针灸从心胆论治脑卒中后焦虑症的临床研究
摘要
背景：
脑卒中后焦虑是脑血管疾病常见的持久的并发症,国外流行病学研究表明其发病率为20-40%。脑卒中后焦虑是一种长期的痛苦,中等程度以上的焦虑,可以直接干扰中风患者的生活质量和躯体、认知功能的恢复,甚至可以引起脑血管卒中再犯。近10年来,专科医生热衷于脑卒中后情绪障碍的研究,其中,脑卒中后抑郁障碍的在临床研究已相对成熟,而脑卒中后焦虑症的临床研究则不多,特别是随机试验较不成熟。许多国外的研究多集中躯体功能恢复干预方面以及西药的疗效、副作用的对比研究。
现代医学主要采用抗焦虑药物治疗,但这些抗焦虑药物都存在程度不等的不良反应。此外,有些患者对药物耐受较差,或有些抗焦虑药物疗效不佳,因此,研究种疗效好、安全、无不良作用,并且能提高脑卒中后焦虑患者生存质量的治疗方法成为目前的研究重点。针刺治疗立足于整体脏腑调节,即可调节情绪,又可改善情绪导致的躯体症状,并使得躯体症状的改善有可能先于情绪症状。在查阅近10年的文献研究后,发现目前多数有关针灸治疗脑卒中后焦虑研究存在观察指标有限、缺乏随机试验、可重复性不强等问题。针灸从心、胆治疗该病可能具有规范操作、可重复性好等优势,值得临床进一步研究,以促进该疗法的推广应用。
目的：
本研究通过严格的随机对照试验,以心、胆着手,评价针灸心胆论治PSAD的疗效,以及在改善患者生存质量方面的作用。
方法：
所有病人均来源于束青中医诊所门诊,将符合纳入标准的70例脑卒中后焦虑受试者随机分为治疗组(心胆论治组)35例和对照组(常规针刺组)35例。
两组的基础治疗一致,西药治疗均采用脑血管病的规范治疗。
心胆论治组取穴：百会、印堂、内关双、阳陵泉双；艾灸选穴四花；埋针双侧心俞、胆俞穴。
治疗组操作方法：先针刺内关、阳陵泉穴,进针深度是10-12mm,采取均匀提插捻转手法,以得气为度,并配合调气法(针完后嘱咐患者深呼吸6次,休息1分钟后再深呼吸6次,重复该过程直到出针),再针百会、印堂穴,进针深度5-6mm,采取均匀捻转手法,得气即止。留针时间为30分钟。接着取四花穴进行艾柱直接灸(艾柱大小约20mm×20mm×10mm),先于四花穴处涂以万花油(既使得艾柱能与皮肤粘合而不至于脱落,还可防止烫伤皮肤),操作者将艾柱置于患者四花穴处,点燃艾柱至患者感觉皮肤微微灼热感时,将艾柱移去,每穴5壮。后取双侧心俞和胆俞埋皮内针,针尖由外侧向脊柱方向,沿皮下横向平刺,针柄留于皮外,然后用医用胶布粘贴固定,留置3天后与脊柱反方向撕下胶布,取出皮内针。
常规针刺组选穴：内关、水沟、太冲、神门(根据“中国中医药出版社”所出版的《针灸学》中郁证治疗选穴)
对照组操作方法：先针刺水沟穴,用雀啄法,以眼眶湿润为度。再针内关、太冲、神门,采取均匀提插捻转手法,以得气为度,进针深度4-5mm,采取均匀捻转提插手法,得气即止。留针时间为30分钟。
两组均2天治疗1次,4周为1疗程。
两组治疗前后应用汉密尔顿焦虑量表(HAMA). Zung氏焦虑自评量表(SAS)评价脑卒中后焦虑的疗效,同时应用汉密尔顿焦虑量表(HAMA)评分中三因子评分来详细评估心胆论治组的优势所在。应用生活自理能力评定Barthel指数(BI)评估两组治疗前后患者躯体功能恢复情况。采用特定脑卒中生存质量评分(stroke scale-quality of life, SS-QOL),从整体及生理、心理、社会、环境5个方面评价患者的生存质量。
采用SPSS18.0统计分析软件处理运用描述性分析、卡方检验、秩和检验等统计方法,与常规针刺组进行对照,探讨各组治疗脑卒中后焦虑的效果差异。
结果：
1.治疗组与对照组组在性别、年龄、病程、病情轻重等方面对比无统计学差异(P>0.05),基线一致,具可比性。
2.治疗组的总有效率为80%高于对照组71.42%的总有效率,两者相比差异无统计学意义(P>0.05),提示治疗组与对照组的疗效相当。
3. HAMA评分比较：治疗组治疗前后HAMA评分明显下降,经配对t检验,具有显著性差异(P<0.05),说明心胆论治对于改善焦虑方面疗效肯定。对照组治疗前后HAMA评分明显下降,具有统计学差异(P<0.05),两组组间对比,经独立样本t检验,无显著差异(P>0.05),表明两组疗效相当。
HAMA中包含精神性焦虑、躯体性焦虑、睡眠因子等三个因子,可以通过两组对三个因子的影响程度来明确心胆论治在治疗焦虑方面的优势所在。治疗组和对照组患者在精神性焦虑因子评分、躯体性焦虑因子评分、以及睡眠因子评分上,治疗前与治疗后相比差异均有统计学意义(P<0.05),说明两组疗法对患者精神性焦虑症状改善、躯体性焦虑症状改善、睡眠情况改善均具有明显的效果。治疗组与对照组在改善患者睡眠方面疗效相当(P>0.05)。治疗组在改善患者精神性焦虑症状、躯体性焦虑症状等方面的效果优于对照组(P<0.05)；说明治疗组在治疗精神性焦虑和躯体性焦虑方面较对照组有一定的优势。
4.脑卒中患者生存质量量表(SS-QOL)比较：治疗组与对照组治疗前后比较差异均有显著性差异(P<0.05)；组间比较显示,治疗组组QOL评分与对照组比较差异有显著性差异(P<0.05)。提示治疗后两组QOL评分有明显改善,而治疗组改善较对照组明显(P<0.05)。两组患者生理、心理、社会、环境评分比较情况,治疗前后两组数据经方差分析LSD检验,组内比较显示,两组治疗后心理、生理、社会、环境与治疗前比较差异有统计学意义(P<0.05)；组间比较经t检验显示,治疗后治疗组生理、心理、环境评分与对照组比较差异均有统计学意义(P<0.05)。提示治疗1个疗程后,两组心理、生理、社会、环境4组评分均有不同程度改善,治疗组在生理、心理及环境等方面改善优于对照组。
5. Zung氏焦虑自评量表(SAS)评分比较：治疗组及对照组组治疗前后SAS评分均明显下降,具有显著性差异(P<0.05)；组间治疗后对比,无显著差异(P>0.05),表明两组疗效相当。
6.生活自理能力评定Barthel指数(BI)：两组治疗前后BI评分均有显著提高,具有显著性差异(P<0.05)；组间对比没有显著性差异(P>0.05),说明两组对患者的躯体功能恢复改善程度相当。对治疗组BI评分的提高与HAMA减分率的相关性进行研究,发现两组均有相关性,具显著性差异(P<0.05),提高BI评分提高者焦虑疗效好。
结论：
1.治疗组(心胆论治组)治疗脑卒中后焦虑与对照组(常规针刺组)总体疗效相当,但心胆论治组在治疗精神性焦虑和躯体性焦虑方面较常规针刺组有一定的优势,并且取穴简便、处方规范、可重复性强,值得临床进一步推广。
2.心胆论治组能有效改善中风病焦虑患者生存质量。疗效优于常规针刺组。
Background
Anxiety after having a stroke is a common long-term complications of cerebrovascular diseases. It is shown by the epidemiology research in abroad that the morbidity is about20%to40%. Anxiety after apoplexy is a lasting suffering. Medium or high degree of anxiety can affect the living quality of the patients and the recovery of body function and cognition function directly or even cause a second attack of cerebrovascular diseases.
In the last decade, specialist physician have been keen to the study of the emotional disorder after apoplexy. The clinical study about depression after apoplexy is fairly mature while the clinical research of anxiety after apoplexy is relatively unsufficient, expecially in the aspect of the imperfection of the randomized trails. Researches in aborad mainly concentrates in the intervention of body function recovery as well as the comparative study of the curative effects and the adverse reactions of the west medicine.
Modern medicine usually adopts anti-anxiety medicines for treatment, which have different degree of side-effects. Besides, there are other problems such as some patients can not torlerate the adverse effect of medicines and some anti-anxiety medicines are ineffective. Therefore, the hotspot of the current research is to find out an effective and safe therapeutic method without toxic or side-effect to improve the living qality of the anxious patients after hacing a stroke. Acupuncture is based on the adjustment of the function of the viscera which can regulate the mood and improve the physical symptoms realted to the mood, enabling the preceding improvement of physical syptoms. By reviewing the literature research in the last decade, it is found that the majority of the current study after apoplexy has the problems of limited observing items, unregulate randomized trials and bad repeatability.
Based on the adjustment of heart and gall, acupuncture enjoys the advantages of regulate operation and good repeatability and is worthy of further research in order to promote the popularization and application.
Objetive
This paper makes comments on the curative effects by stimulating the gallbladder meridian points and the heart meridian for the treatment of PSAD as well as the effecrs on the improvement of the living standard of the patients.
Method
All patients are from the clinics of the Dongqing Chinese medicine clinic and70of them are accorded with the inclusive criteria. They are devided into two groups randomly,35of which is the heart and gallbladder treatment group and the rest of which belong to the general acupuncture group. The acupoint selection of the heart and gallbladder treatment group:Baihui, ophryon, Neiguan point and Yanglingquan point:the point selection of moxa-moxibustion is four flowers? Needles should be imbedded in bilateral Xinyu, Danyu. The point selection of the general apuncture is Baihui, Zhisanzhen, Anming, Neiguan, Shenmen, and Sanyinjiao. If the patients have phlegm then give more apuncture in the Fenglong. If the patients is Qi-deficiency, then give more apuncture in the Tazhong and Qihai. Similarly, Blood stagnation, Geyu. Kidney deficiency, Shenyu, Yaoyangguan, taixi.
The heart and gallbladder treatment group:stimulate Neiguan and Yanglingquan. The depth is about10-12mm. The tecnique is to give the apuncture with regular speed to bring about the desired sensation combined with modulating QI-Xue. Then stimulate Baihui, Zhisan and the depth is about4-5mm with the same method. The time fot the retention of the needle is about30mins. Then stimulate the Sihua directly using moxa cones. Remove the unburned moxa cones with cutton swab when2/3of the moxa cones was burnt and patients feel warm or silght burning pain.5cones for each point. Finally, withdraw the imbedding needles in the bilateral Xinyu and Danyu. The intracutaneous5mm-long needle should be stimulated in and the needle handle should be left utside from the diection of outboard to the spinal column through horizontal inserction of needle. Then use the medical proof fabric to fix them. After2-day needle rentention, withdraw themubcutaneous ubcutaneous intracutaneous
The general acupuncture group:Stimulate anming, Neiguan, Shenmen, Taichong and Sanyinjiao, the depth is about10-12mm, the tecnique is to give the apuncture with regular speed to bring about the desired sensation.Then stimulate Baihui, Zhisan and the depth is about4-5mm with the same method. The time fot the retention of the needle is about30mins.
Both groups receive one treatment in2days and4weeks is one treatment course. The two groups has the same basic treastment and both groups adopts regular therapy of cerebrovascular diseases. The basic apuncture therapy is applied to improve the limb function.
Use HAMA and Zung SAS to evaluate the curative effects of anxiety after apoplexy before and after the treatment and meanwhile, use the three-factor score in the HAMA to refine the evaluation of the advantages of the heart and gallbladder treatment group. Apply the Bartherl BI to assess the body function recovery in the two groups before and after the treatment. Use the stroke scale—quality of life, SS-QOL to evaluate the living quality of patients from the following5aspects, overall condition, physiology, psycology, society and environment.
Adopt SPSS18.0statistical analysis software to cope with the statistical methods like the descriptive analysis, Chi-square test and rank sum test. Compare the results with the general apuncture group to study the difference of curative effcts after apoplexy.
Result
1the treament group makes no statistical difference compared with drug group in the aspects such as gender, age, course of the disease, illness level (P>0.05). The baseline is consistent, comparable.
2the total effective rate of treatment group is97.14%higher than88.57%of the control group, but the difference has no statistical significance (P>0.05), what prompted the curative effect of treatment group is equal to control group.
3In treatment group, the HAMA decrease obviously after the treatment. By the paired t-test, this result has significant difference (P<0.05), which implys the exact efficacy of the treatment for anxiety. That also happens in the control group. In the contrast of the treatment group and control group, by independent sample t-test, there is no significant difference (P>0.05) shown in the curative effect.
HAMA scores is composed by psychiatric anxiety, somatic anxiety, and sleep factor. Both treatments are effective in decreasing the scores of psychiatric anxiety, somatic anxiety and sleep factor, the differences have statistical significance (P<0.05). The treatment group has the equal efficacy in improving sleep of patients compared with the control group (P>0.05), but has superior efficacy in reducing patients'psychiatric and somatic anxiety symptoms (P<0.05); that indicates the method adopted by treatment group is better in treating mental and somatic anxiety than control group.
4In the contrast of QOL score, both groups make comparative differences after the treatment (P<0.05) by improving QOL score, and the treatment group is doing better than the control group (P<0.05).
Also, patients'physical, psychological, social, environmental score of two groups are all improved after the treatment, the difference has statistically significant (P<0.05), by analyzing the datas with Analysis of variance and LSD test. In the comparison between the control and treatment groups by the t-test, it shows that the treatment group makes statistical significance in all4cataloges compared with controls (P<0.05) after1course of treatment.
5In the contrast of Zung's anxiety self-evaluation scale (SAS), both groups make differentiation on SAS scores, what are decreased significantly (P<0.05). But compared the two groups after the treatment, no significant difference (P>0.05) is shown, which means the effects are equal
6BI score reflects the degree of physical function recovery of the patients with stroke. Both groups make comparative differences after the treatment (P<0.05) by improving BI score, But compared the two groups after the treatment, no significant difference (P>0.05) is shown, which means the effects are equal
The study of the correlationship between the increasing of BI score and decreasing of HAMA score in the treatment group shows a significant difference (P<0.05), increasing BI score would increase the curative effect on anxiety.
Conelusion
1treatment group makes no big difference from control group in the efficacy, but the treatent group does have certain advantages in treating mental anxiety and somatic anxiety compared to the control group, besides, the points of treatment group are easy to find, the prescription is specific and repeatabe, what make it worth to popularize
2the method of treatment group can effectively improve the quality of life in patients with post-stroke anxiety, which is superior to control group.
脑卒中后焦虑是脑血管疾病常见的持久的并发症,国外流行病学研究表明其发病率为20-40%。脑卒中后焦虑是一种长期的痛苦,中等程度以上的焦虑,可以直接干扰中风患者的生活质量和躯体、认知功能的恢复,甚至可以引起脑血管卒中再犯。近10年来,专科医生热衷于脑卒中后情绪障碍的研究,其中,脑卒中后抑郁障碍的在临床研究已相对成熟,而脑卒中后焦虑症的临床研究则不多,特别是随机试验较不成熟。许多国外的研究多集中躯体功能恢复干预方面以及西药的疗效、副作用的对比研究。
现代医学主要采用抗焦虑药物治疗,但这些抗焦虑药物都存在程度不等的不良反应。此外,有些患者对药物耐受较差,或有些抗焦虑药物疗效不佳,因此,研究种疗效好、安全、无不良作用,并且能提高脑卒中后焦虑患者生存质量的治疗方法成为目前的研究重点。针刺治疗立足于整体脏腑调节,即可调节情绪,又可改善情绪导致的躯体症状,并使得躯体症状的改善有可能先于情绪症状。在查阅近10年的文献研究后,发现目前多数有关针灸治疗脑卒中后焦虑研究存在观察指标有限、缺乏随机试验、可重复性不强等问题。针灸从心、胆治疗该病可能具有规范操作、可重复性好等优势,值得临床进一步研究,以促进该疗法的推广应用。
目的：
本研究通过严格的随机对照试验,以心、胆着手,评价针灸心胆论治PSAD的疗效,以及在改善患者生存质量方面的作用。
方法：
所有病人均来源于束青中医诊所门诊,将符合纳入标准的70例脑卒中后焦虑受试者随机分为治疗组(心胆论治组)35例和对照组(常规针刺组)35例。
两组的基础治疗一致,西药治疗均采用脑血管病的规范治疗。
心胆论治组取穴：百会、印堂、内关双、阳陵泉双；艾灸选穴四花；埋针双侧心俞、胆俞穴。
治疗组操作方法：先针刺内关、阳陵泉穴,进针深度是10-12mm,采取均匀提插捻转手法,以得气为度,并配合调气法(针完后嘱咐患者深呼吸6次,休息1分钟后再深呼吸6次,重复该过程直到出针),再针百会、印堂穴,进针深度5-6mm,采取均匀捻转手法,得气即止。留针时间为30分钟。接着取四花穴进行艾柱直接灸(艾柱大小约20mm×20mm×10mm),先于四花穴处涂以万花油(既使得艾柱能与皮肤粘合而不至于脱落,还可防止烫伤皮肤),操作者将艾柱置于患者四花穴处,点燃艾柱至患者感觉皮肤微微灼热感时,将艾柱移去,每穴5壮。后取双侧心俞和胆俞埋皮内针,针尖由外侧向脊柱方向,沿皮下横向平刺,针柄留于皮外,然后用医用胶布粘贴固定,留置3天后与脊柱反方向撕下胶布,取出皮内针。
常规针刺组选穴：内关、水沟、太冲、神门(根据“中国中医药出版社”所出版的《针灸学》中郁证治疗选穴)
对照组操作方法：先针刺水沟穴,用雀啄法,以眼眶湿润为度。再针内关、太冲、神门,采取均匀提插捻转手法,以得气为度,进针深度4-5mm,采取均匀捻转提插手法,得气即止。留针时间为30分钟。
两组均2天治疗1次,4周为1疗程。
两组治疗前后应用汉密尔顿焦虑量表(HAMA). Zung氏焦虑自评量表(SAS)评价脑卒中后焦虑的疗效,同时应用汉密尔顿焦虑量表(HAMA)评分中三因子评分来详细评估心胆论治组的优势所在。应用生活自理能力评定Barthel指数(BI)评估两组治疗前后患者躯体功能恢复情况。采用特定脑卒中生存质量评分(stroke scale-quality of life, SS-QOL),从整体及生理、心理、社会、环境5个方面评价患者的生存质量。
采用SPSS18.0统计分析软件处理运用描述性分析、卡方检验、秩和检验等统计方法,与常规针刺组进行对照,探讨各组治疗脑卒中后焦虑的效果差异。
结果：
1.治疗组与对照组组在性别、年龄、病程、病情轻重等方面对比无统计学差异(P>0.05),基线一致,具可比性。
2.治疗组的总有效率为80%高于对照组71.42%的总有效率,两者相比差异无统计学意义(P>0.05),提示治疗组与对照组的疗效相当。
3. HAMA评分比较：治疗组治疗前后HAMA评分明显下降,经配对t检验,具有显著性差异(P<0.05),说明心胆论治对于改善焦虑方面疗效肯定。对照组治疗前后HAMA评分明显下降,具有统计学差异(P<0.05),两组组间对比,经独立样本t检验,无显著差异(P>0.05),表明两组疗效相当。
HAMA中包含精神性焦虑、躯体性焦虑、睡眠因子等三个因子,可以通过两组对三个因子的影响程度来明确心胆论治在治疗焦虑方面的优势所在。治疗组和对照组患者在精神性焦虑因子评分、躯体性焦虑因子评分、以及睡眠因子评分上,治疗前与治疗后相比差异均有统计学意义(P<0.05),说明两组疗法对患者精神性焦虑症状改善、躯体性焦虑症状改善、睡眠情况改善均具有明显的效果。治疗组与对照组在改善患者睡眠方面疗效相当(P>0.05)。治疗组在改善患者精神性焦虑症状、躯体性焦虑症状等方面的效果优于对照组(P<0.05)；说明治疗组在治疗精神性焦虑和躯体性焦虑方面较对照组有一定的优势。
4.脑卒中患者生存质量量表(SS-QOL)比较：治疗组与对照组治疗前后比较差异均有显著性差异(P<0.05)；组间比较显示,治疗组组QOL评分与对照组比较差异有显著性差异(P<0.05)。提示治疗后两组QOL评分有明显改善,而治疗组改善较对照组明显(P<0.05)。两组患者生理、心理、社会、环境评分比较情况,治疗前后两组数据经方差分析LSD检验,组内比较显示,两组治疗后心理、生理、社会、环境与治疗前比较差异有统计学意义(P<0.05)；组间比较经t检验显示,治疗后治疗组生理、心理、环境评分与对照组比较差异均有统计学意义(P<0.05)。提示治疗1个疗程后,两组心理、生理、社会、环境4组评分均有不同程度改善,治疗组在生理、心理及环境等方面改善优于对照组。
5. Zung氏焦虑自评量表(SAS)评分比较：治疗组及对照组组治疗前后SAS评分均明显下降,具有显著性差异(P<0.05)；组间治疗后对比,无显著差异(P>0.05),表明两组疗效相当。
6.生活自理能力评定Barthel指数(BI)：两组治疗前后BI评分均有显著提高,具有显著性差异(P<0.05)；组间对比没有显著性差异(P>0.05),说明两组对患者的躯体功能恢复改善程度相当。对治疗组BI评分的提高与HAMA减分率的相关性进行研究,发现两组均有相关性,具显著性差异(P<0.05),提高BI评分提高者焦虑疗效好。
结论：
1.治疗组(心胆论治组)治疗脑卒中后焦虑与对照组(常规针刺组)总体疗效相当,但心胆论治组在治疗精神性焦虑和躯体性焦虑方面较常规针刺组有一定的优势,并且取穴简便、处方规范、可重复性强,值得临床进一步推广。
2.心胆论治组能有效改善中风病焦虑患者生存质量。疗效优于常规针刺组。
Background
Anxiety after having a stroke is a common long-term complications of cerebrovascular diseases. It is shown by the epidemiology research in abroad that the morbidity is about20%to40%. Anxiety after apoplexy is a lasting suffering. Medium or high degree of anxiety can affect the living quality of the patients and the recovery of body function and cognition function directly or even cause a second attack of cerebrovascular diseases.
In the last decade, specialist physician have been keen to the study of the emotional disorder after apoplexy. The clinical study about depression after apoplexy is fairly mature while the clinical research of anxiety after apoplexy is relatively unsufficient, expecially in the aspect of the imperfection of the randomized trails. Researches in aborad mainly concentrates in the intervention of body function recovery as well as the comparative study of the curative effects and the adverse reactions of the west medicine.
Modern medicine usually adopts anti-anxiety medicines for treatment, which have different degree of side-effects. Besides, there are other problems such as some patients can not torlerate the adverse effect of medicines and some anti-anxiety medicines are ineffective. Therefore, the hotspot of the current research is to find out an effective and safe therapeutic method without toxic or side-effect to improve the living qality of the anxious patients after hacing a stroke. Acupuncture is based on the adjustment of the function of the viscera which can regulate the mood and improve the physical symptoms realted to the mood, enabling the preceding improvement of physical syptoms. By reviewing the literature research in the last decade, it is found that the majority of the current study after apoplexy has the problems of limited observing items, unregulate randomized trials and bad repeatability.
Based on the adjustment of heart and gall, acupuncture enjoys the advantages of regulate operation and good repeatability and is worthy of further research in order to promote the popularization and application.
Objetive
This paper makes comments on the curative effects by stimulating the gallbladder meridian points and the heart meridian for the treatment of PSAD as well as the effecrs on the improvement of the living standard of the patients.
Method
All patients are from the clinics of the Dongqing Chinese medicine clinic and70of them are accorded with the inclusive criteria. They are devided into two groups randomly,35of which is the heart and gallbladder treatment group and the rest of which belong to the general acupuncture group. The acupoint selection of the heart and gallbladder treatment group:Baihui, ophryon, Neiguan point and Yanglingquan point:the point selection of moxa-moxibustion is four flowers? Needles should be imbedded in bilateral Xinyu, Danyu. The point selection of the general apuncture is Baihui, Zhisanzhen, Anming, Neiguan, Shenmen, and Sanyinjiao. If the patients have phlegm then give more apuncture in the Fenglong. If the patients is Qi-deficiency, then give more apuncture in the Tazhong and Qihai. Similarly, Blood stagnation, Geyu. Kidney deficiency, Shenyu, Yaoyangguan, taixi.
The heart and gallbladder treatment group:stimulate Neiguan and Yanglingquan. The depth is about10-12mm. The tecnique is to give the apuncture with regular speed to bring about the desired sensation combined with modulating QI-Xue. Then stimulate Baihui, Zhisan and the depth is about4-5mm with the same method. The time fot the retention of the needle is about30mins. Then stimulate the Sihua directly using moxa cones. Remove the unburned moxa cones with cutton swab when2/3of the moxa cones was burnt and patients feel warm or silght burning pain.5cones for each point. Finally, withdraw the imbedding needles in the bilateral Xinyu and Danyu. The intracutaneous5mm-long needle should be stimulated in and the needle handle should be left utside from the diection of outboard to the spinal column through horizontal inserction of needle. Then use the medical proof fabric to fix them. After2-day needle rentention, withdraw themubcutaneous ubcutaneous intracutaneous
The general acupuncture group:Stimulate anming, Neiguan, Shenmen, Taichong and Sanyinjiao, the depth is about10-12mm, the tecnique is to give the apuncture with regular speed to bring about the desired sensation.Then stimulate Baihui, Zhisan and the depth is about4-5mm with the same method. The time fot the retention of the needle is about30mins.
Both groups receive one treatment in2days and4weeks is one treatment course. The two groups has the same basic treastment and both groups adopts regular therapy of cerebrovascular diseases. The basic apuncture therapy is applied to improve the limb function.
Use HAMA and Zung SAS to evaluate the curative effects of anxiety after apoplexy before and after the treatment and meanwhile, use the three-factor score in the HAMA to refine the evaluation of the advantages of the heart and gallbladder treatment group. Apply the Bartherl BI to assess the body function recovery in the two groups before and after the treatment. Use the stroke scale—quality of life, SS-QOL to evaluate the living quality of patients from the following5aspects, overall condition, physiology, psycology, society and environment.
Adopt SPSS18.0statistical analysis software to cope with the statistical methods like the descriptive analysis, Chi-square test and rank sum test. Compare the results with the general apuncture group to study the difference of curative effcts after apoplexy.
Result
1the treament group makes no statistical difference compared with drug group in the aspects such as gender, age, course of the disease, illness level (P>0.05). The baseline is consistent, comparable.
2the total effective rate of treatment group is97.14%higher than88.57%of the control group, but the difference has no statistical significance (P>0.05), what prompted the curative effect of treatment group is equal to control group.
3In treatment group, the HAMA decrease obviously after the treatment. By the paired t-test, this result has significant difference (P<0.05), which implys the exact efficacy of the treatment for anxiety. That also happens in the control group. In the contrast of the treatment group and control group, by independent sample t-test, there is no significant difference (P>0.05) shown in the curative effect.
HAMA scores is composed by psychiatric anxiety, somatic anxiety, and sleep factor. Both treatments are effective in decreasing the scores of psychiatric anxiety, somatic anxiety and sleep factor, the differences have statistical significance (P<0.05). The treatment group has the equal efficacy in improving sleep of patients compared with the control group (P>0.05), but has superior efficacy in reducing patients'psychiatric and somatic anxiety symptoms (P<0.05); that indicates the method adopted by treatment group is better in treating mental and somatic anxiety than control group.
4In the contrast of QOL score, both groups make comparative differences after the treatment (P<0.05) by improving QOL score, and the treatment group is doing better than the control group (P<0.05).
Also, patients'physical, psychological, social, environmental score of two groups are all improved after the treatment, the difference has statistically significant (P<0.05), by analyzing the datas with Analysis of variance and LSD test. In the comparison between the control and treatment groups by the t-test, it shows that the treatment group makes statistical significance in all4cataloges compared with controls (P<0.05) after1course of treatment.
5In the contrast of Zung's anxiety self-evaluation scale (SAS), both groups make differentiation on SAS scores, what are decreased significantly (P<0.05). But compared the two groups after the treatment, no significant difference (P>0.05) is shown, which means the effects are equal
6BI score reflects the degree of physical function recovery of the patients with stroke. Both groups make comparative differences after the treatment (P<0.05) by improving BI score, But compared the two groups after the treatment, no significant difference (P>0.05) is shown, which means the effects are equal
The study of the correlationship between the increasing of BI score and decreasing of HAMA score in the treatment group shows a significant difference (P<0.05), increasing BI score would increase the curative effect on anxiety.
Conelusion
1treatment group makes no big difference from control group in the efficacy, but the treatent group does have certain advantages in treating mental anxiety and somatic anxiety compared to the control group, besides, the points of treatment group are easy to find, the prescription is specific and repeatabe, what make it worth to popularize
2the method of treatment group can effectively improve the quality of life in patients with post-stroke anxiety, which is superior to control group.
引文
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