热敏灸治疗心脾两虚型肿瘤相关性失眠的临床研究

发布时间：2018-05-28 14:22

  本文选题：热敏灸 + 肿瘤相关性　； 参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究通过前瞻性的临床对照研究,观察热敏灸治疗心脾两虚型肿瘤相关性失眠的疗效以及客观指标肿瘤坏死因子(TNF)的变化规律,并了解患者睡眠状况及心脾两虚的中医症状改善的情况。方法:采用随机对照试验研究方法,将在广州市中医医院肿瘤科住院且符合纳入标准的70例肿瘤患者,随机分成治疗组和对照组,各35例。治疗组以热敏灸疗法联合肿瘤科住院常规治疗,对照组仅予肿瘤科住院常规治疗。观察时间为7天,分别在治疗前及治疗后记录患者PSQI评分及心脾两虚型中医症候积分,并抽血查肿瘤坏死因子客观指标,最后进行统计学处理并分析得出结论。结果:1.入组的70例患者基线资料:平均年龄为64.26± 10.02岁,男性患者33例(47.1%),女性患者37例(52.9%),肺癌17例(24.3%),鼻咽癌6例(8.6%),妇科肿瘤6例(8.6%),消化系肿瘤31例(44.3%),其他恶性肿瘤10例(14.3%),肿瘤临床分期Ⅰ期3例,Ⅱ期5例,Ⅲ期20例,Ⅳ期42例,中晚期患者占88.6%;中医症候病情分级轻度1例,中度58例,重度11例,中重度占98.6%;失眠严重程度分级轻度9例,中度31例,重度30例,中重度患者占87.1%。治疗组与对照组上述基线资料比较差异无统计学意义。2.PSQI失眠量表评分及心脾两虚型中医证候积分:与治疗前比较,两组患者治疗后PSQI评分及中医证候积分均有所降低(P0.001)。与对照组比较,治疗组患者联合热敏灸治疗后PSQI总评分7.71±3.064及中医证候总积分11.06±4.820,分别低于对照组患者仅接受住院常规治疗后的PSQI总评分11.56±2.439及中医证候总积分16.12±4.721,差异有意义(P0.001)。提示热敏灸治疗能更明显的缓解症状,疗效更优。3.PSQI失眠量表及心脾两虚型中医证候积分表各单项积分:在PSQI失眠量表各单项评分比较中,两组患者治疗后"睡眠质量"、"入睡时间"、"睡眠时间"、"睡眠效率积分"、"睡眠障碍"、"催眠药物"及"日间功能障碍"七个单项评分均低于两组治疗前各单项的评分(P0.001)。与对照组比较,治疗组患者联合热敏灸治疗后"睡眠质量"、"入睡时间"、"睡眠时间"、"睡眠效率"、"睡眠障碍"及"日间功能障碍"六项评分降低,有显著性差异(P0.05),而"催眠药物"评分差异无统计学意义(P0.05)。在心脾两虚型中医证候积分表各单项比较中,两组患者治疗后,"失眠"、"心悸"、"神疲体倦"、"食纳"、"多梦"、"健忘"、"腹胀"、"便溏"、"面色"、"舌象"及"脉象"十一个单项积分均较治疗前有所降低,有显著性差异(P0.05)。与对照组比较,治疗组患者联合热敏灸治疗后"失眠"、"神疲体倦"、"多梦"、"面色"及"脉象"五个症状改善程度更加明显(P0.05),而两组患者治疗后"心悸"、"食纳"、"健忘"、"腹胀"、"便溏"及"舌象"(P0.05)六项改善程度无明显差异。4.失眠改善疗效与中医症状改善疗效分析:治疗组失眠改善疗效总有效率82.86%,中医症状改善疗效总有效率达88.57%,对照组失眠改善疗效总有效率20.59%,中医症状改善疗效总有效率67.65%,热敏灸联合住院常规治疗在改善睡眠和心脾两虚中医症状方面,疗效更优(P0.01)。5.与对照组比较,治疗组治疗前、后TNF值均无显著性差异(P0.05);与治疗前比较,治疗组与对照组患者治疗后TNF值均无显著性差异(P0.05)。结论:1.热敏灸治疗能有效提高患者睡眠质量,缩短入睡时间,增长睡眠时间,增加睡眠效率,减轻睡眠障碍及日间功能障碍,减少催眠药物的使用。2.热敏灸可改善失眠、神疲体倦、多梦、健忘等精神症状,减轻心悸,增加食纳,缓解腹胀、便溏,改善面色、舌脉象等心脾两虚型症状。3.热敏灸不能显著影响心脾两虚型肿瘤相关性失眠患者的肿瘤坏死因子水平。
[Abstract]:Objective: To observe the therapeutic effect of thermosensitive moxibustion on tumor associated insomnia of heart and spleen two deficiency and the objective index of tumor necrosis factor (TNF), and to understand the situation of the patients' sleep status and the improvement of TCM symptoms with the deficiency of heart and spleen two. Methods: a randomized controlled trial was used in this study. 70 tumor patients hospitalized in the oncology department of Guangzhou traditional Chinese medicine hospital were randomly divided into the treatment group and the control group, each with 35 cases. The treatment group was treated with the heat sensitive moxibustion combined with the oncology department for routine treatment. The control group was only hospitalized in the oncology department for 7 days. The PSQI score was recorded before and after the treatment. The score of TCM syndrome of the two deficiency of heart and spleen, and the objective index of TNF to find out the objective index of TNF. Finally, statistical processing and conclusion were made. Results: the baseline data of 70 patients in the 1. group were 64.26 + 10.02 years old, 33 cases (47.1%), 37 cases (52.9%), 17 cases (24.3%) of lung cancer, 6 cases of nasopharyngeal carcinoma (8.6%), gynecology. 6 cases (8.6%), 31 cases of digestive system tumor (44.3%), 10 cases of other malignant tumors (14.3%), tumor clinical stage I 3 cases, 5 cases in stage II, 20 cases in stage III, 42 cases in stage IV, 42 cases in stage IV, 88.6% in middle and late stage, mild 1 of TCM syndrome, moderate 58 cases, serious 11 cases, moderate severe cases, moderate cases and severe cases of insomnia. There was no significant difference in the baseline data between the 87.1%. treatment group and the control group in the.2.PSQI Insomnia Scale score and the TCM syndrome score of the heart and spleen two deficiency syndrome. Compared with the treatment before treatment, the scores of the PSQI scores and TCM syndrome scores in the two groups were reduced (P0.001). After the moxibustion treatment, the total score of PSQI was 7.71 + 3.064 and the total score of TCM syndrome was 11.06 + 4.820. The total score of PSQI in the control group was 11.56 + 2.439 and the total score of TCM syndrome was 16.12 + 4.721, respectively. The difference was significant (P0.001). It suggested that the thermosensitive moxibustion treatment could relieve the symptoms more obviously and the curative effect was better than that of the.3.PSQI Insomnia Scale. And each single score of TCM syndrome score table of "heart and spleen two" syndrome: in the comparison of the single item scores of the PSQI Insomnia Scale, the two groups of patients after treatment, "sleep quality", "sleep time", "sleep time", "sleep efficiency score", "sleep disorder", "hypnotic drugs" and "daytime dysfunction" were all lower than the scores of the two groups before treatment. P0.001). Compared with the control group, the six scores of "sleep quality", "sleep time", "sleep time", "sleep efficiency", "sleep disorder" and "daytime dysfunction" were reduced in the treatment group after the treatment of heat sensitive moxibustion, and there were significant differences (P0.05), but the difference of "hypnotic drugs" score was not statistically significant (P0.05). In the individual comparison, two groups of patients were treated with "insomnia", "palpitation", "fatigued fatigue", "feeding", "multi dream", "forgetfulness", "abdominal distention", "loose stool", "face", "tongue" and "pulse", which were lower than before treatment (P0.05). Compared with the control group, the treatment group combined with thermosensitive moxibustion treatment, "insomnia", "God tired", "God tired". Two groups of patients' heart palpitations, "heart palpitations", "appetite", "forgetfulness", "abdominal distention", "loose stools" and "tongue elephant" (P0.05), there was no obvious difference in the six improvement degree of.4. insomnia, and the curative effect of insomnia improvement and improvement of TCM symptoms improved: the total effective efficiency of insomnia in the treatment group was 82.86%. The total effective efficiency of insomnia in the treatment group was 82.86%. The total effective rate of TCM symptom improvement was 88.57%, the total effective rate of insomnia improved in the control group was 20.59%, the total effective rate of TCM symptom improvement was 67.65%. The curative effect was better than that of the control group (P0.01).5. and the control group. The TNF value of the treatment group was no significant before the treatment group. Sex difference (P0.05); compared with before treatment, there was no significant difference in TNF value between the treatment group and the control group (P0.05). Conclusion: 1. heat sensitive moxibustion can effectively improve the quality of sleep, shorten the time of sleep, increase the time of sleep, increase the efficiency of sleep, reduce the sleep and sleep disorders and daytime dysfunction, and reduce the use of.2. fever with hypnotic drugs. Moxibustion can improve insomnia, fatigue, dream, forgetfulness and other mental symptoms, reduce heart palpitations, increase food intake, relieve abdominal distention, loose stool, improve face color, tongue and pulse and other heart and spleen two deficiency symptoms.3. thermosensitive moxibustion can not significantly affect the level of tumor and death factor of patients with insomnia related insomnia related to the two deficiency of heart and spleen.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.5
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本文编号：1947059