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Title: 中醫食療對中國杭州社區中年高血壓陰虛體質患者作用的研究 = The effect of Chinese food therapy on community dwelling middle-aged hypertensive Patients with yin deficiency in Hangzhou, China
Authors: Shen, Cuizhen (沈翠珍)
Subjects: Hong Kong Polytechnic University -- Dissertations
Hypertension -- Diet therapy
Medicine, Chinese
Issue Date: 2009
Publisher: The Hong Kong Polytechnic University
Abstract: 背景:中醫認為,高血壓的發病與中醫體質類型有關。流行病學調查顯示:高血壓患者中陰虛體質為 14%-50%。體質具有相對穩定性和動態可變性,陰虛體質是可以調理的。研究表明,中醫食療是調理體質的重要方法之一;但目前缺乏中醫食療調理高血壓陰虛體質的臨床研究。 目的:本研究旨在:(1)確定陰虛型體質類型常見表現評估表。(2)評價中醫食療對調理中年高血壓陰虛體質患者的作用。(3)評價中醫食療對中年高血壓陰虛體質患者控制血壓的作用。(4)評價中醫食療對提高高血壓患者生存質量的作用。(5)評價健康宣教對提高高血壓患者相關疾病知識和改變不良生活方式的作用。方法:本研究採用隨機對照雙盲設計。根據納入標準在杭州市二個社區衛生服務中心選擇中年高血壓陰虛體質患者 85例,按亂數字法分為實驗組和對照組。實驗組(48例)採用中醫食療結合健康宣教,對照組(37例)僅為健康宣教,干預時間12周,觀察4周,共16周。為評估陰虛體 質,制定了陰虛型體質類型常見表現評估表,並進行了效度和信度的檢驗。干預前、干預後 4周、8周、12周、16周分別評定患者陰虛體質的表現、抗高血壓藥物用藥情況、測量血壓及生存質量(MOS SF-36C)和高血壓相關知識問卷調查;比較實驗組和對照組及每組干預前後不同時間上述指標的變化,以確定中醫食療對調理高血壓陰虛體質、減少抗高血壓藥物用量、控制血壓、提高生存質量及健康宣教對提高高血壓相關知識和改變不良生活方式的作用。
結果:陰虛型體質類型常見表現評估表具有良好的效度和信度。干預後 4周、8周、12周、16周,實驗組患者陰虛體質類型的數量逐漸減少,大部分陰虛體質的表現得到改善如咽幹、舌質偏紅或絳紅、舌少苔、舌見龜裂紋、失眠、心煩等,與對照組及干預前相比差異有顯著性(p<0.001)。干預後 12周、16周,實驗組 SF-36八個維度、生理內容綜合測量(PCS)、心理內容綜合測量(MCS)和總分(TS)的平均分增加;干預後12周與對照組相比,上述十一項指標除精神健康(MH)外,差異有顯著性(p=0.032-0.000);干預後12周、16周分別與干預前相比,十一項指標除軀體疼痛(BP)、生命活力(VT)及情感職能(RE)外,差異均有顯著性 (p<0.05,p<0.01或 p<0.001);而對照組 SF-36各項指標除社會功能(SF)外變化不明顯。實驗組患者干預後4周、8周收縮壓下降(p分別為0.005和0.008), 抗高血壓藥物減量人數明顯多於對照組(p<0.001),而二組患者干預後4周、8周、12周、16周收縮壓、舒張壓比較差異無顯著性。干預後12周、16周高血壓相關知識的得分增加(分別為p<0.01和 p<0.001),而實驗組與對照組相比差異無顯著性。干預前與干預後4周、8周、12周和16周比較,病人的膳食習慣、運動習慣、服藥規律 性、自我監測血壓及對中醫降壓的認識差異均有顯著性(p<0.05或p<0.01 或 p<0.001)。結論:本研究確定的陰虛型體質類型常見表現評估表可作為臨床陰虛體質評估的工具;研究表明中醫食療可以改善高血壓患者的病理體質、提高生存質量及有助於控制血壓。這一結果支持體質可調論,也為中醫食療作為高血壓重要的非藥物治療方法提供了證據。
Background: Traditional Chinese Medicine (TCM) experts thought that the prevalence of hypertension is related to body constitution. Epidemiological studies have shown 14%-50% of people with hypertension have Yin-deficiency. Since body constitution is relatively stable and dynamic variable, body constitution with Yin-deficiency might be adjusted. Some studies indicate Chinese Food Therapy (CFT) is the major way to restore the Yin-Yang imbalance. However, there is no study using CFT to hypertensive patients with Yin-deficiency. Aims: The purposes of this study are: (1) to determine the Assessment Scale on Common Symptoms of Body Constitution with Yin-Deficiency (ASCSBC).(2) to evaluate the effectiveness of CFT in restoring Yin-Yang balance of middleaged hypertensive patients with Yin deficiency.(3) to evaluate the effectiveness of CFT in controlling blood pressure of hypertension with Yin deficiency. (4) to evaluate the effectiveness of CFT in improving hypertensive patient{174}s quality of life.(5) to evaluate the effectiveness of health education in improving knowledge of hypertension and modification of lifestyle for hypertensive patients with Yin-Deficiency. Methods: Double-blinded, randomized controlled trial was designed. Eightyfive hypertensive patients who met the inclusive criteria recruited from two community health service centres were divided into the intervention group and the control group. The intervention group (n=48) received specific dietary iii instructions and corresponding management of their antihypertensive medication if indicated and brief health education, whilst the control group (n=37) received routine support involving brief health education for 12 weeks and follow-up 4 weeks. Due to assessment of body constitution with Yindeficiency, the ASCSBC was designed and tested its validation and reliability Data were collected at baseline, after intervention at four, eight, 12 and 16 weeks follow-up. Comparisons were made to examine the effects of Chinese food therapy on Yin-deficiency symptoms, reduction of hypertensive medication, blood pressure and quality of life of hypertensive patients and to determine the effects of health education in improving knowledge of hypertension and modifying lifestyles for hypertensive patients with Yin- Deficiency.
Results: ASCSBC has been shown the high validation and reliability. The intervention group had gradual reduction in the numbers of Yin-Deficiency patients as well as improvement in most of the Yin-deficiency symptoms such as dry throat, red tongue, little coating, cracked tongue, insomnia, dysphoria and so on after intervention 4, 8, 12 and 16 weeks follow-up, and significant differences were found compared to the control group and baseline respectively (P<0.001). Mean scores of SF-36 in eight domains, Physical Component Summary (PCS), Mental Component Summary (MCS) and Total Score (TS) were increased in the intervention group after intervention 12 and 16 weeks follow-up. Eleven items except for Mental Health (MH) had significant differences compared to iv the control group (P=0.032-0.000) after intervention 12 weeks. As mean scores of SF-36 were compared from baseline to 12 weeks and 16 weeks, there were significantly difference in six domains (except for Role limitations due to physical health RP, Vitality VT) or five domains (expect for VT, Social function SF and Role limitations due to emotional problems RE), PCS, MCS and TS in the intervention group respectively (P<0.05 or P<0.01 or P <0.001), while there were no significant differences except for SF in the control group. Significant differences were found in SBP in the intervention group compared from baseline to after 4 and 8 weeks respectively (P=0.005 and 0.008). The number of reducing antihypertensive medication is higher than that of the control group (P<0.001) after intervention, while there were no significant difference in the mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the control group at 4, 8, 12 and 16 weeks followup. The mean scores of knowledge related to hypertension were increased after intervention 12, 16 weeks (P<0.01 and P<0.001 respectively), while no significant differences were found compared to the control group. Compared from baseline to after intervention 4, 8, 12 and 16 weeks follow-up, there were significant differences in diet habits, exercise, taking medication regularly, self administration of blood pressure and views for effects of Traditional Chinese Medicine lowering blood pressure (P<0.05 or P<0.01 or P<0.001). Conclusions: ASCSBC might be used to assess the body constitution with Yin-deficiency in clinical practice. The study has been shown that CFT may contribute to Yin-Yang balance, improve quality of life and control blood pressure. The results has supported the theory of body constitution adjustment and provided the evidence for CFT becoming major way of the non-pharmacy therapies on hypertensive patients.
Degree: Ph.D., Xianggang li gong da xue hu li xue yuan, 2009
Description: xxiii, 415 leaves : ill. (some col.) ; 30 cm.
PolyU Library Call No.: [THS] LG51 .H577P SN 2009 Shen
Rights: All rights reserved.
Type: Thesis
URI: http://hdl.handle.net/10397/4020
Appears in Collections:SN Theses
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