杵针疗法结合情志护理对中风后抑郁患者康复效果的研究

（护理学院）二一三届硕士研究生学位论文杵针疗法结合情志护理对中风后抑郁患者康复效果的研究Chuzhen therapy combined with emotion nursing effect ofrehabilitation in patients with post-stroke depression学 科 专 业 ： 护理学研究生学号： 2010s494二一三年四月成都中医药大学 2010 级硕士学位论文中文摘要研究目的1、探讨杵针疗法结合情志护理对中风后抑郁患者的康复效果。2、通过临床论证和效果评价反馈，探索出适合中风后抑郁患者的杵针疗法。3、探讨出一套适合中风后抑郁患者情志护理的干预方法。4、以试验研究的结果和中医护理的基本理论方法为依据，使杵针疗法和情志护理在中医临床护理实践模式中进一步得到推广应用。研究方法运用临床随机对照研究方法，将 120 例患者随机分为对照组、杵针组和杵针情志组，根据中医辨证分型为肝郁痰阻型、痰火郁结型、心脾两虚型、肝肾阴虚型 4 种证型。对照组 41 例，在常规治疗的基础上，采用中风护理常规进行干预；杵针组 39 例，在对照组的基础上，加入杵针疗法进行干预，杵针疗法基础方选取天谷八阵、神道八阵、四关穴和十鬼祟穴，各证型分别辨证配穴进行干预；杵针情志组 40 例，在对照组的基础上，加入杵针疗法结合情志护理进行干预，杵针疗法同杵针组，情志护理方法有情志相胜法、移情易性法、暗示疗法、五音疗法、发泄疏导法等。三组均于干预前及干预 6 周后采用巴氏指数评定量表、脑卒中临床神经功能缺损量表、脑卒中影响量表、汉密尔顿抑郁量表进行评价。研究结果1、综合分析，对三组的BI评分、神经功能缺损评分、SIS评分、HAMD评分干预前后进行比较，统计结果其差异均有统计学意义（P0.05），说明三种方案对中风后抑郁的康复都是有效的。2、方差分析结果，干预后三组BI评分、神经功能缺损评分、SIS评分、HAMD评分各项指标之间比较，具有统计学意义（P0.05），杵针组与杵针情志组的康复疗效均优于对照组。说明杵针疗法和杵针疗法结合情志护理这两种方案比常规护理具有优势。3、通过LSD法进行多重比较分析，干预后杵针组与杵针情志组对BI评分、神经功能缺损评分进行比较，结果无统计学差异（P0.05）；而对SIS评分、HAMD评分进行比较，结果显示具有统计学意义（P0.05）；说明杵针情志组在改善生活质1成都中医药大学 2010 级硕士学位论文量和抑郁程度效果优于杵针组。4、三组抑郁程度改善总有效率对照组60.98%，杵针组76.92%，杵针情志组87.50%，三组之间比较具有统计学差异（P0.05）。研究结论杵针疗法结合情志护理能够显著提高中风后抑郁患者的日常生活能力和生活质量，降低神经功能缺损程度和抑郁程度，对中风后抑郁患者的康复具有很好的疗效。整个干预方案体现了中医护理的特色和优势，杵针疗法作为一种无创伤疗法可以在医院、社区和家庭中广泛推广和应用。关键词 杵针疗法；情志护理；中风后抑郁；康复；随机对照研究2成都中医药大学 2010 级硕士学位论文AbstractObjective1.To investigate Chuzhen therapy combined with emotion nursing rehabilitation effect of patients with post-stroke depression.2.Through the evaluation of clinical demonstration and effect feedback , to explore the suitable Chuzhen therapy in patients with post-stroke depression.3.To investigate a set of suitable emotion nusing intervention methods for patients with post-stroke depression.4.The further application of Chuzhen therapy and emotion nursing in clinical nursing practice mode based on experiment results and nursing basic theory of TCM.MethodsAccording to the randomized controlled ,the 120 patients were randomly into control group ,Chuzhen group and Chuzhen emotion group, and according to TCM syndrome differentiation,it was divided into 4 main types:depressed liver and phlegm obstruction , phlegm within fire,heart-spleen deficiency,deficiency of liver-yin and kidney-yin. Among them,39 cases of controlgroup ， used routine nursing methods;41 cases of Chuzhen group,adopted Chuzhentherapy in rehabilitation part on the basis of nursing routine，the basic methods ofChuzhen therapy selected Tiangu Bazhen 、 Shendao Bazhen 、 Siguan-acupoint and Shiguisui-acupoint.It was intervened by different syndrome respectively with different acupoint.40 cases of Chuzhen emotion group,the rehabilitation parts were intervened on the basis of Chuzhen therapy combined with emotion nursing .Themethods of emotion nursing were suppressing surplus feelings therapy 、 empathytransgender therapy、suggestion therapy 、five-tone therapy、dredging therapy,etc.Allthe three groups were evaluated by BI、CSS、SIS and HAMD before treatment and after treatment for six weeks.Results1.In general, compared with BI 、CSS 、SIS and HAMD scores about three groups3成都中医药大学 2010 级硕士学位论文before and after the intervention,the results have significant differences (P0.05).Nevertheless compared with SIS and HAMD scores,it has significant differences (P0.05).It shows that Chuzhen emotion group in improving quality of life and depression degree is better than Chuzhen group.4. Three groups depression degree to improve the total effective rate in the control group 60.98%, Chuzhen group 76.92%, and 87.50% of Chuzhen emotion group, compared between three groups has statistics difference 0.05).ConclusionChuzhen therapy combined with emotion nursing has very good curative effect on the rehabilitation of patients with post-stoke depression，which improves their daily life ability、quality of life and reduces the degree of nervous function defect and the degree of depression. The whole embodies the characteristics and advantages of TCM nursing intervention plans.As a result, Chuzhen therapy as a non-invasive therapy can be widely applicated and promoted in the hospital, community and family.Key Words: Chuzhen therapy; emotion nursing; post-stoke depression; rehabilitation; randomized controlled study4成都中医药大学 2010 级硕士学位论文目 录中英文缩略词 .7引 言.8主要概念 . 10研究背景 . 121 中风后抑郁的研究现状. 121.1 现代医学对中风后抑郁的认识. 121.2 中医对中风后抑郁的认识. 142 研究的理论基础. 202.1 辨证论治. 202.2 五行学说. 212.3 经络学说. 222.4 七情学说. 223 研究目的及意义. 233.1 研究目的. 233.2 研究意义. 23研究对象与方法 . 241 研究对象. 241.1 研究对象