经穴组24hMSBP变化情况与非经非穴组、等待治疗组比较,差异均有统计学意义(P0.05)；非经非穴组与等待治疗组比较,差异均无统计学差异(P0.05)。(2)24h收缩压改善值：入组6周后,经穴组24hMSBP改善值大于5mmHg,且持续至入组12周。经穴组24hMSBP改善值在入组6周、入组9周、入组12周时,与非经非穴组、等待治疗组比较,差异均有统计学意义(P0.05)；非经非穴组与等待治疗组比较,差异均无统计学意义(P0.05)。(3)24h舒张压变化情况：入组6周后,经穴组24hMDBP呈现下降趋势,至12周时,下降约3mmHg。入组6周、9周、12周,3组间24hMDBP变化比较,差异均无统计学意义(P0.05)。但在入组6周时,经穴组24hMDBP变化情况与非经非穴组比较,差异具有统计学意义(P0.05)。(4)24h舒张压改善值：24hMDBP改善值在入组6周后、入组12周时,经穴组与等待治疗组比较,差异有有统计学意义(P0.05)。非经非穴组24hMDBP改善值在3个时间节点,与经穴组、等待治疗组比较,差异均无统计学意义(P0.05)。2.心理期待效应对针刺降压效应的影响(1)在经穴组、非经非穴组组内,期待值高低分成后,高低期待值对针刺后24hMSBP变化及改善值影响,差异均无统计学意义(P0.05)(2)通过logistic回归分析,结果显示,在经穴组和非经非穴组组内,低期待值对比高期待值治疗后24hMSBP变化情况及其改善值,随着血压升高1mmHg,低期待值的效应优于高期待值,但差异均无统计学意义(P0.05)。(3)通过对6个条目与24h血压变化情况做相关性检验,结果显示,经穴组、非经非穴组中条目1、2、3、4、6分别与24hMSBP变化及其改善值的相关性,差异均无统计学意义(P0.05)；期待值条目7中高低期待值与24hMSBP变化情况的相关性,差异均无统计学意义(P0.05)。而在经穴组内,条目7中高低期待与24hMSBP的影响,差异有统计学意义(P0.05)；非经非穴组中,差异则无统计学意义(P0.05)。结论：1.从针刺降压疗效上而言,经穴组血压改善值优于非经非穴组、等待治疗组,说明针刺经穴降压疗效明显,且针刺经穴降压疗效在短期内有持续效应；2.从期待值分层与针刺疗效上看,在经穴组和非经非穴组组内,高低期待值分层并未对血压变化情况及改善值产生影响；从相关性上看,期待值高低与针刺后血压改善情况不存在相关性,即说明心理期待效应并不参与针刺起效。
[Abstract]:Objective: To evaluate the therapeutic effect of acupuncture for treatment of grade 1 hypertension; to explore the effect of psychological expectation on the effect of acupuncture antihypertensive effect. Methods: This study is a prospective, multi center, large sample, randomized 1. clinical curative effect of acupuncture treatment on grade 1 hypertension, the Zhaolin primary bed test. Hypertension (grade 1) as the research carrier, using the RCT design method, will meet the inclusion criteria of 319 Cases of EH patients, the central randomization system is divided into acupoint group and non acupoint group, for treatment group. According to the treatment plan, acupoint group and non acupoint group to 1 weeks of the 3 acupuncture intervention 30min/ times, 18 times for a total of 6 weeks; treatment group were not treated with acupuncture intervention. The research lasted for 13 weeks, 1 weeks of baseline, treatment period of 6 weeks in group ninth weeks, 12 weeks for the two follow-up, a total of 4 visits. The primary outcome measures: 24h after treatment the average systolic pressure. Diastolic blood pressure and To improve the value of.2. psychological expectation effect on acupuncture effect of this part of the study in the first part of the study used acupoints group and non acupoint group in the research program. Before entering the group of subjects performed acupuncture expected value assessment, and to be assigned according to the statistics, the expected value for patients with score level stratification. Blood pressure data only collected into the group of 0 weeks, 6 weeks in group two 24h mean systolic blood pressure and improve blood pressure value. Through correlation analysis and regression analysis, to explore the level of acupuncture expectations average systolic blood pressure change on the influence of acupuncture on 24h. Results: the clinical efficacy evaluation of 1. acupuncture treatment of primary high blood pressure (systolic blood pressure 1 24h) change: the group after 6 weeks, 24hMSBP meridian group declined to ninth weeks when the minimum, Twelfth weeks tended to be steady. Into the group of 6 weeks, 9 weeks, 12 weeks, three time nodes, the change of 24hMSBP in acupoints group and non acupoint group, waiting for 娌荤枟缁勬瘮杈，

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