得气与经穴效应关系及得气部分机体影响因素的随机对照试验研究

发布时间：2018-06-25 00:26

本文选题：得气 + HAMA量表　；参考：《北京中医药大学》2016年博士论文

【摘要】：目的1.得气与经穴效应关系研究：以寒湿凝滞证原发性痛经(Primary dysmenorrhea,PD)患者为研究对象,通过随机对照试验与得气二次评价相结合的设计,研究毫针不同刺法干预产生的得气与不得气对三阴交穴镇痛效应及缓解焦虑效应的影响,了解得气与经穴效应的关系,为临床科学应用和丰富得气理论提供循证医学依据。2.得气部分机体影响因素研究：通过评价寒凝证PD患者非经期时的植物神经功能和焦虑状态,观察痛经发作时毫针不同刺法干预三阴交穴出现的得气情况,初步探讨患者非经期时的生理功能和心理状态对痛经发作时针刺得气的影响。方法纳入68例寒凝证PD患者,以1：3的比例随机分为期望得气组17例和期望不得气组51例,以毫针不同刺法作为两组的区别点,期望得气组给予双侧三阴交穴粗针、深刺、施手法干预,而期望不得气组则给予双侧三阴交穴细针、浅刺、不施手法干预。于第一次月经结束后3-7天内上午8：00-11：00,对其进行植物神经功能检查,根据公式计算植物神经平衡指数(夕值)；并嘱其回忆月经前一周的焦虑状态,填写HAMA焦虑量表,计算HAMA总分。于第二次月经痛经发作当天,以0-100mm的视觉模拟评价量表(VAS)测量其腹痛程度(VAS-P值),当VAS-P值≥40mm时,根据随机方案对患者双侧三阴交穴进行相应的针刺干预,留针30min后起针,并于针刺前、起针即刻、起针后10min、20min和30min分别以VAS量表测量其腹痛程度(VAS-P值)和焦虑程度(VAS-A值)。起针后,采用本课题组前期编写,且经过信度效度检验的《受试者针感临床评价量表》对患者实际得气与否进行二次评价,根据评价结果,将期望得气组患者二次分为实际得气组(A组)和实际不得气组(B组)、将期望不得气组患者二次分为实际得气组(C组)和实际不得气组(D组)VAS值组内比较采用配对样本t检验或非参数检验；组间比较采用纵向数据回归模型的边际均数模型。根据植物神经平衡指数夕值将患者二次分为植物神经功能正常者组(E组),交感神经功能增强或亢进组(F组)和副交感神经功能增强或亢进者组(H组)；根据HAMA总分将患者二次分为可能焦虑或焦虑组(M组)和非焦虑组(N组),采用独立样本t检验或非参数检验对各组实际得气总分进行比较；采用卡方检验对各组患者的实际得气率进行比较；实际得气患者的植物神经平衡指数夕值、HAMA总分与得气总分的关系采用双变量相关性分析方法。结果1.得气与经穴效应关系研究：经对数据进行整理和分析,发现其中4例患者针刺前腹痛VAS-P值40mm,8例患者量表评价前后矛盾,故剔除这12例数据,最终纳入统计分析的有效样本量共计56例：期望得气组14例,期望不得气组42例。其中,期望得气组实际得气者(A组)14例[14/14,100%],期望得气组实际不得气者(B组)0例,期望不得气组实际得气者(C组)25例[25/39,59.5%],期望不得气组实际不得气者(D组)17例[17/39,40.5%]。①基线比较：期望得气组与期望不得气组患者治疗前年龄、经期、月经周期、发病病程以及针刺前VAS-P值和VAS-A值比较均未见明显差异(P均0.05)。②组内比较：B组因样本量为0而未做统计,期望得气组、期望不得气组、A组、C组以及D组起针即刻、起针后10、20、30min的VAS-P值及VAS-A值与针刺前相比均显著降低,差异具有统计学意义(P均0.05)。③组间比较：根据得气量表对得气实际情况进行二次评价后,期望得气组的实际得气率为100%,期望不得气组的实际得气率为59.5%,前者明显高于后者,差异具有统计学意义(P0.05)。期望得气组患者腹痛VAS-P值显著低于期望不得气组,A组患者腹痛VAS-P值显著低于D组,A+C组患者腹痛VAS-P值显著低于B+D组,A组患者腹痛VAS-P值显著低于C组,差异均具有统计学意义(P均0.05)；C组与D组患者腹痛VAS-P值的差异无统计学意义(P0.05)。A组患者焦虑VAS-A值显著低于D组,A+C组患者焦虑VAS-A值显著低于B+D组,差异均具有统计学意义(P均0.05)；期望得气与期望不得气组、C组与D组、A组与C组患者焦虑VAS-A值的差异均无统计学意义(P均0.05)。2.得气部分机体影响因素研究：根据植物神经平衡指数夕值将患者二次分为植物神经功能正常者(E组)14例[14/56,25%],交感神经功能增强或亢进者(F组)0例,副交感神经功能增强或亢进者(H组)42例[42/56,75%]；根据HAMA焦虑总分将患者二次分为可能焦虑或焦虑者(M组)26例[26/56,46.4%],非焦虑者(N组)30例[30/56,53.6%]。①植物神经功能：F组因样本量为0而未作统计,E组与H组得气总分的差异无统计学意义(P0.05),实际得气率的差异亦无统计学意义(P0.05)；各组植物神经平衡指数y值与得气总分亦无显著相关性(P0.05)。②HAMA焦虑状态：M组与N组患者得气总分的差异无统计学意义(P0.05),实际得气率的差异亦无统计学意义(P0.05),各组HAMA.总分与得气总分亦无显著相关性(P0.05)。结论1.得气与经穴效应关系的研究：①得气与不得气均能增强寒凝证PD患者三阴交穴的镇痛和缓解焦虑效应,但得气更佳；②在毫针粗针、深刺、施手法的综合干预下,得气率更高,得气率高则镇痛效应和缓解效应更佳。2.得气部分机体影响因素的研究：非经期时寒凝证PD患者的植物神经功能和焦虑状态具有一定的规律,但尚不能认为二者是影响痛经发作时针刺得气的机体因素。
[Abstract]:Objective to study the relationship between 1. and the effect of acupoint effect: the patients of Primary dysmenorrhea (PD) with cold damp stagnation syndrome were used as the research object, and the effect of gas and no gas on the analgesic effect and relieving anxiety of the three yin points was studied by the combination of the randomized controlled trial and the two evaluation of gas. To understand the relationship between gas and acupoint effect, to provide evidence based medicine based on.2. for clinical scientific application and rich gas theory. By evaluating the autonomic nervous function and anxiety state of PD patients during the non menstrual period of cold coagulating syndrome, the effects of different prickly needles on the emergence of the three yin acupoints during the episodes of dysmenorrhea were observed. The effect of the physiological function and psychological state of the patients during non menstrual period on the spiny breath of dysmenorrhea was preliminarily investigated. Methods 68 cases of PD patients with cold coagulation syndrome were randomly divided into 17 cases of expectant gas group and 51 cases of expectant no gas group with the proportion of 1:3, with the difference point between the two groups with the different needles of the needles, and the expectant gas group was given bilateral three yin. Cross acupoint thick needles, deep prickles, and manipulation intervention, and expect no gas group to give two side three yin points fine needle, shallow puncture, no manipulation intervention. At 8:00-11:00 in the morning after the first period of the period, the plant nerve function examination, according to the formula calculation of plant nerve balance index (Eve value), and to recall the first week of the month of menstruation In the state of anxiety, the HAMA anxiety scale was filled in and the total score of HAMA was calculated. On the day of second menstrual menstrual dysmenorrhea, the degree of abdominal pain (VAS-P) was measured with the 0-100mm visual analogue scale (VAS). When the VAS-P value was more than 40mm, the corresponding acupuncture intervention was carried out on the patients' bilateral Sanyinjiao acupoints according to the random scheme, and the needle was left to 30min and before the acupuncture. Immediately after the needle, 10min, 20min and 30min were used to measure the degree of abdominal pain (VAS-P) and the degree of anxiety (VAS-A) with the VAS scale respectively. After the needle, the two evaluation was made by the subject group, which was written in the previous group, and the reliability and validity test was used to evaluate the patient's actual gas or not. The patients were divided into the actual gas group (group A) and the actual non gas group (group B). The patients were divided into the actual gas group (group C) and the actual non gas group (group D) with the actual gas group (group A) and the actual non gas group (Group D). The paired sample t test or non parametric test was used in the VAS group. The value of nerve balance index was divided into two times of the patient's group (group E) with normal autonomic nerve function (group F), group of sympathetic nerve function or hyperactivity (group F) and parasympathetic nerve function enhancement or hyperactivity group (group H). According to the total score of HAMA, the patients were divided into possible anxiety or anxiety group (group M) and non anxiety group (group N), using independent sample t test or non The actual gas score of each group was compared by the parameter test; the actual gas rate of each group was compared with the chi square test. The relationship between the total score of HAMA and the total gas score was analyzed by the method of bivariate correlation analysis. Results the relationship between gas and acupoint effect of 1. was studied: through the data After sorting and analyzing, 4 patients were found to have VAS-P value 40mm before acupuncture, and 8 patients were evaluated before and after the assessment. Therefore, the 12 cases were eliminated, and 56 cases were included in the statistical analysis: 14 cases in the expected gas group and 42 cases in the expectation of no gas group, of which 14 cases of [14/14100%] were expected in the expected gas group (group A). Expectation was expected. There were 0 cases (group B), 25 cases of [25/39,59.5%] in group C, and 17 cases of [17/39,40.5%]. (group D) in expectation of no gas group (group D), 17 cases of baseline comparison: the age, menstrual cycle, course of onset, VAS-P value and VAS-A value before acupuncture, the menstrual cycle, the course of onset, and the value of VAS-A. There was no significant difference (P 0.05). In group B, there was no statistics in group B because of the amount of sample, expected gas group, expecting no gas group, A group, C group and D group immediately, the VAS-P value and VAS-A value of 10,20,30min decreased significantly after the needle, and the difference was statistically significant (P 0.05). 3 The actual gas rate of the expected gas group was 100%, the actual gas yield of the expected gas group was 59.5%, the former was significantly higher than the latter, the difference was statistically significant (P0.05). The VAS-P value of abdominal pain in the patients of expected gas group was significantly lower than that of the expected gas group, and the VAS-P value of abdominal pain in group A patients was significant, and the value of abdominal pain in group A was significant. The VAS-P value of abdominal pain in group A+C was significantly lower than that of group B+D, and the VAS-P value of abdominal pain in group A was significantly lower than that in group C (P 0.05), and there was no significant difference between the C group and the D group (P, 0.05), and the anxiety value of the patients in the C group and the D group was significantly lower than that in the group. All of them were statistically significant (P 0.05); there was no statistical difference between group C and group D, group A and group C, and group A and C group (P all 0.05) the influence factors of the air part of.2., according to the night value of the plant nerve balance index, the patients were divided into two cases of normal autonomic nerve function (E group), 14 cases of [14/56,2. 5%], 0 cases of sympathetic nervous function or hyperactivity (group F), 42 cases of [42/56,75%] with enhanced parasympathetic nerve function or hyperactivity (group H); 26 cases of [26/56,46.4%], 30 cases of non anxiety (group N) [30 /56,53.6%]. (group N), 30 cases of [30 /56,53.6%]. (group N), and 30 cases of autonomic nervous function, according to the total score of anxiety and hyperfunction of parasympathetic nerve, and 30 cases of [30 /56,53.6%]. (group N): the F group was not made by the sample size of 0. Statistics showed that there was no significant difference in total gas score between group E and group H (P0.05), and there was no significant difference in the actual gas rate (P0.05), and there was no significant correlation between the y value of the plant nerve balance index and the total gas score (P0.05). (P0.05) HAMA anxiety state: there was no significant difference in the total gas score between the M group and the N group (P0.05), and the actual gas rate was found. There was no statistically significant difference (P0.05), and there was no significant correlation between the total score of HAMA. and the total gas score of each group (P0.05). Conclusion the study of the relationship between Qi and acupoint effect of 1. is that both qi and Qi can enhance the analgesic and relieving anxiety effects of the three Yin points of PD patients with cold coagulation, but get better gas; 2. Under the combined intervention, the results of higher gas rate, higher gas rate, higher gas rate and better effect of analgesia and relieving effect on the body influence factors of.2. were studied: the autonomic nervous function and anxiety state of PD patients in non menstrual period cold coagulating syndrome had certain regularity, but the two were not considered to be the body factors affecting the time needling of dysmenorrhea.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R246

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