患者针感与临床疗效关系初步探究

发布时间：2018-06-20 13:59

本文选题：针感 + 原发性痛经　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:初步探究单纯性肥胖病、原发性痛经两种不同性质疾病患者的针感与临床疗效之间的关系;不同性质疾病相同穴位的针感差异比较;为假针刺试验设计方法提供思路。方法:纳入单纯性肥胖病患者30例,每周治疗3次,隔日一次,每个疗程治疗10次,每次治疗30min,每1Omin行针一次。2个疗程后观察患者体质量(W)、肥胖度(A%)、体质指数(BMI)、体脂百分率(F%)、胸围(cm)、腰围(cm)、髋围(cm)、股围(cm)的指标变化。针感的记录应用改良的针刺刺激量的规则(M-QNS)以及针刺刺激量一效应调查表(F-QNS-E),分别记录左侧上肢曲池穴、腹部天枢穴、下肢足三里穴每次治疗行针一次时的"最强针感",内容包括:①针感类型:局部针感(痛感或和非痛感)和循经感传,②针感强度:采用视觉模拟评分法(VAS)按0~10等级记录针感强度。2个疗程结束后,计算每位患者针感强度平均值、循经感传出现次数、痛感出现次数,统计分析单纯性肥胖病患者针感与临床疗效的关系。纳入原发性痛经患者30例,填写痛经主观积分量表,予针灸持续治疗2个月经周期,在月经来潮的第25-27天进行,连续治疗3~5天,第2个周期行经结束时再次填写痛经主观积分量表,采用尼莫地平法,计算减分率,判断疗效。针感记录方法同单纯性肥胖病患者,研究主穴取腹部关元、左侧下肢足三里和三阴交。数据综合处理后,统计分析原发性痛经患者针感与临床疗效的关系。结果:针灸治疗单纯性肥胖病患者总有效率为90%,各项指标较治疗前均显著下降,P㩳0.01。单纯性肥胖病患者各穴非痛感强度比较中足三里、天枢差异有统计学意义,P㩳0.01;循经感传率中天枢与曲池、足三里比较均有统计学意义,P㩳0.01;痛感出现率中曲池与足三里间差异有统计学意义,P㩳0.01。曲池、天枢、足三里非痛感强度、循经感传率、痛感出现率与疗效之间均无相关性,P㩳O.05。针灸治疗原发性痛经患者总有效率为90%。痛经患者非痛感强度及循经感传率比较中足三里、三阴交与关元比较差异有统计学意义,均P㩳0.01;痛感出现率中,关元、三阴交与足三里差异有统计学意义,P㩳0.01。关元、足三里、三阴交穴非痛感强度、循经感传率、痛感出现率与疗效之间均无相关性,P㩳0.05。足三里穴针感在原发性痛经及单纯性肥胖病患者中比较,非痛感强度、循经感传率均无差异,P㩳0.05;而原发性痛经患者的足三里穴更易出现痛感,差异有统计学意义,P㩳0.01。结论:①尚未发现单纯性肥胖病患者针感强弱(非痛感强度、循经感传率、痛感出现率)与疗效有相关性;②尚未发现原发性痛经患者针感强弱(非痛感强度、循经感传率、痛感出现率)与疗效有相关性;③足三里在原发性痛经患者针感中更易出现痛感;④关于假针刺试验设计方法的启示:本研究未发现针感强弱与疗效间的相关性,既往研究予轻、浅刺激作为对照试验设计的方法有待进一步商榷。
[Abstract]:Objective: to explore the relationship between acupuncture sensation and clinical efficacy in patients with simple obesity and primary dysmenorrhea, to compare the difference of acupuncture sensation at the same acupoints of different diseases, and to provide ideas for the design of pseudoacupuncture test. Methods: 30 patients with simple obesity were treated 3 times a week, once every other day, 10 times per course of treatment. After two courses of treatment, we observed the changes of body weight, fat and fat, body mass index (BMI), body fat percentage (F), chest circumference (cm), waist circumference (cm), hip circumference (cm) and femoral circumference (cm). The acupuncture sensation was recorded by the modified regular acupuncture stimuli (M-QNSs) and the F-QNS-E5 by the questionnaire of acupuncture stimulation-effect. The points of the left upper limb were recorded, respectively, and the abdominal Tianshu points were recorded, respectively. The "strongest needling feeling" of Zusanli acupoint in the lower extremity, which includes the types of needle sensation: local acupuncture (pain or non-pain) and meridian transmission. (2) Needle intensity: visual analogue score was used to record the needling intensity according to grade 0 ~ 10. After two courses of treatment, the average needling intensity of each patient, the number of times of appearing along meridian sensation, the number of times of occurrence of pain, and the number of times of occurrence of pain were calculated. The relationship between acupuncture sensation and clinical efficacy in patients with simple obesity was analyzed statistically. Thirty patients with primary dysmenorrhea were enrolled in the study. The subjective integral scale of dysmenorrhea was filled out, and acupuncture was given for 2 menstrual cycles, which were performed on the 25-27 days of menstrual menorrhagia for 3 to 5 consecutive days. At the end of the second cycle, the subjective integral scale of dysmenorrhea was filled out again, and Nimodipine method was used to calculate the reduction rate and to judge the curative effect. The method of acupuncture recording was the same as simple obesity. The main points were collected from abdominal Guan Yuan, left leg Zusanli and Sanyinjiao. After comprehensive treatment, the relationship between acupuncture sensation and clinical efficacy in patients with primary dysmenorrhea was analyzed statistically. Results: the total effective rate of acupuncture and moxibustion in treating simple obesity patients was 90. Comparison of non-pain intensity at different acupoints in patients with simple obesity, there was significant difference in Tianshu between Zusanli and Zusanli, and there was a significant difference between Tianshu and Quchi along the meridian. There were significant differences between Zusanli and Zusanli in the incidence of pain, and the difference between Zusanli and Zusanli was statistically significant. Quchi, Tianshu, Zusanli non-pain intensity, along the meridian sensory transmission rate, the incidence of pain and curative effect were not correlated with P0. 05. The total effective rate of acupuncture and moxibustion in treating primary dysmenorrhea was 90. There was significant difference between Zusanli, Sanyinjiao and Guan Yuan in patients with dysmenorrhea (P < 0.01), but there was significant difference in the occurrence rate of pain between Guanyuan, Sanyinjiao and Zusanli in dysmenorrhea patients. There was no correlation between the non-pain intensity, the transmission rate along the meridian, the occurrence rate of pain and the curative effect of Guan Yuan, Zusanli and Sanyinjiao. There was no difference in the intensity of non-pain and the rate of transmission along meridians in patients with primary dysmenorrhea and simple obesity, while in patients with primary dysmenorrhea, pain was more likely to occur at Zusanli (P < 0.01). Conclusion there is no correlation between acupuncture intensity (non-pain intensity, transmission rate along meridian, occurrence rate of pain) and curative effect in patients with simple obesity. (2) there is no significant correlation between acupuncture intensity (non-pain intensity, transmission rate along meridian) and effect in primary dysmenorrhea patients. There is a correlation between the occurrence rate of pain and the curative effect. In patients with primary dysmenorrhea, pain is more likely to appear in the acupuncture sense. 4. The enlightenment of pseudoacupuncture test design method: this study has not found the correlation between the strength of acupuncture and the curative effect. Previous studies on light and shallow stimuli as a control trial design methods need to be further discussed.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246

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