摘要目的:探讨五行音乐联合子午流注择时穴位按摩对老年慢性心力衰竭（CHF）患者负性情绪及睡眠质量的影响。方法:选取2022年1月至2023年6月在杭州师范大学附属医院治疗的老年CHF患者112例，采用随机对照临床研究方法，依据随机数字表法分为两组，对照组56例和研究组56例；在心力衰竭常规护理的基础上，对照组给予五行音乐干预，研究组给予五行音乐联合子午流注择时穴位按摩干预。比较两组干预前后的汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分、匹兹堡睡眠质量指数（PSQI）评分、明尼苏达慢性心衰生活质量量表（MLHFQ）各维度评分以及睡眠疗效和患者护理满意度。结果:干预后，两组HAMA、HAMD评分［研究组：（11.29±2.48）分、（12.48±3.36）分，对照组：（15.93±3.35）分、（16.50±4.32）分］较干预前［研究组：（20.13±5.18）分、（23.95±8.97）分，对照组：（19.36±5.45）分、（23.79±7.61）分］均降低（ t=15.35、10.24，5.65、8.93，均 P < 0.001），且研究组均明显低于对照组（ t=-8.34、-5.49，均 P < 0.001）。干预后，两组的PSQI评分［研究组：（7.05±0.96）分，对照组：（9.91±1.28）分］较干预前［研究组：（12.98±2.21）分，对照组：（12.50±2.48）分］均降低（ t=24.68、9.79，均 P < 0.05），且研究组明显低于对照组（ t=-13.34， P < 0.05）。从MLHFQ各维度评分比较结果看，干预后，两组情绪领域、身体领域、其他领域评分［研究组（9.36±2.29）分、（16.95±3.80）分、（18.50±2.33）分，对照组：（12.93±2.00）分、（19.98±3.98）分、（20.04±2.24）分］较干预前［研究组：（15.57±1.55）分、（26.23±4.63）分、（21.18±2.50）分，对照组：（16.09±1.87）分、（25.32±4.40）分、（21.57±2.69）分］均降低（ t=21.66、18.55、8.44，11.29、11.73、4.61，均 P < 0.001），且研究组明显低于对照组（ t=-8.79、-4.13、-3.56，均 P < 0.05）。研究组患者护理满意度优于对照组［98.21%（55/56）比87.50%（49/56），χ 2=-3.09， P < 0.05］。研究组的睡眠疗效总有效率为92.86%（52/56），高于对照组的78.57%（44/56）（χ 2=-2.09， P < 0.05）。 结论:五行音乐联合子午流注择时穴位按摩用于老年CHF患者可有效缓解负性情绪，提高其生活质量、睡眠质量，并提高患者护理满意度。

abstractsObjective:To investigate the effect of five-element music therapy combined with meridian-based acupoint massage timed according to qi circulationon on negative emotions and sleep quality in older adults with chronic heart failure. Methods:A total of 112 older adult patients with chronic heart failure who received treatment at The Affiliated Hospital of Hangzhou Normal University between January 2022 and June 2023 were included in this study. They were randomly divided into a control group ( n = 56) and a study group ( n = 56) using the random number table method. Based on conventional treatment, the control group received five-element music therapy, while the intervention group underwent a combination of five-element music therapy and meridian-based acupoint massage timed according to qi circulation. Before and after the intervention, a comparison was made between the two groups in terms of the scores of the Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), and various dimensions of the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Additionally, the sleep outcome and patient satisfaction were also compared between the two groups. Results:After intervention, the scores of the HAMA and HAMD in the study group were (11.29 ± 2.48) points and (12.48 ± 3.36) points, respectively. In contrast, the control group had scores of (15.93 ± 3.35) points and (16.50 ± 4.32) points, respectively. After intervention, the scores of the HAMA and HAMD scales in both the study and control groups demonstrated a significant reduction in comparison with their respective pre-intervention scores [study group: (20.13 ± 5.18) points, (23.95 ± 8.97) points, control group: (19.36 ± 5.45) points, (23.79 ± 7.61) points, t = 15.35, 10.24, 5.65, 8.93, all P < 0.001). After intervention, the scores of the HAMA and HAMD scales in the study group were significantly lower than those in the control group ( t = -8.34, -5.49, both P < 0.001). After intervention, the scores of the PSQI in the study and control groups were (7.05 ± 0.96) points and (9.91 ± 1.28) points, respectively. After intervention, the scores of PSQI in both the study and control groups demonstrated a significant reduction compared with their respective pre-intervention scores [study group: (12.98 ± 2.21) points, control group: (12.50 ± 2.48) points, t = 24.68, 9.79, both P < 0.05]. After intervention, the score of the PSQI in the study group was significantly lower than that in the control group ( t = 13.34, P < 0.05). Based on the scores across various dimensions of the MLHFQ, it was observed that after intervention, the scores of emotional, physical, and other domains in both the study and control groups [study group: (9.36 ± 2.29) points, (16.95 ± 3.80) points, (18.50 ± 2.33) points; control group: (12.93 ± 2.00) points, (19.98 ± 3.98) points, (20.04 ± 2.24) points] decreased significantly compared with their pre-intervention scores [study group: (15.57 ± 1.55) points, (26.23 ± 4.63) points, (21.18 ± 2.50) points, control group: (16.09 ± 1.87) points, (25.32 ± 4.40) points, (21.57 ± 2.69) points, t = 21.66, 18.55, 8.44, 11.29, 11.73, 4.61, all P < 0.001]. After intervention, the scores of emotional, physical, and other domains in the study group were significantly lower than those in the control group ( t = -8.79, -4.13, -3.56, all P < 0.05). Patient satisfaction in the study group was superior to that that in the control group [98.21% (55/56) vs. 87.50% (49/56), χ2 = -3.09, P < 0.05]. Total effective rate of intervention on sleep in the study group was significantly higher than that in the control group [92.86% (52/56) vs. 78.57% (44/56), χ2 = -2.09, P < 0.05]. Conclusion:Five-element music therapy combined with meridian-based acupoint massage timed according to qi circulationon in the treatment of chronic heart failure in older adults can effectively alleviate negative emotions, improve the quality of life and sleep, and increase patient satisfaction with nursing care.