胃护理干预联合回医烙灸治疗老年原发性骨质疏松症(骨蚀)随机平行对照研究
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摘要
[目的]观察脾胃护理干预联合回医烙灸治疗老年原发性骨质疏松症(骨蚀)疗效。[方法]使用随机平行对照方法,将85例住院及门诊患者按就诊顺序号抽签随机分两组。对照组41例温针灸(直径0.30mm、长25～40mm毫针),脾胃经整体取穴:三阴交、血海、足三里、梁门、中脘、内关、阴陵泉、脾俞、胃俞;随证局部取穴,血海、梁门泻法为主,三阴交、足三里、中脘、内关、阴陵泉、脾俞、胃俞,留针30min,留针期间加灸,每5min行针1次,1次/d;常规护理:①心理护理:据文化层次,年龄、爱好、生活习惯等针对性心理疏导;②健康教育:了解OP的预防,发病机制和康复等问;③饮食护理:增加钙、含维生素D多食物;④运动指导:依年龄、性别、健康状况、体能等选择适当的方式、时间、强度等;⑤用药护理:根据疏松程度,按医嘱及时、正规用药。干预组44例脾胃护理:养神,疏导患者思维、精神,与患者谈心、提供阅览相关书籍等,告诫少思寡欲;省言,"服药讫,忌语话一二时辰许";调情志,情绪疏导,有的放矢做好心理护理,观其表,调其神,说理开导、定志安神、暗示转移;节饮食,辨证膳食指导,遵循饮食权衡之法,合理选用寒温适宜,避免饮食偏嗜;服药后忌酒、湿面、大料物之类,宜温食及薄滋味;慎起居,忌劳倦,告诫患者忌浴当风、汗当风,调适生活起居;正常劳动和体育锻炼,避免劳累;常规护理同对照组;回医烙灸:烙灸器烧红,灸,以局部皮肤微微发红为度,皮肤溃破、流水、流脓,注意局部清洁,预防感染,30min/次,1/d。连续干预治疗10d为1个疗程,疗程间休息3～5d,继续下一疗程。观测临床表现、NPRS评分、SF-36评分、不良反应。连续干预治疗6疗程(60d),判定疗效。[结果]临床疗效、骨密度疗效治疗组优于对照组(P<0.05)。NPRS评分两组均有明显降低(P<0.05),治疗组降低优于对照组(P<0.01)。SF-36评分两组均有明显改善(P<0.05),治疗组改善优于对照组(P<0.05)。[结论]脾胃护理干预联合回医烙灸治疗老年原发性骨质疏松症(骨蚀),疗效满意,无严重不良反应,值得推广。
[Objective] To observe the curative effect of Spleen-stomach nursing intervention combined with Huiyi branding moxibustion in the treatment of senile primary osteoporosis(bone erosion). [Method] 85 inpatients and outpatients were randomly divided into two groups by drawing lots according to the order of visiting. In the control group, 41 cases were treated with warm needling(0.30 mm in diameter, 25-40 mm in length), and the spleen-stomach meridian was selected as a whole: Sanyinjiao, Xuehai, Zusanli, Liangmen,Zhongwan, Neiguan, Yinlingquan, Pishu and Weishu; with local acupoints selected, Xuehai and Liangmenxie were the main methods, Sanyinjiao, Zusanli, Zhongwan, Neiguan, Yinlingquan, Pishu and Weishu were retained for 30 minutes, and moxibustion was added every 5 minutes. Routine nursing: 1.Psychological nursing: targeted psychological counseling according to cultural level,age,hobbies and living habits; 2. Health education: understanding the prevention, pathogenesis and rehabilitation of OP; 3.Dietary nursing: increasing calcium and vitamin D-containing foods; 4.Sports guidance: selecting appropriate ways, time and intensity according to age, sex, health status and physical fitness,etc. Medication nursing: According to the degree of looseness, timely and regular medication according to doctor's advice. In the intervention group, 44 cases of spleen and stomach nursing: nourishing the spirit, soothing the patient's thinking and spirit, talking with the patient, providing reading related books and so on, admonishing the lack of thinking and desire; omitting the words, "taking medicines, avoiding words for twelve hours"; flirting with the will, emotional guidance,targeted psychological nursing, watching its surface, regulating its spirit, speaking rationally, calming mind,suggesting shift; diet-saving, dietary guidance based on syndrome differentiation. Following the method of dietary balance, rational selection of cold and temperature is appropriate to avoid dietary preference; after taking medicine, avoid alcohol, wet noodles, large materials, such as warm food and thin taste; cautious living, tired,warning patients to avoid bathing, sweat, wind, adjust life and living; normal work and physical exercise, avoid fatigue; routine nursing and control group; return to medicine and branding moxibustion:branding moxibustion device burning red, moxibustion, local. Skin is slightly reddish, skin ulceration,running water, pus, pay attention to local cleaning,prevention of infection, 30 minutes/time, 1/d. Continuous intervention treatment for 10 days is a course of treatment, with a 3-5 day interval, and the next course of treatment is continued. Clinical manifestations, NPRS scores, SF-36 scores and adverse reactions were observed. Continuous intervention treatment for 6 courses(60 days) to determine the efficacy. [Result] The clinical efficacy and bone mineral density of the treatment group were better than those of the control group(P<0.05). NPRS scores in both groups were significantly decreased(P<0.05), and the reduction in treatment group was better than that in control group(P<0.01). The SF-36 scores in both groups were significantly improved(P<0.05), and the improvement in the treatment group was better than that in the control group(P<0.05). [Conclusion] Spleen-stomach nursing intervention combined with Huiyi branding moxibustion has satisfactory curative effect on senile primary osteoporosis(bone erosion), and has no serious adverse reactions.It is worth popularizing.
[Objective] To observe the curative effect of Spleen-stomach nursing intervention combined with Huiyi branding moxibustion in the treatment of senile primary osteoporosis(bone erosion). [Method] 85 inpatients and outpatients were randomly divided into two groups by drawing lots according to the order of visiting. In the control group, 41 cases were treated with warm needling(0.30 mm in diameter, 25-40 mm in length), and the spleen-stomach meridian was selected as a whole: Sanyinjiao, Xuehai, Zusanli, Liangmen,Zhongwan, Neiguan, Yinlingquan, Pishu and Weishu; with local acupoints selected, Xuehai and Liangmenxie were the main methods, Sanyinjiao, Zusanli, Zhongwan, Neiguan, Yinlingquan, Pishu and Weishu were retained for 30 minutes, and moxibustion was added every 5 minutes. Routine nursing: 1.Psychological nursing: targeted psychological counseling according to cultural level,age,hobbies and living habits; 2. Health education: understanding the prevention, pathogenesis and rehabilitation of OP; 3.Dietary nursing: increasing calcium and vitamin D-containing foods; 4.Sports guidance: selecting appropriate ways, time and intensity according to age, sex, health status and physical fitness,etc. Medication nursing: According to the degree of looseness, timely and regular medication according to doctor's advice. In the intervention group, 44 cases of spleen and stomach nursing: nourishing the spirit, soothing the patient's thinking and spirit, talking with the patient, providing reading related books and so on, admonishing the lack of thinking and desire; omitting the words, "taking medicines, avoiding words for twelve hours"; flirting with the will, emotional guidance,targeted psychological nursing, watching its surface, regulating its spirit, speaking rationally, calming mind,suggesting shift; diet-saving, dietary guidance based on syndrome differentiation. Following the method of dietary balance, rational selection of cold and temperature is appropriate to avoid dietary preference; after taking medicine, avoid alcohol, wet noodles, large materials, such as warm food and thin taste; cautious living, tired,warning patients to avoid bathing, sweat, wind, adjust life and living; normal work and physical exercise, avoid fatigue; routine nursing and control group; return to medicine and branding moxibustion:branding moxibustion device burning red, moxibustion, local. Skin is slightly reddish, skin ulceration,running water, pus, pay attention to local cleaning,prevention of infection, 30 minutes/time, 1/d. Continuous intervention treatment for 10 days is a course of treatment, with a 3-5 day interval, and the next course of treatment is continued. Clinical manifestations, NPRS scores, SF-36 scores and adverse reactions were observed. Continuous intervention treatment for 6 courses(60 days) to determine the efficacy. [Result] The clinical efficacy and bone mineral density of the treatment group were better than those of the control group(P<0.05). NPRS scores in both groups were significantly decreased(P<0.05), and the reduction in treatment group was better than that in control group(P<0.01). The SF-36 scores in both groups were significantly improved(P<0.05), and the improvement in the treatment group was better than that in the control group(P<0.05). [Conclusion] Spleen-stomach nursing intervention combined with Huiyi branding moxibustion has satisfactory curative effect on senile primary osteoporosis(bone erosion), and has no serious adverse reactions.It is worth popularizing.
引文
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[9]史兴忠,许建峰,林瑞珠,等.回医烙灸疗法结合康复训练治疗腰椎间盘突出症的临床研究[J].宁夏医科大学学报,2013,35(12):1309-1311.
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[2]中国老年学和老年医学学会骨质疏松分会.中国老年骨质疏松症诊疗指南(2018)[J].中国骨质疏松杂志,2018,(12):154-156.
[3]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2011-06-05].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[4]郑筱萸.中药新药治疗骨质疏松症的临床研究指导原则[M].北京:中国医药科技出版社,2002:356.
[5]国家中医管理局.中医病证诊断疗效标准(中华人民共和国中医药行业标准)[M].南京:南京大学出版社,1994:213.
[6]李东垣.脾胃论[M].北京:人民卫生出版社,2005.
[7]王曙红.临床护理评价量表及应用[M].长沙:湖南科学技术出版社,2011:228-230.
[8]牛阳.《回回药方》研究[M].银川:黄河出版传媒集团,2010:134-136.
[9]史兴忠,许建峰,林瑞珠,等.回医烙灸疗法结合康复训练治疗腰椎间盘突出症的临床研究[J].宁夏医科大学学报,2013,35(12):1309-1311.
[10]单于德,单利.回族医学独特的烙灸疗法[J].中国民族民间医药杂志,2002,20(3):136-137.