通督治郁针法治疗PSSD伴抑郁患者临床疗效观察

发布时间：2018-02-03 18:57

本文关键词： 卒中后睡眠障碍针刺疗法通督治郁针法帕罗西汀　出处：《安徽中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的根据中医针灸理论,采用通督治郁针法治疗PSSD伴抑郁症状。通过观察针刺疗法对卒中后睡眠障碍伴抑郁患者的匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Indexs,PSQI)和汉密尔顿抑郁指数量表(Hamilton Depression Rating Scale,HAMD)评分的影响,来初步推断通督治郁针法治疗PSSD伴抑郁患者的效果,为中医针刺治疗PSSD伴抑郁的有效性和安全性提供临床科学依据。方法从临床收集符合PSSD伴抑郁诊断标准的病例60例。所有收集来的病例均按入组先后的顺序随机分为2组,把60例患者按就诊先后顺序随机编为1~60号,通过随机数字表法按1:1比例分为治疗组30例和对照组30例。治疗组采用针刺疗法,以“通督治郁针法”为主要穴位,辨证配以疏肝理气或宁心安神穴位。取穴:主穴取太冲、百会、神庭、人中、内关、印堂、神门、合谷。对照组采用西药艾司唑仑1mg睡前半小时服用+帕罗西汀20mg一日一次,清晨顿服,时间共为4周。分别在治疗前及治疗后第2周和第4周予以采取静脉血检查血电解质、血常规、肝肾功能和心电图检查,并在治疗前后分别观察PSQI和HAMD评分的变化,分别与治疗前做比较以及做组间的比较。计数资料均选用(—X±S)来表示,运用t检验,计量资料则采取X2检验。观察结果,如果P0.05则表示相应的治疗后有显著性差异,倘若P0.01提示和治疗前比较有非常显著性差异,假如P0.05可以认为不存在显著性差异。在治疗过程中,同时观察、记录、分析临床不良事件的发生。于治疗的过程中,均予以两组患者基础疾病的常规性治疗。包括调控血压、血糖等等。结果(1)在治疗后的第2周,治疗组和对照组的PSQI评分较治疗前比较均有显著性差异(P0.05),而两组间的相比较也有显著性差异(P0.05);治疗后的第4周,两组的PSQI评分和治疗前比较均有非常显著性差异(P0.01),并且组间相比较也有非常显著的差异(P0.01)。(2)在治疗后的第2周,两组的HAMD评分和治疗前相比较,无显著性差异(P0.05)而两组之间相比较,也没有显著的差异(P0.05);治疗后的第4周,两组的HAMD表评分结果同治疗前的量表相比较存在显著的差异(P0.05),而两组间之内相比,也呈现显著的差异(P0.05)。(3)在治疗后的第2周和第4周,电解质、血常规、肝肾功能和心电图检查结果,分别与治疗前相比较,两者均无显著性差异(P0.05)。(4)治疗期间,在治疗组出现的不良反应有3例,在对照组出现的不良反应有11例,有统计学差异(P0.05)。结论以“通督治郁针法”为主治疗卒中后睡眠障碍,能够明显的改善卒中后睡眠障碍患者的失眠症状,疗效优于单纯口服艾司唑。以“通督治郁针法”为主治疗卒中后睡眠障碍伴抑郁,也能够有效改善卒中后睡眠障碍患者的抑郁情况,为其治疗卒中后睡眠障碍也能提供帮助。
[Abstract]:Objective according to the acupuncture and moxibustion theory of TCM. The Pittsburgh Sleep quality Index (Pittsburgh Sleep quality Index) scale for patients with post-stroke sleep disorder and depression was observed by using Tongdu treatment of depression acupuncture in treating PSSD patients with depressive symptoms. Pittsburgh Sleep Quality Indexs. PSQI and Hamilton Depression Rating scale (Hamd) score. To preliminarily infer the effect of Tongdu treatment of depression in patients with PSSD combined with depression. To provide clinical scientific basis for the efficacy and safety of acupuncture in the treatment of PSSD with depression. Methods 60 cases of PSSD with depression were collected from the clinic. All the collected cases were classified into the group. The sequence was randomly divided into two groups. 60 patients were randomly divided into treatment group (n = 30) and control group (n = 30) according to the proportion of 1: 1 by random digital table. The treatment group was treated with acupuncture. "Tongdu treatment of depression needling method" as the main acupoints, syndrome differentiation to soothe the liver or calm the heart Anshen acupoints. Acupoints: the main point to take Taishong, Baihui, Shenting, people, Neiguan, Yin Tang, Shenmen. The control group received paroxetine 20mg once in the morning on 1st. The blood electrolytes, blood routine, liver and kidney function and electrocardiogram were examined before treatment and 2 and 4 weeks after treatment. The changes of PSQI and HAMD scores were observed before and after treatment, and compared with those before treatment and between groups. The metrological data were taken X2 test. Observation results, if P0.05 means that the corresponding treatment has significant difference, if P0.01 hint and treatment before there is a very significant difference. If P0.05 can be considered there is no significant difference. In the treatment process, observe, record, analyze the occurrence of clinical adverse events. In the course of treatment. Both groups were given routine treatment for basic diseases, including regulating blood pressure, blood sugar and so on. Results 1) 2 weeks after treatment. The PSQI scores of the treatment group and the control group were significantly higher than those of the control group (P 0.05), and the difference between the two groups was also significant (P 0.05). At the 4th week after treatment, the PSQI scores of the two groups were significantly different from those before treatment (P 0.01). There was also a significant difference between the two groups (P 0.01). At the second week after treatment, the HAMD scores of the two groups were compared with those before treatment. There was no significant difference between the two groups (P0.05) and there was no significant difference between the two groups. At the 4th week after treatment, there was a significant difference between the two groups in HAMD scale scores compared with the pre-treatment scale (P0.05), and within the two groups, there was a significant difference between the two groups. There was also a significant difference (P 0.05). The results of electrolyte, blood routine, liver and kidney function and electrocardiogram were compared before and after treatment at the 2nd and 4th week after treatment. There was no significant difference between the two groups during the treatment period, there were 3 cases of adverse reactions in the treatment group and 11 cases in the control group. There is a statistical difference (P 0.05). Conclusion "Tongdu treatment of depression acupuncture" treatment of post-stroke sleep disorders, can significantly improve the insomnia symptoms of patients with post-stroke sleep disorders. The curative effect is better than the simple oral Estrazole. "Tongdu treatment of depression" is the main treatment of post-stroke sleep disorders with depression, but also can effectively improve the depression of patients with post-stroke sleep disorders. It can also be helpful for the treatment of sleep disorders after stroke.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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