耳穴贴压、针灸联合认知-情绪干预在乙型肝炎肝硬化中的应用价值

Application value of auricular point sticking and pressing and acupuncture combined with cognitive-emotional intervention in hepatitis B cirrhosis

目的:研究耳穴贴压、针灸联合认知-情绪干预在乙型肝炎肝硬化中的应用价值。方法:选取2022年2月~2023年2月于本院消化内科诊治的118例乙型肝炎肝硬化患者为研究对象,按非随机临床同期对照研究及患者自愿原则分为对照组和中医联合组各59例。对照组予以常规内科治疗,配合常规护理及认知-情绪干预干预,中医联合组在对照组基础上予以耳穴贴压、针灸干预。比较两组患者1个月后干预效果,并分析干预前后中医症候积分、肝脏功能、肝脏纤维化、心理状态和自我效能水平。结果:中医联合组干预总有效率96.61%显著高于对照组86.44%(P<0.05);干预后两组患者胁肋闷痛、抑郁、食后胃胀满、嗳气不舒、便溏浠和口淡缺味症状积分,丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和总胆红素(TBIL)水平,Ⅲ型前胶原(PC-Ⅲ)、Ⅳ-C型胶原(Ⅳ-C)和透明质酸(HA)水平和肝脏硬度值(LSM)数值,以及SDS评分和SAS评分,与干预前相比均显著降低,且中医联合组上述指标降低趋势优于对照组(P<0.05);干预后两组患者白蛋白(ALB)水平,情绪管理、不适和疼痛忍耐、遵医嘱服药、良好作息、自我防护意识和健康行为管理的评分,与干预前相比均显著升高,且中医联合组上述指标升高趋势优于对照组(P<0.05)。结论:耳穴贴压、针灸联合认知-情绪干预可显著增强乙型肝炎肝硬化干预效果,可改善中医症候,促进肝脏功能恢复,减轻肝脏纤维化程度,缓解抑郁和焦虑情绪,并提高自我效能水平。

Objective:To study the application value of auricular point sticking and pressing and acupuncture combined with cognitive-emotional intervention in hepatitis B cirrhosis.Methods:A total of 118 patients with hepatitis B cirrhosis who were diagnosed and treated in the hospital from February 2022 to February 2023 were selected as the research subjects.They were divided into the control group and the combination group according to the principle of non-randomized clinical concurrent controlled study and the voluntary principle,with 59 patients in each group.The control group was given conventional medical treatment,routine nursing and cognitive-emotional intervention.On this basis,the combination group was given auricular point sticking and pressing as well as acupuncture.One month later,intervention effects in the two groups were compared.Traditional Chinese medicine symptom scores,liver function,hepatic fibrosis,psychological states and self-efficacy level were analyzed before and after intervention.Results:The total effective rate of intervention in the combination group was 96.61%,significantly higher than 86.44%in the control group(P<0.05).After intervention,the scores for stuffy pain of lateral thorax,depression,postprandial gastric distention and fullness,belching,loose stools and tastelessness in the mouth,the levels of alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),type Ⅲ procollagen(PC-Ⅲ),typeⅣ-C collagen(Ⅳ-C)and hyaluronic acid(HA),liver stiffness measurement(LSM),SDS scores and SAS scores in the two groups decreased significantly.The above indicators in the combination group were lower than those in the control group(P<0.05).After intervention,albumin(ALB)levels and the scores for emotion management,discomfort and pain tolerance,medication adherence,good routines,selfprotection awareness and health behavior management in the two groups increased significantly.These indicators in the combination group were higher than those in the control group(P<0.05).Conclusion:Auricular point sticking and pressing and acupuncture combined with cognitive-emotional intervention can significantly enhance the intervention effect on hepatitis B cirrhosis,improve traditional Chinese medicine symptoms,promote the recovery of liver function,alleviate hepatic fibrosis,relieve depression and anxiety,and improve self-efficacy.