耳穴压豆联合痰瘀双解方治疗冠心病（心绞痛）合并抑郁症的卫生技术评估研究

发布时间：2018-05-10 13:13

本文选题：耳穴压豆 + 痰瘀双解方　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:利用中医中药内外兼治策略,采用耳穴压豆疏通经络,改善自主神经功能的机理,配合痰瘀双解方治疗冠心病(心绞痛)合并抑郁症,通过卫生技术评估方法,探讨该治疗方案的安全性和有效性,为冠心病(心绞痛)合并抑郁症的中医治疗提供新的思路和方法,为各层次决策者合理使用冠心病(心绞痛)合并抑郁症的临床治疗方案提供科学信息和决策依据。方法:采用随机、对照的研究方法,遵循循证医学的研究原则,将符合诊断、纳入和排除标准的患者按照SPSS19.0计算的随机数字表法分为对照组和试验组。对照组采用氯吡格雷以抗血小板,阿托伐他汀降脂,β受体阻滞剂,硝酸酯类药物扩冠等治疗。每晚予阿普唑仑0.4 mg睡前2h口服抗抑郁等西药治疗。试验组在对照组的基础上联合使用耳穴压豆及中药痰瘀双解方8周,以心绞痛评分量表及汉密尔顿抑郁量表-17评分为疗效评价指标,以血尿常规及肝肾功能为安全性观察指标,评价耳穴压豆联合痰瘀双解方在冠心病心绞痛合并抑郁症中应用的疗效性及安全性。统计学分析应用统计软件SPSS19.0,计量资料为正态分布的予t检验,不符合的予非参数检验,针对计数资料予卡方检验,对于等级资料予秩和检验。检验符合P0.05为统计学上显著差异。结果:1.基本资料分析:共计纳入60例,其中试验组及对照组各30例,两组之间年龄进行t检验(P=0.795),性别构成进行卡方检验(P=0.980),两组间统计学上无显著差异(P0.05),具可比性。2.疗效性评价:两组间治疗前心绞痛量表评分、汉密尔顿抑郁量表分值对比,统计学上无差异(P0.05),(同组治疗前后有显著差异P0.05),且试验组好于对照组,显著差异(P0.05);试验组总有效率好于对照组,具显著差异(P0.05)。3.安全性评价:(1)两组在治疗后复查肝肾功能,未发现血常规及肝肾功能指标较前有明显异常;(2)两组在服药过程中未出现严重不良反应,安全性分级两组差异无统计学意义(P0.05)。结论:1.耳穴压豆联合痰瘀双解方在冠心病心绞痛合并抑郁症的治疗中可有效降低患者的心绞痛量表评分及汉密尔顿抑郁量表-17评分,具有良好的疗效性。2.耳穴压豆联合痰瘀双解方在冠心病心绞痛合并抑郁症的治疗中未对肝肾功能、凝血功能造成不良影响,未出现严重不良反应,具有良好的安全性。
[Abstract]:Objective: to improve the mechanism of autonomic nervous function by using the internal and external treatment strategy of traditional Chinese medicine (TCM), to improve the mechanism of improving autonomic nervous function by using the ear point pressing beans and dredging the meridian, and to treat coronary heart disease (angina pectoris) with depression by means of health technique evaluation method. To explore the safety and effectiveness of the treatment scheme, and to provide a new way of thinking and method for the treatment of coronary heart disease (angina pectoris) with depression. To provide scientific information and decision basis for the rational use of clinical treatment of coronary heart disease (angina pectoris) with depression. Methods: according to the principle of evidence-based medicine, the patients who met the criteria of diagnosis, inclusion and exclusion were divided into control group and experimental group according to the random digital table method calculated by SPSS19.0. The control group was treated with clopidogrel as antiplatelet, Atto vastatin, 尾 receptor blocker, nitrate ester drugs and so on. Alprazolam 0.4 mg 2 h before bedtime oral antidepressant and other western medicine treatment. On the basis of the control group, the experimental group was treated with auricular acupoint pressure bean and traditional Chinese medicine phlegm and blood stasis for 8 weeks. The scores of angina pectoris and Hamilton depression scale -17 were taken as the therapeutic evaluation index, and the routine blood and urine routine and liver and kidney function were used as safety observation indexes. Objective: to evaluate the efficacy and safety of auricular acupoint combined with phlegm and blood stasis decoction in angina pectoris of coronary heart disease combined with depression. Statistical software SPSS 19.0 was used for statistical analysis. The metrological data were pre-t test for normal distribution, non-parametric test for nonconformance, chi-square test for counting data and rank sum test for rank data. The statistical difference was statistically significant (P 0.05). The result is 1: 1. Analysis of basic data: a total of 60 cases were included, including 30 cases in the test group and 30 cases in the control group. The age of the two groups was examined by t test (P < 0. 795), and the sex composition by chi-square test (P < 0. 980). There was no significant statistical difference between the two groups (P 0. 05), which was comparable. Evaluation of curative effect: there was no statistical difference in the scores of angina pectoris scale and Hamilton depression scale between the two groups before and after treatment (P 0.05), and the trial group was better than the control group. The total effective rate of the experimental group was better than that of the control group, with significant difference (P0.05. 3). Safety evaluation: 1) after treatment, there was no obvious abnormal blood routine and liver and kidney function indexes in the two groups. There was no serious adverse reaction in the course of taking medicine, and there was no significant difference in safety grading between the two groups (P 0.05). Conclusion 1. In the treatment of coronary heart disease angina pectoris complicated with depression, auricular acupoint pressure bean combined with phlegm and double release prescription can effectively reduce the angina pectoris scale score and Hamilton depression scale -17 score, which has good curative effect. 2. In the treatment of coronary heart disease angina pectoris combined with depression, auricular acupoint pressure bean combined with phlegm and blood stasis double solution prescription did not cause adverse effects on liver and kidney function and coagulation function, and had no serious adverse reactions, so it had good safety.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259;R277.7

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