“通督安神”针刺法治疗中风后焦虑障碍的临床观察

发布时间：2018-05-24 05:04

本文选题：中风后焦虑障碍 + 通督安神　；参考：《黑龙江中医药大学》2017年硕士论文

【摘要】：目的:通过"通督安神"针刺法与西药帕罗西汀治疗中风后焦虑障碍的随机对照研究,评价"通督安神"针刺法治疗中风后焦虑障碍的临床疗效、起效时间和安全性。方法:将70名确诊为中风后焦虑障碍的患者,随机分为两组(治疗组和对照组),每组35例。治疗组运用"通督安神"针刺法,选取穴位:百会、四神聪、神庭、印堂、水沟、膻中、神门(双侧)、内关(双侧),平补平泻,每日针刺1次,疗程共4周。对照组给予口服西药盐酸帕罗西汀片,每日1次,每次10mg,4天后加量,每日1次,每次20mg,疗程共4周。两组患者均给予基础治疗,包括脑中风疾病基础药物治疗和改善肢体功能的常规体针治疗(不取神门、内关穴)。观察指标:1.于治疗1w、2w、4w,采用汉密尔顿焦虑量表(HAMA)和Zung氏焦虑自评量表(SAS),评价治疗组和对照组治疗中风后焦虑障碍的临床疗效和治疗起效时间。2.于治疗1w、2w、4w采用HAMA三因子(包含精神性焦虑因子、躯体性焦虑因子和睡眠因子)评分来细化针刺治疗组的优势所在。3.两组患者在治疗后均采用副反应量表(TESS)评分测评治疗组与对照组的安全性。结果:1.临床疗效评价(1)两组患者治疗前、治疗4周后HAMA量表评分比较:两组患者在治疗前HAMA量表评分无差异,P0.05,具有可比性。治疗4周后,两组患者HAMA评分均较疗前明显下降(P0.05),两种疗法均可明显改善PSAD患者的焦虑症状。且治疗4周后,治疗组与对照组间HAMA评分无统计学差异(P0.05),两组疗效相当。(2)两组患者治疗4周后总疗效比较:治疗组总有效率为82.9%,对照组的总有效率为80.0%,差异无统计学意义,P0.05,两组疗效相当。(3)两组患者治疗前和治疗4周HAMA三因子比较:两组患者治疗前HAMA三因子评分无差异,P0.05,具有可比性。治疗4周后HAMA精神焦虑因子、睡眠因子和躯体焦虑因子评分均较疗前明显下降(P0.05),说明两种疗法均可明显改善PSAD患者的精神焦虑症状、躯体焦虑症状和睡眠质量。治疗4周后,治疗组与对照组间HAMA精神焦虑因子和睡眠因子评分无明显差异(P0.05),无统计学意义,两组在改善精神焦虑症状和睡眠质量方面疗效相当。而治疗4周后,治疗组与对照组HAMA躯体性焦虑因子评分有明显差异(P0.05),治疗组在改善躯体性焦虑症状方面优于对照组。(4)两组患者在治疗前、治疗4周SAS量表评分比较:两组患者SAS量表评分治疗前无差异,P0.05,具有可比性。治疗4周后,两组患者SAS评分均较疗前明显下降(P0.05),两种疗法均可明显改善PSAD患者的焦虑症状。且治疗4周后,治疗组与对照组间SAS评分无统计学差异(P0.05),两组疗效相当。2.起效时间评价(1)治疗组治疗1周后,HAMA、SAS评分即较疗前有明显下降,差异有统计学意义(P0.05),说明治疗组在治疗1周后,即对PSAD有明显疗效。而对照组在治疗1周后,两量表评分较疗前也有所降低,但差异不显著,没有统计学意义,P0.05。治疗2周后,对照组HAMA、SAS评分才较疗前有明显降低,差异有统计学意义,P0.05,表明对照组在治疗2周后才起效,提示治疗组抗焦虑障碍较对照组起效快。(2)治疗组在治疗1周后,躯体性焦虑因子评分相比治疗前具有显著性差异(P0.05),在治疗2周时呈现出极显著差异性,且与对照组相比较有统计学差异(P0.05),提示治疗组在改善躯体焦虑的方面1周时便起效,相比对照组有优势。两组患者在精神性焦虑因子、睡眠因子等方面均在治疗2周时相比治疗前评分呈现显著性差异(P0.05),提示两组治疗方法均在治疗两周时起效,且疗效相当(P0.05)。3.安全性评价药物对照组在治疗过程中,有2例患者出现口干、1例患者出现头晕、3例患者出现便秘、1例出现嗜睡,出现副反应人数占对照组的20%。针刺治疗组没有出现副反应,仅有1例出现皮下血肿,但未出现晕针、滞针、断针、感染等其他针刺异常情况发生。结论:1."通督安神"针刺法治疗中风后焦虑障碍与西药对照组疗效相当,两者均能明显改善中风后焦虑障碍患者的焦虑症状。2."通督安神"针刺法治疗中风后焦虑障碍起效较西药对照组起效迅速。3."通督安神"针刺法和西药对照组均能明显改善中风后焦虑障碍患者的精神性焦虑症状、躯体性焦虑症状和睡眠症状,但在改善躯体性焦虑症状疗效和起效时间上优于西药对照组。4."通督安神"针刺法的安全性要优于西药对照组。
[Abstract]:Objective: To evaluate the clinical efficacy, time and safety of "Tong Du Anshen" acupuncture method for the treatment of post apoplectic anxiety disorder through a randomized controlled study of "Tong Du Anshen" acupuncture and paroxetine in the treatment of post apoplectic anxiety disorder. Methods: 70 patients with apoplexy after apoplexy were randomly divided into two groups (the treatment group and the control group). There were 35 cases in each group. The treatment group, using the acupuncture method of "Tong Du and God", selected acupoints: Baihui, Si Shen Cong, God's court, printing hall, ditch, mutton (bilateral), Neiguan (bilateral), flat filling and diarrhea, 1 times a day for 4 weeks. The control group was given oral western medicine Paroxetine Hydrochloride Tablets, 1 times a day, 4 days plus dose, 1 times a day, each time, course of treatment, 20mg, treatment course, each time, treatment course. A total of 4 weeks. The two groups were given basic treatment, including basic medication for cerebral apoplexy and routine body acupuncture treatment to improve limb function (not taking the Shen gate, Neiguan point). 1. in the treatment of 1W, 2W, 4W, the Hamilton Anxiety Scale (HAMA) and Zung's anxiety self rating scale (SAS) were used to evaluate the treatment group and the control group in the treatment of post apoplectic anxiety The clinical efficacy of the disorder and the onset time of treatment was.2. in the treatment of 1W, 2W, 4W using HAMA three factors (including mental anxiety factors, somatic anxiety factors and sleep factors) to refine the advantages of the acupuncture treatment group.3. two patients were treated with the side reaction scale (TESS) score after treatment to evaluate the safety of the treatment group and the control group. Results: 1. clinical efficacy evaluation (1) two groups of patients before treatment, 4 weeks after the HAMA scale score comparison: two groups of patients before treatment HAMA scale score no difference, P0.05, comparable. After 4 weeks of treatment, two groups of patients with HAMA scores were significantly lower than before treatment (P0.05), and two treatments can significantly improve the anxiety symptoms of patients with PSAD, and after the treatment for 4 weeks after the treatment, There was no significant difference in HAMA score between the treatment group and the control group (P0.05). (2) the total curative effect of the two groups of patients after 4 weeks was compared: the total effective rate of the treatment group was 82.9%, the total effective rate of the control group was 80%, the difference was not statistically significant, P0.05, and the two groups had the equivalent effect. (3) the two group patients were compared with the 4 weeks before and 4 weeks: two group, two group. The scores of HAMA three factors were no difference before treatment, and P0.05 was comparable. After 4 weeks of treatment, the scores of HAMA mental anxiety factors, sleep factors and somatic anxiety factors were significantly lower than those before treatment (P0.05), indicating that the two treatments could obviously improve the mental anxiety symptoms, somatic anxiety symptoms and sleep quality of PSAD patients. After 4 weeks treatment, the treatment group was treated. There was no significant difference in the scores of HAMA mental anxiety and sleep factors (P0.05) between the control group and the control group (P0.05). The two groups had the same effect on improving mental anxiety and sleep quality. And after 4 weeks of treatment, the score of HAMA somatic anxiety factor in the treatment group and the control group was significantly different (P0.05). The treatment group was improving somatic anxiety symptoms. (4) two groups of patients before treatment, 4 weeks of SAS scale score comparison: the two group of patients with no difference before the SAS scale treatment, P0.05, comparable. After 4 weeks of treatment, the two groups were significantly lower than before the treatment (P0.05), two treatments can significantly improve the anxiety of PSAD patients. After 4 weeks, treatment group, treatment group There was no significant difference in SAS score between the control group and the control group (P0.05), the two groups were equivalent to.2. time evaluation (1) after 1 weeks of treatment in the treatment group, HAMA, the SAS score was significantly lower than before the treatment, the difference was statistically significant (P0.05), indicating that the treatment group had a significant effect on PSAD after the treatment, and the control group was compared with the two scale after 1 weeks of treatment. The difference was not significant, but the difference was not statistically significant. After 2 weeks of P0.05. treatment, the control group HAMA, SAS score was significantly lower than before the treatment, the difference was statistically significant, P0.05, indicating that the control group was only effective after 2 weeks of treatment, suggesting that the anti anxiety disorder in the treatment group was faster than the control group. (2) the treatment group was somatic anxiety after 1 weeks of treatment. There was a significant difference in factor score before treatment (P0.05), which showed significant difference at 2 weeks and compared with the control group (P0.05), suggesting that the treatment group was effective at 1 weeks in improving physical anxiety and compared with the control group. The two groups were in the aspects of mental anxiety factors, sleep factors and so on. There was a significant difference between the 2 weeks before treatment (P0.05), suggesting that two groups of treatment methods were all effective at two weeks, and the curative effect was equivalent (P0.05).3. safety evaluation of the drug control group in the treatment process, there were 2 patients with dry mouth, 1 patients with dizziness, 3 patients with constipation, 1 cases of somnolence, and side effects. The 20%. acupuncture treatment group of the control group had no side effects, only 1 cases had subcutaneous hematoma, but there were no needles, stagnation needles, broken needles, infection and other abnormal conditions. Conclusion: 1. "Tong Du Anshen" acupuncture treatment of anxiety disorder after apoplexy is equivalent to the western medicine control group, both can obviously improve the anxiety disorder after apoplexy. .2. "Tong Du Anshen" acupuncture method for the treatment of post apoplectic anxiety disorder is more effective than the western medicine control group, which can improve the mental anxiety symptoms, somatic anxiety symptoms and sleep symptoms in the patients with anxiety disorder after apoplexy, but it can improve the effect of somatic anxiety symptoms. And the onset time was better than that of Western medicine control group. The safety of.4. "Tong Du Anshen" acupuncture method was better than that of Western medicine control group.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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