Effect of auricular Shenmen point pressure on anxiety symptoms of elderly patients with anxiety disorder in community
-
摘要:
目的 探索耳神门穴点压对社区老年期广泛性焦虑障碍(GAD)的治疗效果及额叶功能的改善作用。 方法 选择2020年9月—2021年6月就诊于上海市静安区南京西路街道社区卫生服务中心及上海市长宁区精神卫生中心的老年期GAD患者90例,采用随机数字表法将患者随机分为耳穴刺激组(47例)和对照组(43例),耳穴刺激组接受耳神门穴王不留行籽点压,对照组则对耳垂部进行点压,共8周。干预前后分别采用汉密尔顿焦虑量表(HAMA)、老年焦虑量表(GAI)及额叶功能量表(FAB)进行评估。 结果 耳穴刺激组与对照组在基线时点的人口学资料、焦虑症状及额叶功能差异均无统计学意义(均P>0.05)。干预8周后,与对照组比较,耳穴刺激组的HAMA及GAI得分显著降低[(15.41±6.79)分vs. (24.32±4.96)分,(7.97±2.71)分vs. (11.99±2.87)分, 均P<0.05],而FAB得分显著升高[(10.79±3.41)分vs. (3.61±2.32)分, P<0.05]。HAMA的减分值与FAB增分值呈负相关关系(r=-0.205,P=0.006),HAMA躯体维度得分差值与GAI得分差值呈正相关关系(r=0.472,P<0.001)。 结论 耳神门穴点压对社区老年期GAD患者的焦虑症状具有显著的改善作用,其作用机制可能与额叶功能改善相关。 Abstract:Objective This study aims to explore the effect of auricular Shenmen point pressure on generalised anxiety disorder (GAD) and the improvement of frontal lobe function in elderly people in community. Methods Between September 2020 and June 2021 in Jing' an district of Shanghai West Nanjing Road community health service centre and Changning district of Shanghai Mental Health Centre, 90 elderly patients with GAD were recruited and randomly divided into auricular point pressure (AP) group (n=47) and control group (n=43) by random number table. The AP group accepted the 8-week seed point pressure at the ear Shenmen acupoint. The Hamilton Anxiety Scale (HAMA) and Geriatric Anxiety Inventory (GAI) were used before and after intervention, respectively. Frontal assessment battery (FAB) was evaluated in the assessment of frontal lobe. Results No significant differences in demographic data, anxiety symptoms and frontal lobe function were found between AP and control groups at baseline (all P>0.05). After 8-week intervention, the HAMA and GAI scores in the AP group were significantly lower than the control group [(15.41±6.79) points vs. (24.32±4.96) points, (7.97±2.71) points vs. (11.99±2.87) points, both P < 0.05], while the FAB scores significantly increased [(10.79±3.41) points vs. (3.61±2.32) points, P < 0.05] compared with those in the control group. The decreasing score of HAMA was negatively correlated with the increasing score of FAB (r=-0.205, P=0.006). The decrease in the HAMA somatic dimension score was positively correlated with the increase in the GAI score (r=0.472, P < 0.001). Conclusion Auricular point pressure at Shenmen point can significantly improve anxiety symptoms in elderly patients with GAD in community, and its mechanism of action may be related to improvement of frontal lobe function. -
Key words:
- Auricular point pressure /
- Anxiety /
- Somatisation symptoms /
- Frontal lobe function
-
表 1 耳穴刺激组与对照组患者基线时点的人口学资料比较
Table 1. Comparison of demographic data at baseline between patients in the ear point stimulation group and the control group
组别 例数 年龄
(x±s,岁)性别(例) 受教育年限
(x±s,年)居住状况(例) 家庭年收入
(x±s,万)病程
(x±s,月)男性 女性 独居 同居 耳穴刺激组 31 59.71±9.08 14 17 11.20±3.62 20 11 8.83±2.28 10.32±5.84 对照组 33 62.67±6.42 13 20 10.57±3.35 18 15 9.08±2.80 12.47±4.16 统计量 -1.303a 0.005b 0.816a 0.243b -0.304a -1.672a P值 0.199 0.944 0.415 0.622 0.736 0.094 注:a为t值,b为χ2值。 表 2 耳穴刺激组与对照组GAD患者基线时点的临床症状及额叶功能比较(x±s,分)
Table 2. Comparison of clinical symptoms and frontal lobe function of GAD patients at baseline between auricular point stimulation group and control group (x±s, points)
组别 例数 HAMA HAMA-心理 HAMA-躯体 HAMD-17 GAI FAB 耳穴刺激组 31 25.04±1.65 9.52±0.73 15.52±1.26 8.74±0.47 12.39±0.68 2.47±0.62 对照组 33 24.84±1.20 10.37±0.80 13.47±0.94 6.77±0.55 12.48±0.56 2.33±0.69 t值 1.155 0.546 0.281 0.231 0.369 0.520 P值 0.254 0.585 0.780 0.818 0.714 0.606 表 3 耳穴刺激组与对照组GAD患者干预前后焦虑症状严重程度及额叶功能比较
Table 3. Comparison of anxiety symptom severity and frontal lobe function of GAD patients between auricular point stimulation group and control group before and after intervention
项目 耳穴刺激组
(x±s,分)对照组
(x±s,分)差值估计 SE 95% CI t值 P值 F值 P值 HAMA 基线 25.04±1.65 24.84±1.20 1.263 0.374 0.273~2.253 0.864 0.393 30.157 < 0.001 2周末 22.89±9.76 24.03±10.69 -1.570 0.512 -2.925~-0.215 -0.932 0.412 4周末 19.97±10.68 23.56±8.40 -3.426 0.733 -5.365~-1.487 -2.221 0.027 6周末 18.26±9.37 23.04±9.89 -5.139 1.385 -8.803~-1.475 -3.118 0.004 8周末 15.41±6.79 24.32±4.96 -7.836 1.816 -12.641~-3.031 -5.472 < 0.001 HAMA-心理 基线 9.52±0.73 10.37±0.80 -0.351 0.104 -0.626~-0.076 -0.528 0.427 10.434 0.033 2周末 8.16±2.43 9.97±4.12 -1.247 0.383 -2.260~-0.234 -0.739 0.128 4周末 7.95±4.16 9.63±3.58 -1.546 0.412 -2.636~-0.456 -1.624 0.461 6周末 7.70±3.41 9.50±2.46 -1.810 0.456 -3.016~-0.604 -1.686 0.092 8周末 7.05±2.79 9.51±2.10 -2.194 0.517 -3.562~-0.826 -1.748 0.047 HAMA-躯体 基线 15.52±1.26 13.47±0.94 1.047 0.227 0.446~1.648 0.911 0.361 28.679 < 0.001 2周末 12.77±3.64 13.95±5.41 -1.801 0.047 -1.925~-1.677 -1.432 0.097 4周末 10.92±4.12 13.61±6.30 -3.637 0.115 -3.941~-3.333 -2.915 0.036 6周末 8.79±3.91 13.55±3.19 -5.583 0.629 -7.247~-3.919 -4.030 0.008 8周末 6.47±3.70 13.65±2.47 -7.037 0.902 -9.423~-4.651 -5.942 < 0.001 GAI 基线 12.39±0.68 12.48±0.56 -0.154 0.020 -0.207~-0.101 -0.160 0.517 31.526 < 0.001 2周末 10.17±3.14 11.94±4.75 -2.206 0.471 -3.452~-0.960 -1.975 0.044 4周末 9.84±4.10 11.50±5.94 -2.831 0.759 -4.839~-0.823 -2.371 0.029 6周末 8.10±3.76 11.78±3.60 -3.372 0.834 -5.579~-1.165 -2.858 0.014 8周末 7.97±2.71 11.99±2.87 -3.910 1.391 -7.590~-0.230 -3.126 0.008 FAB 基线 2.47±0.62 2.33±0.69 1.316 0.336 0.644~1.988 0.744 0.155 15.710 0.004 8周末 10.79±3.41 3.61±2.32 6.132 1.570 2.992~9.272 4.691 < 0.001 -
[1] HUANG Y Q, WANG Y, WANG H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiat, 2019, 6(3): 211-224. doi: 10.1016/S2215-0366(18)30511-X [2] 王春燕, 张学平. 焦点解决模式对老年焦虑障碍共病高血压患者的心理护理作用[J]. 中华全科医学, 2020, 18(10): 1779-1782. doi: 10.16766/j.cnki.issn.1674-4152.001617WANG C Y, ZHANG X P. Psychological nursing effect of the solution-focused model on elderly patients with hypertension and generalized anxiety disorder[J]. Chinese Journal of General Practice, 2020, 18(10): 1779-1782. doi: 10.16766/j.cnki.issn.1674-4152.001617 [3] 范曼丽, 魏裕涛, 魏佳娜, 等. 基于数据挖掘的针灸治疗焦虑症经穴运用规律分析[J]. 中国中医基础医学杂志, 2019, 25(3): 357-360. doi: 10.19945/j.cnki.issn.1006-3250.2019.03.022FAN M L, WEI Y T, WEI J N, et al. Law of meridian and acupoint selection in acupuncture treatment for anxiety based on data-mining method[J]. Chinese Journal of Basic Medicine in Traditional Chinese Medicine, 2019, 25(3): 357-360. doi: 10.19945/j.cnki.issn.1006-3250.2019.03.022 [4] 陈默, 梁碧. 耳穴贴压疗法辅助治疗肝火扰心型亚健康失眠的临床研究[J]. 中国基层医药, 2021, 28(3): 335-339. doi: 10.3760/cma.j.issn.1008-6706.2021.03.004CHEN M, LIANG B. Clinical study on auricular plaster therapy in the auxiliary treatment of insomnia caused by liver fire disturbance in a sub-healthy population[J]. Chinese Journal of Primary Medicine and Pharmacy, 2021, 28(3): 335-339. doi: 10.3760/cma.j.issn.1008-6706.2021.03.004 [5] GOH W Y, CHAN D, ALI N B, et al. Frontal assessment battery in early cognitive impairment: psychometric property and factor structure[J]. J Nutr Health Aging, 2019, 23(10): 966-972. doi: 10.1007/s12603-019-1248-0 [6] 美国精神医学学会. 精神障碍诊断与统计手册(第五版)[M]. 北京: 北京大学出版社, 2016.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)[M]. Beijing: Peking University Press, 2016. [7] ZIMMERMAN M, MARTIN J, CLARK H, et al. Measuring anxiety in depressed patients: a comparison of the Hamilton anxiety rating scale and the DSM-5 Anxious Distress Specifier Interview[J]. J Psychiatr Res, 2017, 93: 59-63. doi: 10.1016/j.jpsychires.2017.05.014 [8] MOLDE H, NORDHUS I H, TORSHEIM T, et al. A cross-national analysis of the psychometric properties of the geriatric anxiety inventory[J]. J Gerontol B Psychol Sci Soc Sci, 2020, 75(7): 1475-1483. doi: 10.1093/geronb/gbz002 [9] 程锦, 程文炜, 刘晓芳, 等. 层次结构数据的分析方法及SPSS实现[J]. 中华老年医学杂志, 2020, 39(10): 1236-1240. doi: 10.3760/cma.j.issn.0254-9026.2020.10.030CHENG J, CHENG W W, LIU X F, et al. Analyzing methods of hierarchically structured data and its implementation in SPSS Statistics[J]. Chinese Journal of Geriatrics, 2020, 39(10): 1236-1240. doi: 10.3760/cma.j.issn.0254-9026.2020.10.030 [10] RAIJ T, NUMMENMAA A, MARIN M F, et al. Prefrontal cortex stimulation enhances fear extinction memory in humans[J]. Biol Psychiatry, 2018, 84(2): 129-137. doi: 10.1016/j.biopsych.2017.10.022 [11] 赵奎, 张梅刃, 曾啸, 等. 耳穴压豆疗法对老年髋部骨折患者术后谵妄、睡眠时间及焦虑水平的影响[J]. 现代生物医学进展, 2021, 21(12): 2386-2390. doi: 10.13241/j.cnki.pmb.2021.12.041ZHAO K, ZHANG M R, CENG X, et al. Effect of auricular acupoint pressing therapy on postoperative delirium, sleep time and anxiety level of elderly patients with hip fracture[J]. Progress in Modern Biomedicine, 2021, 21(12): 2386-2390. doi: 10.13241/j.cnki.pmb.2021.12.041 [12] 潘子彦, 黄峰, 许荣梅. 心理疏导法并耳穴刺激治疗老年焦虑症的疗效[J]. 中国老年学杂志, 2017, 37(22): 5666-5667. doi: 10.3969/j.issn.1005-9202.2017.22.083PAN Z Y, HUANG F, XU R M. Psychotherapy and auricular stimulation in the treatment of senile anxiety[J]. Chinese Journal of Gerontology, 2017, 37(22): 5666-5667. doi: 10.3969/j.issn.1005-9202.2017.22.083 [13] 杨丽华, 段培蓓, 侯庆梅, 等. 耳穴贴压干预成年患者焦虑的Meta分析[J]. 中华现代护理杂志, 2019, 25(26): 3337-3342. doi: 10.3760/cma.j.issn.1674-2907.2019.26.008YANG L H, DUAN P B, HOU Q M, et al. Meta-analysis of auricular-plaster therapy intervening with anxiety in adults[J]. Chinese Journal of Modern Nursing, 2019, 25(26): 3337-3342. doi: 10.3760/cma.j.issn.1674-2907.2019.26.008 [14] 袁丹丹, 周静, 吴宁宁, 等. 个体化心理辅导联合耳穴压豆对产褥期产妇焦虑和抑郁的干预效果[J]. 中华全科医学, 2021, 19(9): 1539-1541, 1568. doi: 10.16766/j.cnki.issn.1674-4152.002106YUAN D D, ZHOU J, WU N N, et al. Intervention effect of individualised psychological counselling combined with ear acupoint pressing on anxiety and depression during puerperium[J]. Chinese Journal of General Practice, 2021, 19(9): 1539-1541, 1568. doi: 10.16766/j.cnki.issn.1674-4152.002106 [15] BUTT M F, ALBUSODA A, FARMER A D, et al. The anatomical basis for transcutaneous auricular vagus nerve stimulation[J]. J Anat, 2020, 236(4): 588-611. doi: 10.1111/joa.13122 [16] MATHEW E, TABET M N, ROBERTSON N M, et al. Vagus nerve stimulation produces immediate dose-dependent anxiolytic effect in rats[J]. J Affect Disord, 2020, 265: 552-557. doi: 10.1016/j.jad.2019.11.090 [17] NOBLE L J, CHUAH A, CALLAHAN K K, et al. Peripheral effects of vagus nerve stimulation on anxiety and extinction of conditioned fear in rats[J]. Learn Mem, 2019, 26(7): 245-251. doi: 10.1101/lm.048447.118 [18] BADRAN B W, DOWDLE L T, MITHOEFER O J, et al. Neurophysiologic effects of transcutaneous auricular vagus nerve stimulation (taVNS) via electrical stimulation of the tragus: a concurrent taVNS/fMRI study and review[J]. Brain Stimul, 2018, 11(3): 492-500. doi: 10.1016/j.brs.2017.12.009 [19] CUI H R, ZHANG B, LI W, et al. Insula shows abnormal task-evoked and resting-state activity in first-episode drug-nave generalized anxiety disorder[J]. Depress Anxiety, 2020, 37(7): 632-644. doi: 10.1002/da.23009 [20] CARLINO E, PIEDIMONTE A, BENEDETTI F. Nature of the placebo and nocebo effect in relation to functional neurologic disorders[J]. Handb Clin Neurol, 2016, 139: 597-606.
计量
- 文章访问数: 247
- HTML全文浏览量: 83
- PDF下载量: 2
- 被引次数: 0