文章摘要
沈嫣,钱玥.高龄睡眠障碍患者的中医证型分析及护理干预效果研究[J].浙江中医药大学学报,2021,(5):555-559.
高龄睡眠障碍患者的中医证型分析及护理干预效果研究
Analysis of TCM Syndrome Type and Effect of Nursing Intervention in Elderly People with Sleep Disorders
投稿时间:2020-12-28  
DOI:10.16466/j.issn1005-5509.2021.05.023
中文关键词: 睡眠障碍  高龄老人  匹兹堡睡眠量表  中医证型  中医干预  临床护理  性别差异  生活质量
英文关键词: sleep disorders  elderly  Pittsburgh sleep quality index  TCM syndrome type  TCM intervention  clinical nursing  gender difference  quality of life
基金项目:
作者单位
沈嫣 杭州市五云山医院 杭州 310008
杭州市健康促进研究院 
钱玥 杭州市五云山医院 杭州 310008
杭州市健康促进研究院 
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中文摘要:
      [目的]调查分析杭州市高龄睡眠障碍患者的中医证型分类现状,并分析相应的中医护理干预效果。[方法]2018年12月至2019年12月选取杭州市五云山医院80岁以上的睡眠障碍患者200例,采用匹兹堡睡眠量表及《中医内科病症诊断疗效标准》对其睡眠障碍情况及中医证型进行分析调查,并结合中医理论探索针对性的中医护理干预效果。[结果]高龄老人中86~90岁的睡眠状况最差(P<0.05);男性睡眠情况好于女性(P<0.05)。睡眠障碍患者中医证型占比由高到低依次为心脾两虚、心虚胆怯、阴虚火旺、痰热内扰、肝郁化火,睡眠症状严重程度由高到低依次为肝郁化火、痰热内扰、心脾两虚、阴虚火旺、心虚胆怯。通过辨证分析,个性化确定系统综合治疗方案,阴虚火旺证、心虚胆怯证失眠选取药枕、足浴、药膳等;肝郁化火、痰热内扰证者加用情志护理如冥想放松、五音疗法,并加用祛痰热、泻肝火的中医导引术。干预后高龄患者的PSQI总分较前有改善,差异有统计学意义(P<0.01),尤其在睡眠时间、睡眠效率、日间功能情况方面改善明显(P<0.01);睡眠质量及入睡时间方面前后比较差异也具有统计学意义(P<0.05)。[结论]高龄睡眠障碍患者中86~90岁睡眠障碍情况最多,而不同性别间主要中医证型不同,男性以肝郁化火证、痰热内扰证、心脾两虚证多见,女性以阴虚火旺证、心虚胆怯证多见。应根据不同性别、不同证型,开展系统多元的临床护理干预,同时应注意加强老年患者睡眠的自我管理。
英文摘要:
      [Objective] To investigate and analyze the current situation of traditional Chinese medicine(TCM) syndrome classification of sleep disorders in elderly people in Hangzhou, and analyze the corresponding effect of TCM nursing intervention.[Methods]From December 2018 to December 2019,200 elderly people over 80 years of age were selected from Wuyunshan Hospital of Hangzhou.The Pittsburgh sleep quality index(PSQI) and the “Diagnostic Efficacy Standard of TCM Internal Medicine” were used to analyze and investigate the condition of sleep disorder and TCM syndrome type, and to explore the effect of TCM nursing intervention combined with TCM theory.[Results] The elderly aged 86~90 had the worst sleep condition(P<0.05); men slept better than women(P<0.05). The proprtion of TCM syndrome in patients with sleep disorders was in the order of deficiency of the heart and spleen, deficiency of the heart and gallbladder, Yin deficiency and fire excess, disturbance of phlegm and heat, fire derived from stagnation of the liver. The severity of sleep symptoms from high to low was fire derived from stagnation of the liver, disturbance of phlegm and heat, deficiency of the heart and spleen, Yin deficiency and fire excess, deficiency of the heart and gallbladder.Through syndrome differentiation analysis, individualized comprehensive treatment plan was determined.Medicine pillow, foot bath and medicated diet were selected for insomnia of Yin deficiency and fire excess syndrome, deficiency of the heart and gallbladder syndrome; emotional nursing, such as meditation and relaxation, five tone therapy, and TCM guidance of eliminating phlegm heat and purging the liver fire, were added to patients with fire derived from stagnation of the liver syndrome, and disturbance of phlegm and heat syndrome. The total PSQI score of the elderly after intervention was significantly improved(P<0.01), especially in sleep time, sleep efficiency, daytime function(P<0.01), and there were also significant differences in sleep quality and sleep atency before and after the intervention(P<0.05).[Conclusion]Among the elderly,86~90 years old people have the most sleep disorders, but the main TCM syndrome types are different between genders. In male, fire derived from stagnation of the liver syndrome, disturbance of phlegm and heat syndrome, deficiency of the heart and spleen syndrome are more common; while in female, Yin deficiency and fire excess syndrome, deficiency of the heart and gallbladder syndrome are more common. According to different genders and syndrome types, clinical nursing intervention should be carried out systematically and diversified, at the same time, attention should be paid to strengthen the self-management of sleep in the elderly.
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