【作者】 张丽芬；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 失眠症中医学称“不寐”指经常不能获得正常睡眠为特征一类病证,或因睡眠障碍,表现入睡困难、早醒等一类病证,每遇劳累和情绪紧张加剧,严重影响患者的工作和生活质量,现代医学对于失眠症从定义、流行病学、病因、病理机制、临床分型、症状等多方面进行了大量的讨论。中医针灸治疗是目前治疗失眠症采用非西药疗法中的常用方法,近年来在临床上广泛应用,取得了一定得效果,本研究在这些认识的基础上从耳穴贴压治疗入手,探讨其对治疗失眠症的临床疗效。研究目的：目前为止,临床上尚无一种理想的安眠药物,仍有待进一步深入研究解决。在失眠的治疗上,应强调个体化原则,在采用耳穴贴压治疗的同时,加强心理、行为、认知等综合治疗,增强病人战胜失眠的信心,使患者更快、更好地解除失眠带来的各种烦恼。多数治疗失眠的药物易引起耐受性和依赖性,且常出现“宿醉”现象,影响患者第2天的工作,并可能增加次日的日间睡眠,从而干扰夜间入睡,使治疗进一步复杂化。对应于药物治疗的缺陷和不良反应,耳穴贴压的重要性日益凸显,因此给中医耳穴应用带来了广阔的远景。专病专方治疗是中医治疗大军中的翘楚,探索专穴专病也是从这思路展开的,应用耳穴治疗失眠,临床上已经有大量的医学工作者取得可喜的成果,但是,失眠的耳穴主穴应用,离不开多穴配合,因此,试图通过观察一组失眠者单以“神门穴”贴压,研究单一贴压“神门穴”治疗失眠疗效的可行性。为祖国耳穴专穴疗效研究,作出努力工作。研究方法：首先,通过查阅维普1994～2009年以失眠、不寐、耳穴贴压为关键词查找的文献为基础,对失眠症的中西医发病机制、中西医的治疗研究进展及针灸治疗失眠症的研究进展进行详细的文献研究。在此基础上,采用前瞻性研究方法。对2009年1月至2009年12月的广州中医药大学第一附属医院、省第二中医院,90例门诊失眠患者采用随机表。分为神门单一穴组30例和常用五穴组30例及五穴去除神门四穴组30例,共三组。通过临床病例询问量表、睡眠状况自评量表记录观察耳穴贴压疗法的临床疗效和操作方法。同时对比观查三组不同耳穴的贴压治疗方法,按制定的观察表格收集资料经复核后,录入计算机,进行统计分析。将90例合格受试患者按随机数字表分成3组：神门组(耳穴贴压神门单一穴)30例,四穴组(为耳穴贴压心、内分泌、皮质下、交感穴)30例,五穴组(耳穴贴压神门、心、内分泌、皮质下、交感穴)30例,所有患者分别采用SRSS评定治疗前后一个月的睡眠质量。三组患者处理方法如下：治疗时间：每周1次,每4周为一疗程,观察一个疗程。临床疗效采用《中药新药临床研究指导原则》对失眠症的疗效标准进行评价,并观察三组治疗前后SRSS量表的各项评分及总体评分进行疗效对比。通过临床研究耳穴贴压治疗失眠的临床治疗,分析选穴不同的三组临床疗效比较。并将不同选穴三组在性别、病程、中医证型、主症、发病因素、量表积分等指标进行比较,分析单一失眠选穴治疗失眠的优缺点。有助于更好的应用耳穴贴压治疗失眠,以相对安全而有效的方法,使患者更愿意接受治疗,减轻患者因失眠造成生活质量下降,并对耳穴贴压的临床操作总结经验,以提高临床疗效。研究结果：治疗结果表明,三组采用三种不同选穴治疗后,失眠症状均提示有一定的疗效改善。疗效比较：显示三组不同选穴贴压患者疗效,差异不具统计学意义。1.经过一个疗程的治疗后评价,三组总的临床疗效达到86.7%。且三组间疗效相当。2.临床疗效与性别关系：经研究发现三组失眠患者,女性失眠症的人数的发病分布占比明显多于男性；且临床疗效无差异。3.临床疗效与病程：总的临床疗效与病程关系研究显示病程越短的患者总的临床疗效越好；研究发现患者的病程越久,其疗效相对与病程短的急性期的为低；三组组间比较,所有研究的患者主症经贴压耳穴治疗皆有改善。4.临床疗效与中医证型：三组治疗失眠症的中医证型临床疗效,没有差异,皆有改善,而以肝火扰心、痰热扰心占比最多,治疗后改善人数也相对最多。5.以睡眠状况自评量表评价：五穴组,和四穴组在改善患者失眠的缓解程度并无明显优于单一神门为主穴的耳穴贴压法,单用神门同样具有一定疗效,同时发现患者心理上更愿意采用多穴的贴压治疗,这可能来自收费的性价比心理作用,认为,花同样的钱,能多贴几穴,在金钱上也不吃亏,而且疗效可能更好的潜意识心理作用所致。结论中医耳穴贴压治疗失眠症有一定的临床疗效,且无药物的副作用,安全简便,患者易接受选用不同耳穴贴压疗法均能改善失眠患者主观睡眠质量,入睡时间,睡眠效率,且没有差异,能够改善患者的生活品质,值得临床推广应用耳穴贴压法治疗失眠症。单一神门组、四穴组、五穴组贴压治疗失眠皆有疗效,三组并无差异。更多还原

【Abstract】 Insomnia, namely sleeplessness in TCM, refers to the frequent disability to obtain normal sleep, or sleep disorders such as difficult-to-fall-asleep and early-wake-up. Such diseases and symptoms, along with overworkedness and emotional tensions, seriously affect the quality of life and work. Modern medicine has done numerous studies on insomnia from various respects such as definition, epidemiology, etiology, pathogenesis, clinical typing, symptoms and so forth. As a non-western medicine treatment TCM acupuncture is widely used to release insomnia nowadays. With the above in mind, our research aims to explore the effectiveness of auricular stick-press clinical therapy treating insomnia.Research purpose:Shortage of ideal sleeping drug nowadays calls for further study in the area. As a principle insomnia treatment shall be personalized. Along with auricular therapy, methods of psychology, behavior, and patient perception shall be emphasized to upgrade the patient confidence, therefore help remove patients with the disease faster and better. Most of the drugs for insomnia tend to cause tolerance and adaptation. The frequent "hangover" phenomenon disturbs the patient’s next day work and sleep, making treatment interference further complicated. The defects and adverse reactions by the drug therapy highlight the importance and broad prospect of TCM auricular application. Treatment and prescription on a case-by-case basis is a TCM advantage, which also leads to specific acupuncture point treatment for specific disease. Auricular insomnia therapy has achieved gratifying achieve-ments in clinical application so far, however, the main insomnia auricular point application requires multi-point operation. In this study, by researching the single Shenmen Point stick-press therapy, we try to work on its feasibility and contribute to the single-point auricular therapy research for the motherland. Research Methodology:First, through the access (1994-2009 with insomnia, insomnia, auricular application for keywords search based on the literature, insomnia and pathogenesis, and research progress of treatment and acupuncture treatment of insomnia research progress of detailed literature research. On this basis, the prospective research methods adopted. On January 2009,2009 in Guangzhou university of TCM in December, the first hospital,90 second hospital outpatient insomnia patients using random table. A single point group is divided into "shenmen" and 30 cases acupuncture point group of 30 cases and five points and four points of three group,30 cases. Through the clinical cases, ask sleep self-evaluation questionnaire record auricular application therapy of clinical and operating methods. At three different contrast observed the ears of pressure treatment, according to the observed data collected form for the review, entry computer, statistical analysis. By trying to 90 cases of patients with qualified by random number list into three groups: (auricular application "shenmen" single point),30 cases for four point auricular application (heart, endocrine, subcortical, consensual acupuncture point),30 cases acupuncture point group auricular application (shenmen, heart, endocrine, subcortical, consensual acupuncture point),30 cases were all patients SRSS evaluation by one month before and after the treatment of sleep quality. Each patient treatment methods are as follows:Time:1 times per week, four weeks for a period. Using the clinical curative effect of Chinese medicine clinical research guiding principles for insomnia curative standard into evaluation, Before and after the treatment group and observe three SRSS scale of the score and the overall rating efficacy.Clinical research auricular application for insomnia, analysis the clinical treatment of three different choose acupuncture clinical curative effect. And different point three groups in selected course, gender, cultural differences, the factors, such as a comparison and analysis of the chosen acupuncture treatment of sleep sleep. Help better application auricular application in treatment of insomnia, relatively safe and effective method, make more willing to accept treatment, patients with ease patients who suffer from insomnia, causing the quality of life of auricular application of clinical operation experiences, to improve the clinical curative effect.Research Results Treatment results show that 3 groups of patients all receive certain statistically similar curative effects.1. After 1st period of treatment, the 3 groups’overall evaluation of curative effect reaches 86.7%, and there is no apparent difference among 3 groups in this respect.2. Relationship between clinical curative effect and gender:the study shows there are many more female patients than male patients out of the 3 selected groups. There is no apparent difference between different genders in the area of curative effect.3. Clinical effect and the course:study on relationship between general clinical curative effect and the disease course shows that the patients with shorter disease courses receive better clinical effect. Patients with longer disease courses receive lower curative effects than that in the acute phase. Comparison between 3 groups shows that all the patients receiving treatment find their conditions improved.4. Clinical curative effect and the TCM syndrome type:there is no group difference between clinical curative effects corresponding to TCM syndrome type. All patients improve their conditions. Patients suffering from Cardiac function disturbed by liver-fire number the first and also receive the best curative effects after treatment.5. Sleep quality self-reported questionnaire evaluation:Five point group and four point group receive no better curative effect than single point group, which as the same receive certain effect. Meanwhile, it is found that patients psychologically tend to take multi-point stick-press treatment. This may be the result of cost performance subconsciousness. With the same cost, the patients are more willing to take multi-point treatment wishing for better curative effects.ConclusionTCM auricular therapy has certain clinical curative effect of insomnia blessed with no drug side-effects. It is safe, convenient and easy to be accepted by the patients. Different auricular application therapies can all improve subjective sleep quality. There is no difference between fall-asleep timing and sleeping quality. All of the therapies can upgrade the patients living quality and shall be further adopted to treat insomnia in clinical applications.更多还原