耳穴貼壓對於慢性精神分裂症患者改變肥胖相關參數之探討

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Title:	耳穴貼壓對於慢性精神分裂症患者改變肥胖相關參數之探討 Effects of Auricular Acupressure on Body Weight Parameters in Patients with Chronic Schizophrenia
Authors:	景瀚儀
Contributors:	中西醫結合研究所碩士班
Keywords:	耳穴貼壓;肥胖參數;精神分裂症 Auricular Acupressure;obesity parameters;Schizophrenia
Date:	2011-07-11
Issue Date:	2011-10-17 15:45:02 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	目的: 由於大多數精神科藥物有增加體重的副作用，故體重控制已成為精神科治療的重要議題。肥胖不僅是導致第二型糖尿病、代謝症候群及心血管疾病的危險因子，也會影響治療的順從度以及疾病復發率。本篇研究為首篇探討耳穴貼壓對於慢性精神分裂症患者肥胖相關參數之影響。方法: 收案標準依據DSM-IV診斷為精神分裂症並居住於慢性病房超過兩個月，年齡介於20歲至60歲之間且BMI ≧24 kg/m2，經精神科專科醫師判定精神狀態穩定，能以文字或語言和研究者溝通。本研究為採兩組前後測時間序列之實驗研究設計,經由招募到受試者共86人，依據病房別分層隨機分派為兩組：耳穴按壓組及對照組各43人。耳穴貼壓之穴位選擇飢點、胃點、神門、內分泌四個穴位，以每週2次,每次分別維持3天及4天兩耳交替方式，進行8週單側耳穴貼壓。為提高資料收集之客觀性，貼耳穴者與收集評估指標者分別由不同人擔任。本計畫共九周，效果指標包括體重、腰圍、體脂率。結果: 參加者以女性較多占54.1%，男性占45.9%；大部分(70.8%)無從事病房外之復建工作；藥物方面大多有使用第二代抗精神病用藥，占79.2%。參加者之平均身高160.9cm：平均年齡47.7歲；平均罹病時間為15年；平均發病年齡為32.8歲；平均住院時間為5.2年。第一周至第八週間，實驗組與對照組體重、腰圍改變之幅度，兩組間並未達顯著差異，惟在腰圍方面，第一周時對照組上升趨勢較明顯(平均增加2.1公分)，但實驗組卻只增加1公分。在體重方面實驗組在第一周下降0.2公斤,反之對照組增加0.5kg。在前測時兩組體脂率並無顯著差異，施測第八周對照組與前測值相比無顯著差異。結論: 本研究發現在第一周時耳穴貼壓對於體重及腰圍之減輕有些微之效果。在第二周之後便失去此短暫之作用，我們推測會造成耳穴貼壓沒有效果的原因，可能由於精神病患者的體重增加是由於抗精神藥物的效應所產生的結果，而精神病人的抗精神藥物療法無法中斷，故長期體重控制並不建議單以耳穴貼壓一種方式來控制體重。中醫治療肥胖的理論為依據病患的證型，以及所對應之經絡，給予適當的治療，未來的研究建議依據疾病證型，提供不同的經絡穴位施治。 Objective: This study is the first to evaluate effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. Methods: Eighty-six subjects were recruited and randomly assigned to an Auricular Acupressure group and a Control group. Inclusion criteria were: meeting established criteria for schizophrenia, staying in chronic ward for two months or more, aged 20-60 years, body mass index ≧24 kg/m2, diagnosed by a psychiatrist, stable mental status and able to communicate in writing or verbally. Auricular acupressure was given at four acupuncture points (hunger, stomach, shenmen and endocrine) twice a week for 8 weeks and to each ear for 3-4 consecutive days alternately. Body weight, waist circumference and body fat percentage were measured pre- and post-intervention. Results: Most subjects were female (54.1%), males were 45.9%. Subjects’ mean age was 47.7 years, mean body height 160.9cm, mean onset age 32.9 years, and mean disease duration 15 years. No significant differences were found between groups from first to 8th weeks in extent of body weight changes and waist circumference. Controls had a mean increase of 2.1cm in waist circumference and 0.5kg in weight after first week. AA group had a mean increase of 1cm in waist circumference and 0.2kg weight reduction after first week. No significant differences were found in body fat percentage between groups at pretest; no significant differences were found in body fat percentage from baseline measurement to 8th week posttest in either group. Conclusions: Auricular acupressure had only mild effects on reducing body weight and waist circumference in the first week and temporary effects disappeared after second week. Auricular acupressure is not suggested as a sole weight management tool. Future studies should perform auricular acupressure at different acupuncture points according to each subject’s meridians.
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