| 1Research BackgroundCHD Angina Pectoris is a kind of heart disease that badly harm human health. According to Epidemiology Research, CHD morbidity is growing obviously in our country; the annual growing rate is nearly7.5%in city; the death rate of CHD occupies17%in circulation system disease, it takes up26%in city. Some other research shows that CHD morbidity is growing year after year and it might happen quite often in20years. So far, there are lots of clinic treatment methods for CHD which including drug therapy, interventional therapy and operative treatment etc. With the development of Medical Science and Technology, the death rate of CHD decreased distinctly. But angina pectoris, myocardial infarction etc. caused by CHD badly lower patients’quality of life. Right now, people have realized that prolonging life or relieving symptom is not the most important purpose of disease treatment. Except for death and recovery, most CHD patients live with disease, taking death rate as researching purpose could not evaluate the situation of living with disease and the other effect of treatment. In this case, one important purpose of treatment is improving patients’quality of life. In1990, Robin once averred that,"Traditional spirit measurement or medical prevalence index could not reflect the result of chronic disease, but quality of life could synthetically evaluate the effect of disease."CHD angina pectoris belongs to "Chest Obstruction" category in TCM. It usually relates to pathogenic cold instrusion, improper diet, emotional disorders and elderly physically weak etc. It usually caused by Yin and Yang, Qi and Blood disorders, qi stagnation and poor systolic blockage.According to TCM theory Syndromes differentiation, nursing CHD patients with combination of disease differentiation and syndromes differentiation is full of individual characteristics, is in high pertinency and is with preferable clinical effects which could shorten patients’ time in hospital and promote recovery. Meridian Push Press is widely recognized in TCM. Meridian is a kind of system which connects exterior from skin to flesh interstices with interior of all viscera. It is the extension of the viscera which it belongs to in organism. It enlarges the viscera’s effection and connect the viscera to all parts and organs that relates to meridians circulation. Meridian push press could arouse channel qi, improve channel sensation and far governance role of acupoints through pushing and pressing along with meridian, rubbing and pressing multidirectionally and extending patting. Hand pat could effectively activate ACT compound enzyme of meridian acupoint, produce enough power, make channels between histiocyte unimpeded, accelerate power conduction in meridian, increase quantity of ACT conduction and improve the recovery of damaged nerve. Focus acupressure could dredge heart pulse and smooth qi and blood, it plays superior role in relieving symptom of CHD angina pectoris and improving electrocardiogram. Using different meridian push press treatment for different patients has important significance on improving patients quality of life. It offers basis for further research of clinical care and popularization of TCM in community and explores further on meridian push press could improve patients’ quality of life.2Research PurposeThe mainly purpose of the research is exploring more effective and easier acceptable nursing methods and then offering all round health guidance and improving quality of life for CHD angina pectoris patients through giving corresponding meridian push press, exercises and medication etc. according to CHD angina pectoris’ clinical classification. It provides basis for how to improve quality of life for CHD angina pectoris patients and for further research on clinical nursing. At the same time, it could popularize research achievement in community and offer secondary prevention. So, exploring TCM meridian press push has great significance on improving CHD angina pectoris patients’ quality of life.3Research Study&Methods3.1object:117CHD angina pectoris patients cured in our hospital from Jan.2011to Otc.2012. Divide object into2groups which is random and parallel control. Meridian push press group has31objects （Male14, Female17, age41-73, average age （58±6.33））. Control group has30objects （Male18, Female12, age43-74, average age （57±7.12））. There is no big difference between group to group from age, gender, average course of disease to cardiac functional grading which is comparable. Each patient signed informed consent before issuing project.Inclusion Standards:①age of40-76;①Comply with "Ischemic Heart Disease Naming and Diagnosing Standards" which named by standardized joint thematic group International Society of Cardiology and World Health Organization;③TCM Diagnosis Standard is set consulting to how to cure thoracic obstruction（Meridian angina pectoris） in "TCM New Medicine Clinical Research Guiding Principle".Exclusion Standard:①Acute myocardial infarction or cardiac function is lower than2grade;②Severe arrhythmia;③Chest pain is caused by other heart disease, Severe neurosis, cervical spondylosis, hyperthyroidism and mental disease etc.④Patient has high blood pressure, severe cardiopulmonary insufficiency, severe arrhythmia, Liver and kidney dysfunction or hematological disorder;⑤Women is pregnant or preparing for pregnancy or in suckling period;⑥People have barrier on understanding or language or live by themselves or have other disease that could affect quality of their lives.3.2Behavioral Intervention Method:3.2.1Give basic cure of conventional western medicine for each group which including taking40mg Isosorbide Mononitrate Tablets （made by Lunan Pharmaceutical Group Corporation）, once per day;100mg/d Aspirin Enteric-coated Tablets（made by Bayer company）; atorvastatin calcium tablets （made by Pfizer）10mg/per night; always prepare Nitroglycerin Tablets in case of angina pectoris attack. 3.2.2Offer routine nursing for control group.3.2.3Give Meridian push press group meridian push press exercise besides routine nursing.Do pericardium meridian massage for all objects in Experimental GroupAdd Heart Meridian of Hand-Shaoyin massage for heart qi deficiency patient;Add spleen Meridian of Foot-Taiyin massage for Spleen Qi deficiency patient;Add Kidney meridian of Foot-Shaoyin massage for kidney qi deficiency patient;Add stomach meridian of foot-yangming massage for blood stasis patient.Operating Method:rub hands and make them warm, luck in hand, push press unidirectionally one time along with meridian and then pat3-5times from up to down along with meridian, do same exercises to side meridian. Pat3-5times from down to up along with meridian and do same exercises to side meridian for blood stasis patient. Give meridian push press exercise according to syndrome.Take2weeks as one treatment course, observe3treatment courses, take and count nitroglycerin tablets when angina pectoris attack.3.3Effect Evaluation Method3.3.1Seattle angina questionnaire（SAQ） test5factors in19items, which including physical limitation, angina stable situation, angina attack, cure satisfaction and disease awareness.3.3.2Scoring Method SAQ rating scale are implemented by trained persons who guide the patient to fill the forms on their own, enquire and let the patient to make up missing part after counter investigation. Patient could choose one option from5-6options in each rating scale. It gets1point if choosing the lowest function situation option and then gets2,3,4,5,6points ordinally. Add scores under each item in each dimensionality get the total scores. The higher the score, the better function of his/her body and the better quality of his/her life.3.4Statistics Method All testing data show with average data plus standard tolerance （x±s）. Compare data from group to group, it takes t check if it shows normal distribution. If it is not comply with normal distribution, it takes rank-sum test with multiple independent samples and process it with SPSS16.0software.4Research Result4.1Comparison of quality of life before and after Meridian push press coordinate with diet therapy。ConclusionCHD has become a major disease between middle aged and elderly people, which harm their health. With the development of the cardiac interventional techniques and cardiac surgical techniques, the death rate of CHD deceased markedly, but angina pectoris, myocardial infarction etc. caused by CHD badly lower patients’ quality of life. Most CHD patients live with disease, so only taking death rate as researching purpose could not evaluate the situation of living with disease and the other effect of treatment. Qiao Zhengxue survey indicate that the physiological function, psychological states and social function of CHD patient are all in unhealthy situation. We should care the factors that influence their quality of life comprehensively. In this case, one important purpose of treatment is improving patients’ quality of life.CHD angina pectoris belongs to "Chest Obstruction" category in TCM. It usually caused by Yin and Yang, Qi and Blood disorders, qi stagnation and poor systolic blockage. Meridian Push Press is a characteristic therapy in TCM. Meridian is a kind of system which connects exterior from skin to flesh interstices with interior of all viscera. It is the extension of the viscera which it belongs to in organism. It enlarges the viscera’s effection and connect the viscera to all parts and organs that relates to meridians circulation. Meridian push press could arouse channel qi, improve channel sensation and far governance role of acupoints through pushing and pressing along with meridian, rubbing and pressing multidirectionally and extending patting. Hand pat could effectively activate ACT compound enzyme of meridian acupoint, produce enough power, make channels between histiocyte unimpeded, accelerate power conduction in meridian, increase quantity of ACT conduction and improve the recovery of damaged nerve. Pressing the important acupoint, for example, the Neiguan point can slow down the heart rate, reduce oxygen consumption of cardiac muscle, improve left heart function, relieve coronary spasm, reduce whole blood viscosity and improve microcirculation. The acupoint pressing shows advantages in relieving CHD Meridian Angina Pectoris, improving electrocardiogram etc.The Form1&2show the difference between Seattle angina scale and dosage of nitroglycerin is of statistics meaning （P<0.01） after3courses of treatment in collateral massage team and the comparison team. It indicates the collateral massage team is better than the comparison team in changing the SAT value dimension and nitroglycerin dosage. Based on different patients’ corporeity different collateral massages are adopted to improve the patients’ quality of life. It also provides the basis for the further clinical nursing study and community promotion of the traditional Chinese medicine and the study achievement can be promoted during the community nursing serving as the secondary prophylaxis. |
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