【作者】 赖明彦；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 博士

【摘要】 目的：探讨电针合并甘麦大枣汤对失眠患者的抑郁程度、焦虑程度及睡眠质量指数的影响。方法：本研究将符合失眠诊断标准和纳入标准的患者60例,随机分为两组,分别为电针合并甘麦大枣汤治疗组与甘麦大枣汤对照组各30例。治疗组取主穴照海、申脉、神门、印堂、四神聪、安眠；配穴心俞、脾俞、足三里。得气后接电针治疗仪,用密波治疗10分钟后改疏密波20分钟。每天治疗1次,一周治疗5天,4周为1个疗程。连续治疗2个疗程。治疗组与对照组均服用甘麦大枣汤,每天分三次(早、午、晚),每次0.05g／每公斤体重,温开水冲服,连续服4周为一疗程,2个疗程后总结疗效。评价指标采用自评抑郁量表(SDS)、自评焦虑量表(SAS)和匹兹堡睡眠质量指数(PSQI)量表作为测量工具,并以1993卫生部“中药新药治疗失眠的临床研究指导原则”中失眠的疗效判定标准作为临床疗效指标。结果：(1)在自评抑郁量表(SDS)评分评价中,治疗组治疗前后比较,差异有统计学意义(P<0.01)。对照组治疗前后比较,差异亦有统计学意义(P<0.01)。而两组间治疗后差值比较,差异亦有统计学意义,P<0.01。(2)在自评焦虑量表(SAS)评分评价中,治疗组治疗前后比较,差异有统计学意义(P<0.01)。对照组治疗前后比较,差异亦有统计学意义,P<0.01。而两组间治疗后差值比较,差异亦有统计学意义(P<0.01)。(3)在睡眠率百分比比较中,治疗组治疗前后比较,差异有统计学意义(P<0.01)。对照组治疗前后比较,差异亦有统计学意义(P<0.01)。而两组间治疗后差值比较,差异亦有统计学意义(P<0.01)。(4)在匹兹堡睡眠质量指数(PSQI)评分评价中,治疗组治疗前后比较,差异有统计学意义(P<0.01)。对照组治疗前后比较,差异亦有统计学意义(P<0.01)。而两组间治疗后差值比较,差异亦有统计学意义(P<0.01)。在各睡眠品质、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能评分评价中,组内及组间的差异亦均有统计学意义(P<0.01)。(5)在评价患者的临床疗效中,两组治疗后临床疗效比较,差异有统计学意义,P<0.05。对照组之显愈率达60.00%,而治疗组之显愈率更达76.67%。结论：(1)电针合并甘麦大枣汤疗法可改善失眠患者的抑郁程度,且疗效优于单用甘麦大枣汤疗法。(2)电针合并甘麦大枣汤疗法可改善失眠患者的焦虑程度,且疗效优于单用甘麦大枣汤疗法。(3)电针合并甘麦大枣汤疗法可改善失眠患者的百分比睡眠率,且疗效优于单用甘麦大枣汤疗法。(4)电针合并甘麦大枣汤疗法可改善失眠患者的睡眠品质、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能。且疗效优于单用甘麦大枣汤疗法。(5)电针合并甘麦大枣汤疗法的临床疗效优于单用甘麦大枣汤疗法。以上,本研究证明电针合并甘麦大枣汤疗法对失眠具有一定的治疗作用,不仅可改善患者的抑郁程度、焦虑程度,亦可促使患者的睡眠品质、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能恢复,且临疗效明显优于单用甘麦大枣汤疗法,因此,本研究说明电针合并甘麦大枣汤疗法适合应用于临床上常见的心脾两虚型失眠症,值得临床上推广应用。更多还原

【Abstract】 Objective To investigate the impact of depression degree, anxiety degree, sleepiness degree, sleep quality index of insomnia patients treated by electro-acupuncture with taking Gan Mai Da Cao Tang.Methods 60 patients conformed to the diagnostic criteria consistent insomnia and inclusion criteria, were randomly divided into two groups, the treatment group treated by electroacupuncture with taking Gan Mai Da Cao Tang, and the control group treated by taking Gan Mai Da Cao Tang,30 cases each. In the aspects of the treatment group, we stimulates the main point including Zhaohai, Shenmai, Shenmen, Yintang, Sishencong, Anmian. and stimulates the matching point including Xinshu, Pishu, Zusanli. When getting qi, we used a electric acupuncture apparatus with the sparse-density wave for 20 minutes after the density wave for 10 minutes.All patients were treated one time per day,5 days per week,4 week for a course of treatment, and 2 months for a observed period of treatment. Then, All patients including the treatment group and the control group took Gan Mai Da Cao Tang, three times per day (morning, afternoon and evening), Each 0.05g/kg, with warm water,1 months for a course of treatment, and 2 months for a observed period of treatment. We evaluated the improvement of insomnia of every patient and the clinical efficacy according to the following items, (1) Self-rating depression scale (SDS), (2) Self-rating anxiety scale (SAS), (3 The Pittsburgh Sleep Quality Index (PSQI), and we used "the guiding principle of clinical research on new drugs" by Ministry of Health of the People’s Republic of China in 1993 as a clinical indicator criteria to determined the clinical efficacy of insomnia.Results (1) In the score evaluation of Self-rating depression scale (SDS), there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). The difference between after treatment of the treatment group and control group, is also statistically significant difference (P<0.01). (2) In the score evaluation of Self-rating anxiety scale (SAS), there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). (4) In the evaluation of percentage rate of sleep, there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01). (5) In the score evaluation of the Pittsburgh Sleep Quality Index (PSQI), there is a statistically significant difference between after treatment and before treatment of the treatment group (P<0.01), and there is a statistically significant difference between after treatment and before treatment of the control group (P<0.01), and the individual results, including sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbances and daytime function, were the same. (6) In the evaluation of clinical efficacy, there is a statistically significant difference between the treatment group and the control group (P<0.05). However, healing rate of the control group was 60.00%, and healing rate of the treatment group was 76.67%.Conclusions (1) The treatment of electroacupuncture and Gan Mai Da Cao Tang can improve the depression degree of Insomnia patients, and it is more effective than the treatment of Gan Mai Da Cao Tang only. (2) The treatment of electroacupuncture and Gan Mai Da Cao Tang can improve the anxiety degree of Insomnia patients, and it is more effective than the treatment of Gan Mai Da Cao Tang only. (3) The treatment of electroacupuncture and Gan Mai Da Cao Tang can improve the Sleepiness degree of Insomnia patients, and it is more effective than the treatment of Gan Mai Da Cao Tang only. (4) The treatment of electroacupuncture and Gan Mai Da Cao Tang can improve the percentage rate of sleep of Insomnia patients, and it is more effective than the treatment of Gan Mai Da Cao Tang only. The treatment of electroacupuncture and Gan Mai Da Cao Tang can improve the sleep quality of Insomnia patients, including sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbances and daytime function, and it is more effective than the treatment of Gan Mai Da Cao Tang only. (6) The clinical efficacy of the treatment of electroacupuncture and Gan Mai Da Cao Tang is superior to the treatment of Gan Mai Da Cao Tang only.Above, this study demonstrated that the treatment of electroacupuncture and Gan Mai Da Cao Tang does have a therapeutic role, not only can improve the depression degree, the anxiety degree, the sleepiness degree and the percentage rate of sleep in patients, but also can promote recovery of sleep quality, sleep latency, sleep time, sleep efficiency, sleep disturbances and daytime function, and it’s clinical efficacy is significantly superior to the treatment of Gan Mai Da Cao Tang only. Therefore, this study shows that the treatment of electroacupuncture and Gan Mai Da Cao Tang is suitable for insomnia patients with type of deficiency of both heart and spleen, and is worthy of clinical application.更多还原