和胃针法治疗失眠伴焦虑状态的随机对照研究
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摘要
目的:观察和胃针法治疗失眠伴焦虑状态的疗效评价。方法:将符合纳入标准的110例失眠伴焦虑状态的患者随机分为和胃针法组和常规穴位组,各55例。两组在治疗前后及3个月随访后观察匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)评分的变化以及临床疗效的比较,并对其进行安全性、依从性评价。结果:3个月随访后,与常规穴位组比较,和胃针法组SAS评分改善明显(P<0.05);治疗后及3个月随访后临床症状评分和胃针法组优于常规穴位组(P<0.01)。与治疗前比较,和胃针法组治疗后及3个月随访后PSQI总分、睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍及日间功能障碍、SAS评分均显著下降(P<0.01)。和胃针法组治疗后及3个月随访后临床症状评分均显著下降(P<0.01)。结论:和胃针法组和常规穴位组均能改善患者的失眠伴焦虑状态,但在改善睡眠时间和焦虑情绪远期疗效方面,和胃针法组优于常规穴位组。
Objective: To observe and evaluate the efficacy of Hewei-acupuncture manipulation on insomnia with anxiety. Methods: A total of 110 cases of insomnia with anxiety state of patients who met the inclusion criteria were randomly divided into the Hewei-acupuncture manipulation group and the conventional acupuncture point group, with 55 cases in each group. The changes of Pittsburgh sleep quality index(PSQI), self-rating anxiety scale(SAS) score and clinical efficacy were observed between the two groups before and after treatment and after 3 months follow-up, and the safety, the compliance were evaluated. Results: After 3 months of follow-up, compared with conventional acupuncture point group, the SAS score in the Heweiacupuncture manipulation group was significantly improved(P<0.05). The differences in clinical symptom scores between the two groups after treatment and after 3 months of follow-up were statistically significant(P<0.01). Compared with before treatment, the total scores of PSQI, sleep quality, time for falling asleep, sleep time, sleep efficiency, sleep disorders, daytime dysfunction and SAS in the Hewei-acupuncture manipulation group were decreased after treatment and 3 months follow-up(P<0.01). The clinical symptom scores of the Hewei-acupuncture manipulation group decreased after treatment and 3 months follow-up(P<0.01). Conclusion: Both the Hewei-acupuncture manipulation group and the conventional acupoint group could improve the state of patients' insomnia with anxiety, but the Hewei-acupuncture manipulation group is better than the conventional acupuncture point group in improving the sleep time and the long-term efficacy of anxiety.
Objective: To observe and evaluate the efficacy of Hewei-acupuncture manipulation on insomnia with anxiety. Methods: A total of 110 cases of insomnia with anxiety state of patients who met the inclusion criteria were randomly divided into the Hewei-acupuncture manipulation group and the conventional acupuncture point group, with 55 cases in each group. The changes of Pittsburgh sleep quality index(PSQI), self-rating anxiety scale(SAS) score and clinical efficacy were observed between the two groups before and after treatment and after 3 months follow-up, and the safety, the compliance were evaluated. Results: After 3 months of follow-up, compared with conventional acupuncture point group, the SAS score in the Heweiacupuncture manipulation group was significantly improved(P<0.05). The differences in clinical symptom scores between the two groups after treatment and after 3 months of follow-up were statistically significant(P<0.01). Compared with before treatment, the total scores of PSQI, sleep quality, time for falling asleep, sleep time, sleep efficiency, sleep disorders, daytime dysfunction and SAS in the Hewei-acupuncture manipulation group were decreased after treatment and 3 months follow-up(P<0.01). The clinical symptom scores of the Hewei-acupuncture manipulation group decreased after treatment and 3 months follow-up(P<0.01). Conclusion: Both the Hewei-acupuncture manipulation group and the conventional acupoint group could improve the state of patients' insomnia with anxiety, but the Hewei-acupuncture manipulation group is better than the conventional acupuncture point group in improving the sleep time and the long-term efficacy of anxiety.
引文
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[20]成词松,诸毅晖.论经络辨证体系的建构原则.中国针灸,2011,31(9):831-833
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[22]杨朔,李伟.治神调脾胃法针刺治疗失眠40例.中外医学研究,2014,12(14):116-117
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[24]钟国球.归脾丸治疗失眠症40例的疗效观察.中国医学创新,2013,10(11):43-44
[25]杨丹.脾胃为五脏藏神关键及针刺足三里干预抑郁症的理论与实验研究.北京:北京中医药大学,2013
[2]贺旭,洪军,林建华.失眠患者睡眠质量与抑郁焦虑状态的相关性研究.中华物理医学与康复杂志,2002,24(8):500-501
[3]潘集阳,赵耕原,张晋碚,等.原发性失眠症患者的焦虑抑郁状态研究.中华行为医学与脑科学杂志,2000,9(3):178-179
[4]中华医学会精神科学会.中国精神障碍分类与诊断标准(CCMD-2-R).南京:东南大学出版社,1995:94
[5]石学敏.针灸学.2版.北京:中国中医药科技出版社,2007:228
[6]王福玲.世界医学会《赫尔辛基宣言》——涉及人类受试者的医学研究的伦理原则.中国医学伦理学,2016,29(3):544-546
[7]谷忠悦,关怀玉.《内经》中心身疾病相关症状经络辨证特点的研究.实用中医内科杂志,2011,25(4):35-36
[8]清·吴澄撰.不居集.达美君等,校注.北京:中国中医药出版社,2002:369
[9]InouéS,Honda K,Komoda Y.Sleep as neuronal detoxification and restitution.Behavioural Brain Research,1995,69(s1-2):91-96
[10]范利锋,王平仁,兰培敏.睡眠机制的研究概况.临床内科杂志,2005,22(10):662-664
[11]张镭潇.针刺与安慰针刺改善失眠伴焦虑情绪的临床随机对照研究.成都:成都中医药大学,2014
[12]邵丹.针刺五脏俞对失眠大鼠脑内抑制性递质调节作用的实验研究.长春:长春中医药大学,2009
[13]张晓梅.电项针对PCPA致失眠大鼠脑内5-HT、5-HIAA、NE、IL-1β含量的影响.哈尔滨:黑龙江中医药大学,2008
[14]佘军.针刺神聪穴对失眠大鼠脑干网状结构单胺类递质调控机制的研究.哈尔滨:黑龙江中医药大学,2007
[15]周全,杨大艳,崔晓,等.脑f MRI观察电针神门及三阴交穴治疗失眠机制.中国介入影像与治疗学,2011,8(3):204-207
[16]Lu J,Greco M A,Shiromani P,et al.Effect of lesions of the ventrolateral preoptic nucleus on NREM and REM sleep.Journal of Neuroscience the Official Journal of the Society for Neuroscience,2000,20(10):3830-3842
[17]胡金凤,王朝辉,齐燕英,等.“针刺五脏俞穴调五脏神”针法对失眠大鼠脑内细胞因子调节作用及其机制的研究.吉林中医药,2008,28(9):688-689
[18]周艳丽,叶险峰.针刺不同腧穴对失眠模型大鼠脑内细胞因子IL-1、TNF-α含量影响的实验研究.中国中医基础医学杂志,2012,18(4):419-420
[19]焦富英,朱婷婷,金迎.中医治疗失眠症研究进展.实用中医内科杂志,2011,25(9):3-5
[20]成词松,诸毅晖.论经络辨证体系的建构原则.中国针灸,2011,31(9):831-833
[21]刘国真.经络辨证与针灸临床.山东中医杂志,1999,18(8):341-342
[22]杨朔,李伟.治神调脾胃法针刺治疗失眠40例.中外医学研究,2014,12(14):116-117
[23]卢世秀,苏凤哲.路志正从脾胃论治失眠.北京中医药,2011,30(1):15-16
[24]钟国球.归脾丸治疗失眠症40例的疗效观察.中国医学创新,2013,10(11):43-44
[25]杨丹.脾胃为五脏藏神关键及针刺足三里干预抑郁症的理论与实验研究.北京:北京中医药大学,2013