摘要
目的
糖尿病是一种常见的内分泌代谢性疾病。糖尿病患者多伴有抑郁、焦虑等状态。糖尿病病人的抑郁情绪、焦虑情绪等精神与心理疾病发生率高于普通人群。因此,糖尿病也是心身疾病的一种,也是被公认为是最容易伴发精神心理疾病的慢性疾病之一。目前糖尿病的治疗仍以药物为主,但是在治疗疾病的同时,积极纠正并发症并改善心理障碍和情绪状态。糖尿病教育、饮食疗法、运动疗法、药物疗法和血糖监测是目前国际糖尿病联盟(IDF)对糖尿病的治疗提出五项综合原则。按照此原则,拟定治疗方案,选择八段锦结合放松功作为特殊的运动疗法治疗2型糖尿病伴发抑郁、焦虑患者。
方法
本研究采用随机对照研究设计,选择2型糖尿病伴抑郁或焦虑患者为研究对象,随机分为治疗组和对照组,治疗组60例,对照组30例。治疗组在原有糖尿病治疗的基础上进行八段锦结合放松功干预,对照组保持原有治疗方案。干预时间为12个月,第18个月随访。通过对比八段锦结合放松功的治疗前后空腹血糖、糖化血红蛋白、胰岛素、C-肽、血脂等生理生化指标,明尼苏达多项人格测验、焦虑自评量表、抑郁自评量表、蒙哥马利抑郁量表等心理指标,糖尿病特异性生存质量量表的变化,探讨八段锦结合放松功对2型糖尿病患者心理和生理作用,观察研究八段锦结合放松功对2型糖尿病伴抑郁或焦虑患者的生理和心理的短期和长期疗效。
结果
1.八段锦结合放松功干预能够降低SAS、SDS、MARDS、HAMA评分(p<0.01),可以改善2型糖尿病伴抑郁或焦虑患者抑郁、焦虑状态；
2.八段锦结合放松功干预能够降低SCL-90总分及躯体化、抑郁、焦虑因子(p<0.01)、强迫、敌对因子(p<0.05),对恐怖、偏执等因子无影响作用,可以改善2型糖尿病伴抑郁或焦虑患者的症状；
3.八段锦结合放松功干预能够降低DSQL评分,可以改善2型糖尿病伴抑郁或焦虑患者的生存质量、生理功能、心理精神状态和治疗影响(p<0.01)；
4.八段锦结合放松功干预可降低2型糖尿病伴抑郁或焦虑患者的糖化血红蛋白(p<0.01)、甘油三酯、空腹血糖、低密度脂蛋白(p<0.05)等生化指标；
5.八段锦结合放松功干预对2型糖尿病伴抑郁或焦虑患者的MMPI抑郁(p<0.05)、精神衰弱(p<0.01)等因子产生影响。八段锦结合放松功不仅对外在的症状有较好的改善作用,还有可能对内在的人格因子发挥作用；
6.研究八段锦结合放松功对2型糖尿病患者一年期干预的心理与生理影响,初步得出疾病的心理疗效为82.00%,总有效率为74.00%。
研究初步证实将八段锦结合放松功纳入糖尿病综合管理的五项原则范畴,进行长期干预对2型糖尿病伴抑郁或焦虑患者心理生理都有一定程度的改善,可以将此治疗模式进一步推广应用于临床。
结论
1.八段锦结合放松功干预可改善2型糖尿病伴抑郁或焦虑患者的抑郁、焦虑等心理指标。这种改善不仅停留在症状层面,引起抑郁、焦虑状态的人格偏移,即性格缺陷(内因)角度也有一定程度的改善,因此这种疗效可能更持久而稳固。另外,进一步证实八段锦结合放松功对部分人格可以产生影响,但需要长期的干预才可实现。
2.八段锦结合放松功干预可降低2型糖尿病伴抑郁或焦虑患者的糖化血红蛋白、甘油三酯等生化指标。此次的干预时间为期1年,结合之前短期的研究结果,初步验证了八段锦结合放松功对生化指标的影响可能是个长期的过程。
3.八段锦结合放松功干预可提高2型糖尿病伴抑郁或焦虑患者的生存质量。结合之前短期的研究结果,我们考虑八段锦结合放松功不仅可以在短期内迅速提高2型糖尿病患者的生存质量,长期的干预也会带来类似的效果。因此,可以推知八段锦结合放松功对2型糖尿病患者生存质量的疗效持久而稳固。
4.初步证实将八段锦结合放松功纳入糖尿病综合管理的五项原则范畴,进行长期干预对2型糖尿病伴抑郁或焦虑患者心理生理都有一定程度的改善,可以将此治疗模式进一步推广应用于临床。
Object
Diabetes is a common endocrine metabolic disease. Diabetic patients usually have depression, anxiety, etc. Diabetes patients have more probability to commit depression, anxiety and other mental or psychological disease than the general population.Therefore, in a sense diabetes belongs to psychosomatic diseases, and it is also acknowledged as the most easily one of the chronic disease with mental diseases. Drugs are currently dominantly used in the therapy of diabetes.Beyond of that, we also correct actively the complications and improve psychological disorders and emotional state when using drugs.According to the five principles for the treatment of diabetes from the International Diabetes Federation(IDF), diabetes education, diet therapy, exercise therapy, drug therapy and blood glucose monitoring, we choose the Ba Duan Jin combining with relaxation Qigong as a special exercise therapy to treat type2diabetes patients with depression and anxiety.
Method
We designed a randomized and controlled study and chose type2diabetes with depression or anxiety patients as our objects. All the participants met inclusion criteria were randomly divided into treatment group(60cases)and control group(30cases). Patients in the treatment group accepted Ba Duan Jin combing Relaxation Qigong on the basis of the original treatment of diabetes treatment. Whereas The control group maintained the original treatment. We treat for12months, and18months follow-up. We observed the fasting blood glucose, glycosylated hemoglobin, insulin, C-peptide, lipids and other biochemical indexes, the Minnesota Multiphasic Personality Tests(MMPI), Self-rating Anxiety Scale(SAS), Self-rating Depression Scale(SDS), Montgomery-Asberg Depression Rating Scale(MARDS) and other psychological indicators, Dermatologic Specific Quality of Life(DSQL) before and after treatment to explore TCM behavioral and psychological therapy for patients with type2diabetes psychological and physiological effects. We mainly observe the physiological and psychological short-term and long-term efficacy of type2diabetes with depression and anxiety treated by Ba Duan Jin combining relaxation Qigong.
Result
1. Ba Duan Jin combining relaxation Qigong can reduce the SAS, SDS, MARDS,HAMA scores (p<0.01). They can improve the depression and anxiety of type2diabetic patients with depression or anxiety in patients;
2. Ba Duan Jin combining relaxation Qigong can reduce the SCL-90score and somatization, depression, anxiety factor (p<0.01), obsessive-compulsive, hostility factor (p<0.05), have no effect on terror, paranoia and other factors.They can ameliorate the patient's symptoms of type2diabetes with depression or anxiety;
3. Ba Duan Jin combining relaxation Qigong can reduce the DSQL score and improve the survival quality, physiological function, psychological quality and treatment effect of patients with type2diabetes with depression or anxiety (p<0.01);
4. Ba Duan Jin combining relaxation Qigong can reduce the patients of type2diabetes with depression or anxiety with glycosylated hemoglobin (p<0.01), triglycerides, fasting glucose, low-density lipoprotein (p<0.05) and other biochemical markers;
5. Ba Duan Jin combining relaxation Qigong have effect on depression (p<0.05), mental exhaustion (p<0.01), and other influence factors of MMPI in type2diabetes patients with depression or anxiety. TCM Behavioral therapy not only affect external symptoms,but also play a role on the inner personality;
6. We study the psychological and physiological effects of Ba Duan Jin combining relaxation Qigong have one-year intervention in patients of type2diabetes with depression or anxiety. And we concluded preliminarily the psychological effective rate was82.00%, the total effective rate was74.00%.
We preliminarily confirm that the TCM behavior therapy should be included into five principles of comprehensive management of diabetes. It has a certain degree of psychological and physiological improvement of long-term intervention in patients with type2diabetes associated with depression or anxiety. This treatment model should be further popularized and applied in clinic.
Conclusion
1. Ba Duan Jin combining relaxation Qigong can improve type2diabetes in patients with depression or anxiety associated with depression, anxiety and other psychological indicators. This improvement not only stay in symptom level, causing depression, anxiety, personality shift state, the character flaws (internal) point of view also has a certain degree of improvement, so this effect may be more durable and stable. In addition, it further proves that the therapy can have an impact on part of Chinese personality behavior, but need to be achieve for long-term interventions.
2. Ba Duan Jin combining relaxation Qigong can reduce type2diabetes in patients with depression or anxiety glycosylated hemoglobin, triglycerides and other biochemical parameters. The intervention time for1year, combined with the results of previous short-term studies, preliminary validates that indexes on biochemical of Chinese behavior therapy may be a long process.
3. Ba Duan Jin combining relaxation Qigong can improve type2diabetes in patients with depression or anxiety the quality of life. Combined with the findings of previous short-term, we consider the Chinese behavior therapy can not only quickly improve survival quality in patients with type2diabetes in the short term, the quality of long-term interventions will also have a similar effect. Therefore, it can be infer that Chinese behavior therapy in patients with type2diabetes lasting effect of quality of life stably.
4. Initially confirms the efficiency of Chinese behavior therapy into five principles for integrated management of diabetes scope for long-term intervention in type2diabetes patients with depression or anxiety having a certain degree of psychological and physiological improvements, which can be applied to clinical treatment mode to further promotion.
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