【作者】 刘慧敏；

【导师】 牟善芳；

【作者基本信息】 山东中医药大学 ， 护理学， 2020， 硕士

【摘要】 目的:观察择时耳穴压豆联合微信平台宣教对维持性血液透析患者失眠的疗效,为MHD失眠患者提供简、便、灵、验的护理治疗方法。方法:本研究选取山东某三甲中医院血液净化中心符合纳入标准的64例维持性血液透析失眠患者,利用计算机生成随机数,尾数单数者为观察组(n=32),尾数双数者为对照组(n=32)。两组给予中医辨证分型。干预期间两组禁用催眠药物,均行常规透析治疗,其余降压、纠正贫血、改善心功能、调节酸碱平衡等对症治疗按原方案进行。将观察组患者纳入创建的研究课题微信群,定期发布透析相关知识,随时关注群内患者问题,及时对症处理。耳穴压豆取神门、交感、皮质下、肾、心、脾为主穴,配穴根据辨病与辨证相结合,随症加减。脾肾阳虚型加内分泌;肝郁化火型加肝、肝阳;痰瘀互结型加百灵2、胆、内分泌;心脾两虚型加胃、胆;阴虚火旺型加肝、内分泌;心胆气虚型加胆;高血压者加耳后降压沟。用探棒轻压选取穴位,寻找敏感点并作标记,75%酒精消毒,将王不留行籽贴贴好,3-5天两耳交替更换。每日辰时(9时)、午时(12时)及酉时(19时)按压耳豆3次,每次按压时间约3-5分钟,2周为1疗程,共做2疗程。对照组仅给予常规透析护理宣教。两组患者在干预前后均采用匹兹堡睡眠质量指数量表(PSQI)、生存质量量表评分(SF-36)及血液透析知识水平问卷进行测评。应用SPSS22.0统计软件进行数据统计分析。结果:两组患者干预前各项指标比较均无差异。PSQI统计分析:干预后观察组患者PSQI总分、睡眠质量、入睡时间、睡眠效率、睡眠障碍、日间功能等六个指标均有显著差异(P<0.01),睡眠时间方面有差异(P<0.05);对照组患者PSQI总分、睡眠质量、睡眠障碍、日间功能等四个指标均有显著差异(P<0.01),在睡眠效率方面亦有差异(P<0.05)。两组组间对照在PSQI总分、睡眠质量、入睡时间、睡眠效率、睡眠障碍方面有显著差异(P<0.01),日间功能方面有差异(P<0.05)。生存质量量表评分(SF-36)统计分析:观察组患者干预后在生理机能、生理职能、总体健康、精力、社会功能、情感职能、精神健康、健康变化等指标有显著差异(P<0.01),躯体疼痛方面有差异(P<0.05);对照组患者在生理机能、社会功能及情感职能等三个指标有显著差异(P<0.01),在生理职能、精神健康及健康变化等三个指标有差异(P<0.05)。组间对照:生理机能、情感职能指标有差异(P<0.05)。血液透析相关知识得分干预后自身及组间对照比较均有显著差异(P<0.01)。自身对照:观察组患者收缩压、舒张压干预后均有显著差异(P<0.01),而对照组干预后无差异(P>0.05);组间对照:舒张压有显著性差异(P<0.01),收缩压有差异(P<0.05)。且两组患者在干预前后PSQI总分差值、收缩压差值、舒张压差值及血液透析知识水平得分差值组间比较均有显著性差异(P<0.01)。两组患者失眠疗效比较,观察组总有效率为90.63%,对照组为34.38%,有显著性差异(P<0.01)。对各中医证型分析,择时耳穴压豆对各证型总有效率均达80%以上,其中对脾肾阳虚型、心脾两虚型、痰瘀互结型疗效尤为显著,总有效率均为100.00%。结论:1.择时耳穴压豆对维持性血液透析失眠患者睡眠质量有明显改善作用,尤对脾肾阳虚型、心脾两虚型、痰瘀互结型疗效更为显著;2.择时耳穴压豆对患者生存质量水平有明显提高且可有效降低高血压水平,对舒张压降压效果更明显;3.通过应用微信平台健康宣教信息的推送,提高了患者对透析知识认知的水平,增加了对耳穴压豆治疗的依从性。两者联合应用可促进患者心身舒适,提高睡眠质量,提升生活质量。其优势在于:①突出中医护理特色技术优势,体现出辨证施护治疗与时辰的相关性,有事半功倍的特点;②目前此类研究临床较少,且操作简便易廉、无副作用,患者易接受,并能广泛推广。更多还原

【Abstract】 Objective:To observe the efficacy of pressing auricular acupoints in an appropriate time combined with health education over WeChat platform on maintained hemodialysis patients with ins to obtomnia,andain a simple,convenient,effective,and experienced nursing treatment method for MHD insomnia patients.Methods:Sixty-four patients with maintenance hemodialysis insomnia from hemodialysis purification center of a triple-A Chinese medicine hospital in Shandong province were enrolled and numbered randomly by the computer.Patients with odd number were allocate to experimental group(n=32),and patients with even number were allocated to control group(n=32).All of the 64 patients were diagnosed and categorized based on the syndrome differentiation of TCM.During the intervention period,all the patients were banned from hypnotic drugs,and routine dialysis treatment was performed.Treatments such as reducing blood pressure,correcting anemia,improving cardiac function,and adjusting acid-base balance were carried out according to the original plan.Patients from the experimental group were incorporated into a WeChat group.Hemodialysis related knowledge was taught through WeChat regularly,questions raised by the patients were answered timely,and treatment was MHD in time.The main acupoints were shenmen(TF4),sympathetic(AH6a),subcortex(AT4),Kidney(CO 10),heart(CO15)and spleen(CO13),and the corresponding points were selected according to the combination of disease differentiation and pattern differentiation.If patients are of Spleen-Kidney Yang deficiency type,endocrine(CO18)will be included;if patients are of Liver depression forming fire type,points of liver(C012)and liver Yang will be included;if patients are of Phlegm-stasis type,points of bailing 2,gallbladder(CO11)and endocrine(C018)will be included;if patients are of heart-spleen deficiency type,points of stomach(C04)and gallbladder(CO11)will be included;if patients are of fire excess from Yin deficiency type.points of liver(CO12)and endocrine(CO18)will be included;if patients are of Heart and gallbladder qi deficiency type,gallbladder(CO11)will be included;if patients with hypertension,groove of posterior surface(PS)will be included.By pressing gently with a probe,sensitive points were located,marked and then disinfected with 75%alcohol.Paste seeds on the right acupoints,and both ears alternate at the interval of 3-5 days.Press the ear beans for about 3-5 minutes,3 times a day at 9 o’clock,12 o’clock and 19 o’clock respectively for two courses with two weeks as a course.The control group was given routine dialysis nursing knowledge only.The Pittsburgh sleep quality index scale(PSQI),quality of life scale score(SF-36)and hemodialysis knowledge level questionnaire were used to evaluate the patients before and after the education.The experimental data were analyzed by SPSS22.0 software.Results:There was no difference between the two groups before intervention.There were significant differences in the experimental group after intervention in the total PSQI score,sleep quality,time to fall asleep,sleep efficiency,sleep disturbance,and daytime function(P<0.01),and differences in sleep time(P<0.05);there were significant differences in the control group in total PSQI scores,sleep quality,sleep disorders,daytime function and other four indicators(P<0.01),as well as differences in sleep efficiency(P<0.05).There were significant differences between the two groups in total PSQI score,sleep quality,time to fall asleep,sleep efficiency,sleep disorders(P<0.01),and differences in daytime function(P<0.05).Statistical analysis of the quality of life scale score(SF-36):There were significant differences in the experimental group in Physical Functioning(PF),Role-Physical(RF),General Health(GH),Vitality(VT),Social Functioning(SF),Role-Emotional(RE),Mental Health(MH)and Reported Health Transition(HT)after intervention(P<0.01),and difference in Bodily Pain(BP)(P<0.05);there were significant differences in the control group in PF,SF and RE(P<0.01),and differences in RF,MH and HT after intervention(P<0.05).Comparison between groups:there were differences between the two groups in PF and RE(P<0.05).Scores of Hemodialysis related knowledge were significantly different in the experimental group and between the groups after intervention(P<0.01).In either group:there was a significant difference in systolic and diastolic blood pressure after intervention(P<0.01),but no difference in the control group(P>0.05);between the two groups:there was a significant difference in diastolic blood pressure(P<0.01)and a difference in systolic blood pressure(P<0.05)in the experimental group.There were significant differences in the total score of PSQI,the difference of systolic pressure,the difference of diastolic pressure and the difference of scores of hemodialysis knowledge level after intervention between the two groups(P<0.01).Comparing the efficacy on insomnia between the two groups,the total effective rate in the experimental group was 90.63%and that in the control group was 34.38%,with a significant difference(P<0.01).According to the analysis of all TCM syndromes,the total effective rate of pressing auricular acupoint in an appropriate time on all syndromes was more than 80%,among which the effect on spleen and kidney Yang deficiency,heart-spleen deficiency,and phlegm-stasis was particularly significant,with the total effective rate of 100.00%Conclusion:1.Pressing auricular acupoint in an appropriate time can significantly improve the sleep quality of MHD patients with insomnia,especially significant for patients with spleen-kidney Yang deficiency,heart-spleen deficiency,or phlegm-blood stasis.2.Quality of Life(QOL)of patients is significantly improved and the level of hypertension can be effectively reduced,especially for diastolic pressure.3.By using WeChat platform to promote health knowledge,the patients’ cognition level of dialysis knowledge was improved,and their compliance to the treatment of auricular acupoint pressure was increased.It could promote patients’ mental and physical comfort,and improve sleep quality and life quality.Its advantages lie in:(1)highlighting the advantages and characteristics of Traditional Chinese Medicine nursing by corelate nursing according to syndrome differentiation with appropriate treating hours,which is every effective;(2)Up to now,similar studies are rare;moreover,it is easy to operate and has no side effects,and it is easy for patients to accept and easy for clinical publicity and education.更多还原