侯春艷 譚娟 張文江
[摘要] 目的 觀察雙心護(hù)理結(jié)合撳針對(duì)冠狀動(dòng)脈粥樣硬化性心臟病患者心理痛苦的影響。 方法 選擇2017年4月~2019年4月中國(guó)中醫(yī)科學(xué)院西苑醫(yī)院心血管三科住院的存在心理痛苦冠心病患者96例,根據(jù)隨機(jī)數(shù)字表法將其分為觀察組48例、對(duì)照組48例。觀察組接受雙心護(hù)理及撳針療法,對(duì)照組予常規(guī)護(hù)理。觀察兩組心理痛苦溫度計(jì)(DT)、焦慮自評(píng)量表(SAS)、抑郁自評(píng)量表(SDS)和中醫(yī)癥狀評(píng)分變化。 結(jié)果 干預(yù)后兩組DT、SAS、SDS評(píng)分均低于干預(yù)前(均P < 0.05)。觀察組DT、SAS、SDS評(píng)分低于對(duì)照組(P < 0.05)。干預(yù)后觀察組胸痛、胸悶、胸脅脹滿、情緒不寧、急躁易怒,心悸評(píng)分均低于干預(yù)前(P < 0.05)。對(duì)照組胸痛、胸悶、情緒不寧,心悸評(píng)分均低于干預(yù)前(P < 0.05)。觀察組胸悶,胸脅脹滿,急躁易怒評(píng)分低于對(duì)照組(P < 0.05)。 結(jié)論 雙心護(hù)理結(jié)合撳針可以減輕冠狀動(dòng)脈粥樣硬化性心臟病患者心理痛苦,改善患者臨床癥狀。
[關(guān)鍵詞] 雙心護(hù)理;撳針;心理痛苦;冠狀動(dòng)脈粥樣硬化性心臟病;氣滯血瘀
[中圖分類(lèi)號(hào)] R541.4? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1673-7210(2020)03(a)-0185-04
[Abstract] Objective To observe the effect of psycho-cardiologic nursing combined with stirrup on psychological distress of patients with coronary atherosclerotic heart disease. Methods From April 2017 to April 2019, a total of 96 patients with coronary heart disease with psychological pain were admitted to The Third Department of Cardiovascular Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine. According to the random number table method, the patients were divided into observation group 48 cases and control group 48 cases. The observation group received psycho-cardiologic nursing and pressneedle therapy, while the control group received routine nursing. The changes of distress thermometer (DT), anxiety self-rating scale (SAS), depression self-rating scale (SDS) and TCM symptom score were observed. Results After intervention, the scores of DT, SAS and SDS in both groups were lower than before intervention (all P < 0.05). The scores of DT, SAS and SDS in the observation group were significantly lower than those in the control group (P < 0.05). After intervention, the scores of chest pain, chest tightness, chest side fullness, restless mood, irritability and palpitations in the observation group were all lower than those before treatment (P < 0.05). In the control group, chest pain, chest tightness, restless mood and palpitations were all lower than those before treatment (P < 0.05). In the observation group, the scores of chest tightness, chest swelling and irritability were significantly lower than those in the control group (P < 0.05). Conclusion Psycho-cardiologic nursing combined with acupuncture can reduce the psychological pain of patients with coronary atherosclerotic heart disease, improve the clinical symptoms of patients.
[Key words] Psycho-cardiologic nursing; Press needle therapy; Psychological distress; Coronary atherosclerotic heart disease; Qi stagnation and blood stasis
3 討論
目前,冠心病是公認(rèn)的雙心疾病,焦慮、抑郁、沮喪、敵意等心理因素對(duì)冠心病的影響?yīng)毩⒂趥鹘y(tǒng)危險(xiǎn)因素之外[9-11]。在臨床工作中,改善患者的心理痛苦可能會(huì)提高臨床療效,改善患者生活質(zhì)量。
心理痛苦指患者不愉快的情感體驗(yàn),包括害怕、脆弱、焦慮、抑郁、恐慌、孤立感,甚至精神危機(jī)等心理障礙。嚴(yán)重干擾患者對(duì)疾病的應(yīng)對(duì)能力和生活質(zhì)量[12-14]。DT是心理痛苦的評(píng)估工具,用于患者自己評(píng)估近1周來(lái)所經(jīng)歷的痛苦程度[14],其運(yùn)用于心血管疾病相關(guān)心理痛苦的研究靈敏度為84.7%,特異度為76.4%[16]。目前對(duì)冠心病患者比較全面的心理痛苦研究報(bào)道較少,本課題組做了初步的探索。
情志所傷是本病的重要病因?!峨s病源流犀燭》曰:“總之七情之由作心痛,七情失調(diào)可致氣血耗逆,心脈失暢,痹阻不通而發(fā)心痛。”[17]雙心護(hù)理即在對(duì)患者實(shí)施疾病護(hù)理的同時(shí)加入心理護(hù)理,關(guān)注患者的心理狀態(tài),有針對(duì)性的心理疏導(dǎo),健康教育,飲食指導(dǎo)等干預(yù)力爭(zhēng)使患者達(dá)到 《醫(yī)經(jīng)原旨》所云:“意志和,精神定,悔怒不起,魂魄不散,五臟俱甯,邪亦安從奈我何哉?!盵18]的理想狀態(tài),積極配合治療,提高臨床效果,改善生活質(zhì)量。
撳針是常用的中醫(yī)護(hù)理技術(shù)。治療本病以行氣活血、解郁調(diào)神為法。《靈樞·口問(wèn)》:“憂思則心系急,心系急則氣道約,約則不利,故太息以伸出之,補(bǔ)手少陰、心主、足少陽(yáng)留之也?!盵18]本研究設(shè)計(jì)即宗此意,神門(mén)為心經(jīng)原穴和輸穴,神氣出入之門(mén)戶(hù),原氣之所過(guò),尤擅治心之所屬神志疾患?!鹅`樞·九針十二原》云:“五臟有疾,當(dāng)取之十二原?!盵18]《靈樞·五亂》:“故氣亂于心則煩心密嘿,俯首靜伏……氣在于心者,取之手少陰、心主之輸?!盵19]故可調(diào)心神。膻中為心包募穴,《素問(wèn)·靈蘭秘典論》:“膻中者,臣使之官,喜樂(lè)出焉?!盵20]在藏象學(xué)說(shuō)中為心包絡(luò),具有代心行事、替心受邪的特點(diǎn)[21],具有調(diào)暢氣機(jī),治一切氣機(jī)不暢之病的功效。太沖為肝經(jīng)原穴和輸穴,可調(diào)達(dá)肝氣之郁。現(xiàn)代研究顯示,針刺膻中、太沖穴可影響大腦多個(gè)功能區(qū),影響心血管調(diào)節(jié)中樞,增加冠狀動(dòng)脈血流量,改善心肌供血;影響抑郁癥情感調(diào)節(jié)相關(guān)的腦區(qū),減輕心理痛苦[22-23]。本研究觀察結(jié)果提示,雙心護(hù)理結(jié)合撳針可以減輕冠狀動(dòng)脈粥樣硬化性心臟病患者心理痛苦,改善患者臨床癥狀,具有一定的臨床應(yīng)用價(jià)值和前景。
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(收稿日期:2019-09-10? 本文編輯:封? ?華)