【作者】 李漾；

【导师】 许能贵；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 目的:通过观察腹针在改善失眠症患者匹兹堡睡眠指数总分及7个睡眠因子评分方面的疗效和安全性,探讨腹针与常规针刺相比在治疗失眠症方面的疗效和优势。并初步探讨其治疗机理,为腹针治疗失眠症提供理论依据。方法:本临床研究采用前瞻性随机对照单盲的方法,以假腹针组作为空白对照组,将纳入病例分为腹针组30例,常规针刺组30例,假腹针组30例。腹针组予以腹针疗法,常规针刺组根据第七版教材《针灸治疗学》中“不寐”的穴位针刺,假腹针组在相应腹穴向左旁开1cm针刺。每天针刺1次,每次留针30分钟。治疗周期共10次(开始每天治疗1次5天,周六周日休息两天,此后每天治疗1次×5次)。治疗前后观察匹兹堡睡眠量表总分及7个睡眠因子评分的变化,并监测相关的安全性指标。治疗结束后1个月通过电话或信函随访。所有数据用spss13.0软件包进行统计分析。结果:(1)腹针组及常规针刺组在治疗后及随访1月匹兹堡总分数均有较明显降低,经统计学处理,P＜0.05,假腹针组治疗后及随访1月匹兹堡总分无明显降低,P＞0.05。腹针组及常规针刺组各项睡眠因子在治疗后及随访1月时评分均有所降低,经统计学分析,P＜0.05。假腹针组在治疗后及随访1月时,各睡眠因子评分无明显变化,P＞0.05。(2)三组中,治疗后的匹兹堡总分和各项睡眠因子评分和随访1月的评分比较,部分因子评分有所增加,部分因子评分有所减少,但均变化不明显。(3)腹针组和常规针刺组比较,治疗后及随访1月匹兹堡总分变化,经统计学处理,无明显差别,P＞0.05。(4)7个睡眠因子中,睡眠质量、入睡时间及睡眠障碍3个因子,腹针组和常规针刺组的评分比较,在治疗后及随访1月时,经统计学处理,腹针组的变化较明显低于常规针刺组,P＜0.05。(5)治疗前后相关安全性检测项目:三组患者均未出现心率、心律、血压,血、尿、大便常规,心电图、肝功能(ALT)、肾功能(BUN)各项指标的异常。(6)感染、损伤、不能忍受疼痛或不适等(治疗中随时观察)腹针组和假腹针组分别出现2例、1例针刺后较明显的皮下瘀血,向患者解释,并嘱其用生土豆片外敷消瘀后患者能坚持治疗;常规针刺组出现3例针刺后较明显皮下瘀血,2例不能忍受疼痛及不适,向患者解释并减轻针刺刺激后,患者可坚持治疗。三组均未出现感染。结论:腹针和常规针刺均能改善失眠患者的匹兹堡睡眠指数,而且疗效能持续到治疗后1月随访。虽然两者比较,腹针对睡眠总体情况的改善并不明显优于常规针刺,但腹针在某些睡眠因子的改善方面优于常规针刺。而且腹针具有痛苦小、处方及操作相对规范的优点,适宜在临床推广。更多还原

【Abstract】 Objective:To explore the effect and advantage of abdominal acupuncture compared with normal acupuncture for insomnia by observing the effect and safety of abdominal acupuncture on changing Pittsburgh sleep quality index（PSQI） and its 7 sleeping factors.To provide theory basis for abdominal acupuncture in treating with insomnia by discussing its mechanism.Methods:Forward-looking,randomized controlled and single-blinded method was used. We divided the cases that met the including criteria into 3 groups:abdominal acupuncture group,normal acupuncture group and pseudo abdominal acupuncture group which was regarded as blank controlled group.Cases in abdominal acupuncture group were treated by abdominal acupuncture;the points chosen in normal acupuncture group were based on the chapter "insomnia" of <Treatment of Acupuncture> of the 7^th edition.For the pseudo abdominal acupuncture group,all the points were lcm left lateral to the right abdominal points.The treating was one time a day,every time the needles were remained for 30 minutes.The treatment process was 10 times（the first week was 5 times every day,Saturday and Sunday stopped,the second week was the other 5 times）. Before and after the treatment,the PSQI and its 7 sleeping factors and the safety index were observed.1 month after the treatment,the PSQI and its 7 sleeping factors were inquired again by telephone and letter.All the data were analyzed by spss 13.0 statically.Results:（1） After the treatment and 1 month after the treatment,the PSQI and 7 sleeping factors were reduced obviously in abdominal acupuncture group and normal acupuncture group,P＜0.05;as there was no significant difference change of PSQI and 7 sleeping factors in pseudo acupuncture group,P＞0.05. （2） For three groups,the PSQI and 7 sleeping factors had no obvious changes between after treatment and 1 month flowing.（3） After treatment and 1 month following,there was no significant difference of PSQI between abdominal acupuncture and normal acupuncture group,P＞0.05.（4） Among 7 sleeping factors,after the treatment and 1 month following,there were significant difference between abdominal acupuncture and normal acupuncture in 3 sleeping factors as sleeping quality,time needed in falling asleep and sleeping disturbance,P＜0.05.（5） The safety test items after the treatment:there were no abnormality in all the 3 groups:heart rate;rhythm of the heart;blood pressure;routine test of blood,urine,defecate;electrocardiogram,function of liver（ALT）,function of kidney（BUN）.（6） During the treatment,we observed infection,injury and patients who couldn’t endure the needle:there were 2 cases in abdominal group,1 case in pseudo abdominal group and 3 cases in normal acupuncture group had obvious subcutaneous blood stasis.We asked the cases to apply raw potato slices to affected area and they persisted in treatment after our explanation.There were 2 cases in normal acupuncture group couldn’t endure the pain and discomfort during the treatment,we also explained to them and reduced the stimulation,they persisted in the treatment. All the 3 groups had no infectious cases.Conclusion:Both abdominal acupuncture and normal acupuncture can reduce the PSQI of insomnia patients,and the effect could last for 1 month following. Abdominal acupuncture is better than normal acupuncture in reducing some sleeping factors although abdominal acupuncture has no obvious advantage for improving general situation of sleeping compare with normal acupuncture,it has less pain,comparative standard prescription and manipulation,which is suitable for popularizing in clinic.更多还原