针刺配合音乐疗法治疗中风后焦虑障碍的临床研究

发布时间：2018-07-25 11:17

【摘要】：目的:本课题在针灸治疗中风病的基础上,针对中风后焦虑状态以“心脑同治”为基本治疗原则,采用情志针法(即以四神针、定神针、内关、神门、三阴交为主穴)配合徵调式乐曲与常规西药治疗作对照,观察两种方法对脑卒中后焦虑患者治疗的临床疗效。方法:收集符合诊断标准中风后焦虑患者,采取患者单盲法,按就诊顺序随机数字表法分为治疗组、对照组。两组均在中风病常规针灸治疗基础上进行干预,治疗组予以情志针法(即以四神针、定神针、内关、神门、三阴交为主穴)配合徵调式乐曲疗法,对照组采用口服西药帕罗西汀,以汉密尔顿焦虑量表(HAMA)为主要观察指标,辅以Zung氏焦虑自评量表(SAS)、生活自理能力评定Barthel指数(BI),来判定两种干预方法治疗中风后焦虑障碍的临床疗效,HAMA、SAS、BI在治疗前、治疗第2、4、6周末各评定一次;治疗后3个月随访时,用HAMA、BI进行评定。运用TESS副反应量表在治疗2、4、6周末各评定一次,观察研究过程中的不良反应发生情况。结果:1.治疗前两组HAMD、SAS、BI评分差异无统计学意义(P0.05)。治疗2周末两组HAMD、SAS、BI评分和治疗前比较,差异均有统计学意义(P0.01),组间比较HAMD、SAS、BI评分差异无统计学意义(P0.05);治疗4周末两组HAMD、SAS、BI评分和治疗前比较,差异均有统计学意义(P0.01),组间比较HAMD、SAS、BI评分差异无统计学意义(P0.05);治疗6周末两组治疗4周末HAMD、SAS、BI评分和治疗前比较,差异均有统计学意义(P0.01),组间比较HAMD、SAS、BI评分差异无统计学意义(P0.05)。2.两组HAMA三因子(精神性焦虑因子、躯体焦虑因子及睡眠因子)评分与治疗前相比,差异均有统计学意义(P0.01),治疗期间观察两组之间HAMD精神性焦虑因子、睡眠因子评分差异无统计学意义(P0.05)。治疗第2周末至第4周末两次组间躯体性焦虑因子评分差异无统计学意义(P0.05),治疗6周末两组间比较评分差异有统计学意义(P0.05)。3.以治疗后HAMA减分率判定两组疗效,治疗组的显效率为55.17%,总有效率为89.66%;对照组的显效率为33.33%,总有效率为85.61%。结果经非参数秩和检验统计学分析,治疗组的总体疗效和对照组相比较有统计学差异(Z=-1.968,P=0.0490.05),治疗组的总体疗效优于对照组。4.两组治疗第2、4、6周末TESS分值有显著性差异(P0.01),治疗组与对照组相比副作用发生少。5.治疗后3个月随访,两组HAMA、BI评分比较,差异无统计学意义(P0.05)。两组在精神性焦虑因子、睡眠因子方面均无显著性差异(P0.05);而治疗组躯体性焦虑因子得分低于对照组,有显著性差异(P0.05)。结论:情志针法配合徵调式音乐治疗中风后焦虑障碍的整体疗效优于口服西药帕罗西汀,尤其针对躯体性焦虑优势明显,同时副反应发生较西药为少,且远期疗效稳定。
[Abstract]:Objective: on the basis of acupuncture and moxibustion treatment of apoplexy, according to the basic treatment principle of "heart and brain treatment" in post-stroke anxiety state, the method of emotional acupuncture was adopted (that is, four mind acupuncture, fixed spirit acupuncture, Neiguan, Shenmen). Sanyinjiao (the main point) and the routine western medicine were used to observe the clinical efficacy of the two methods in the treatment of post-stroke anxiety patients. Methods: patients with post-stroke anxiety were collected and divided into treatment group and control group. On the basis of routine acupuncture and moxibustion treatment for apoplexy, the two groups were treated with emotional acupuncture (that is, four mind acupuncture, fixed mind acupuncture, Neiguan, Shenmen, Sanyinjiao as the main points) and the music therapy. The control group was treated with oral paroxetine and the Hamilton anxiety scale (HAMA) was used as the main observation index. The clinical efficacy of two intervention methods in the treatment of post-stroke anxiety disorder was evaluated with Zung's self-rating anxiety scale (SAS),) (SAS), self-care ability assessment Barthel index (BI),. Before treatment, at the end of the 2nd week of treatment, and at the end of the 6th week, the patients were followed up at 3 months after treatment. The evaluation was carried out with Hamamax BI. The side effects were assessed once at the end of 6 weeks by TESS's side effects scale. The adverse reactions were observed during the course of the study. The result is 1: 1. There was no significant difference between the two groups before treatment (P0.05). At the end of 2 weeks after treatment, there were significant differences between the two groups in the scores of HAMD-SASBI and before treatment (P0.01), but there was no significant difference in the scores of HAMD-SASBI between the two groups (P0.05), and at the end of 4 weeks, the scores of HAMD-SASBI in the two groups were compared with those before treatment. The differences were statistically significant (P0.01), there was no significant difference in the scores of HAMD-SASBI between groups (P0.05), the scores of HAMD-SASBI at the end of 6 weeks and before treatment were all statistically significant (P0.01), and there was no significant difference in scores of HAMD-SASBI between groups (P0.05). 2. The scores of three factors of HAMA (mental anxiety factor, somatic anxiety factor and sleep factor) in the two groups were significantly different from those before treatment (P0.01). During the treatment period, the mental anxiety factor of HAMD was observed between the two groups. There was no significant difference in sleep factor score (P0.05). There was no significant difference in the scores of somatic anxiety between the two groups from the 2nd to 4th weekend (P0.05), but there was significant difference between the two groups at the end of 6 weeks (P0.05). The effective rate of the treatment group was 55.177.The total effective rate was 89.660.The effective rate of the control group was 33.333.The total effective rate was 85.61. Results by non-parametric rank sum test, the total curative effect of the treatment group was significantly different from that of the control group (Z ~ (-1.968) P ~ (0.049) 0.05), and the total curative effect of the treatment group was better than that of the control group. There was a significant difference in TESS scores between the two groups at the end of the 6th week (P0.01). The side effects in the treatment group were less than those in the control group. After 3 months follow-up, there was no significant difference between the two groups (P0.05). There was no significant difference in mental anxiety factor and sleep factor between the two groups (P0.05), while the score of somatic anxiety factor in the treatment group was lower than that in the control group (P0.05). Conclusion: the overall curative effect of emotion acupuncture combined with music therapy for post-stroke anxiety disorder is better than that of oral paroxetine, especially for somatic anxiety, and the side effects are less than those of western medicine, and the long-term curative effect is stable.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

【相似文献】