【作者】 王贵双；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 中医学， 2014， 博士

【摘要】 目的通过随机对照的实验设计方法,对针刺结合太极拳对于失眠的干预作用加以临床观察研究,客观评价其临床疗效,探索失眠诊治的新途径。方法将符合选择标准的90例患者随机分为试验组、针刺组和太极拳组,各30例。试验组采用针刺结合太极拳的方法,针刺方法采用国内著名针灸学家赖新生教授对于失眠的治疗经验,以四神聪、神门、三阴交为主穴,根据患者实际病情辩证加减。太极拳锻炼采用24式太极拳为试验措施。针刺组仅进行针刺治疗,方式与试验组相同。太极拳组仅进行24式太极拳锻炼,方式与试验组相同。每周周一到周五进行试验,周六、周日休息,两周一个疗程,共两个疗程。治疗结束后,随访观察8周。采用匹兹堡睡眠质量指数量表、抑郁自评量表、焦虑自评量表和生存质量测定简表对失眠患者的睡眠质量、抑郁、焦虑和生存质量进行观察。数据采集分6次进行,即在治疗前、治疗2周后、治疗4周后(治疗结束)以及治疗结束后的2周、4周和8周各进行一次数据采集。以SPSS17.0软件对数据加以统计分析。结果1.治疗结束后总有效率的组间比较治疗4周结束后,对三组疗效加以分析比较,试验组共治愈8例,显效17例,有效5例,无效0例,治疗全部有效,总有效率为100%。针刺组治共愈2例,显效11例,有效16例,无效1例,总有效率为96.7%。太极拳组共治愈0例,显效2例,有效23例,无效5例,总有效率为83.3%。三组对于失眠的治疗均有效果。经过比较,试验组对于失眠的疗效优于针刺组和太极拳组(P<0.017),针刺组优于太极拳组P<0.017)。2.治疗前后量表评分差值的组间比较将治疗前后量表评分差值进行组间比较,三组均可以改善失眠患者的入睡时间,无明显差异(P>0.05)。试验组与针刺组比较,除了在睡眠质量、睡眠效率的改善上无明显差异外(P>0.017),在其他方面试验组均优于针刺组(P<0.017)。试验组与太极拳组比较,各方面的改善均优于太极拳组(P<0.017)。针刺组与太极拳组比较,在生存质量的改善上,针刺组优于太极拳组(P<0.017)。在睡眠质量、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍、PSQI,总分、抑郁、焦虑等的改善上,针刺组与太极拳组无明显差异(P>0.017)。3.治疗过程中每次量表评分的组间比较在PSQI总分比较方面,治疗2周后,试验组对于PSQI总分的改善与针刺组无明显差异(P>0.017),两组对于PSQI总分的改善均优于太极拳组(P<0.017)。在治疗4周后,试验组对于PSQI总分的改善优于针刺组和太极拳组(P<0.017),针刺组与太极拳组对于PSQI总分的改善无明显差异(P>0.017)。在抑郁评分比较方面,在治疗2周后,三组无明显差异(P>0.05)。在治疗4周后,试验组对于抑郁的改善优于针刺组与太极拳组(P<0.017),针刺组与太极拳组对于抑郁的改善无明显差异(P>0.017)。在焦虑评分比较方面,在治疗2周后,三组无明显差异(P>0.05)。在治疗4周后,试验组对于焦虑的改善优于针刺组与太极拳组(P<0.017),针刺组与太极拳组对于焦虑的改善无明显差异(P>0.017)。在生存质量评分比较方面,在治疗2周后,三组无明显差异(P>0.05)。在治疗4周后,试验组对于生存质量的改善优于针刺组与太极拳组(P<0.017),针刺组对于生存质量的改善优于太极拳组(P<0.017)。4.治疗前后量表评分的自身比较治疗前后量表评分的自身比较,三组量表评分各个方面均有P<0.05,差异有统计学意义,说明试验组、针刺组与太极拳组对于失眠的改善均有效果。5.远期疗效将随访结束后各量表评分与治疗结束后各量表评分加以比较,三组均有P<0.05,说明试验组、针刺组与太极拳组对于失眠的治疗均有一定远期疗效。将随访结束后量表评分组间加以比较,试验组与针刺组比较,量表评分的各方面均有P<0.017,可以认为在随访结束后试验组的疗效优于针刺组。试验组与太极拳组比较,在PSQI总分方面有P<0.017,说明随访结束后试验组对于失眠的疗效优于太极拳组。但在抑郁评分、焦虑评分以及生存质量评分的比较方面,随访结束后试验组与太极拳组无明显差异(P>0.017)。针刺组与太极拳组比较,针刺组与太极拳对于PSQI总分的改善无明显差异(P>0.017),但在抑郁评分、焦虑评分以及生存质量评分的比较方面,太极拳组优于针刺组(P<0.017)。结论针刺结合太极拳对于失眠的治疗具有明显的临床疗效及远期效果,优于单纯针刺治疗和单纯太极拳锻炼。太极拳锻炼对于失眠有一定的改善作用,可以较好的改善失眠患者的抑郁、焦虑以及生存质量,可以加强针刺的临床治疗效果。更多还原

【Abstract】 ObjectiveThe aim of the study was to observe and study the the intervention effect of insomnia treated with acupuncture combined with Tai Chi. It has two goals, one is to test and verify the effect of insomnia treated by Tai Chi, the other is to explore new ways to treat insomnia.Methods90insomnia patients were randomly divided into the test group, acupuncture group and Tai Chi group,30cases in each group. The test group was treated by acupuncture combined with Tai Chi, using Professor Lai Xinsheng’s experience in treatment of insomnia.(Professor Lai is a domestic famous acupuncturist.) Tai Chi exercise used the24Style. The Acupuncture group only received acupuncture treatment as same to test group. Tai Chi group only received only24Style Tai Chi exercise as same to test group. Monday to Friday for the test of time, Saturday, Sunday rest, a total of4weeks. After the end of treating, it had8week follow-up. Patients’s sleep quality, depression, anxiety and quality of life were observed by PSQI, SDS, SAS and WHOQOL-BREF in6time points (before treating, after2weeks of treating, after4weeks of treating, and2weeks,4weeks and8weeks after the end of treating). In the end, we took SPSS17.0software for statistical analysis of data.Results1. The total efficiency comparison among groupsAfter4weeks of treating, the test group haved8cured cases,17obvious effective cases,5effective cases and0invalid cases, the total effective rate was100%. The acupuncture group haved2cured cases,11obvious effective cases,16effective cases and1invalid cases, the total effective rate was96.7%. Tai Chi group haved0cured cases,2obvious effective cases,23 effective cases, and5invalid cases, the total effective rate was83.3%. Three groups all have the effect for insomnia treatment. By comparison, the test group’s curative effect for insomnia was better than the acupuncture group and the Tai Chi Group (P<0.017), the acupuncture group was better than Tai Chi group (P<0.017).2. Comparison of scale score difference after treating among groupsBy the Comparison of scale score difference after treating, three groups can all shorten insomnia patients’sleep latency with no obvious difference (P>0.05). By the comparison between the test group and acupuncture group, there was no significant difference in improving sleep quality and efficiency (P>0.017), but test group was better than the acupuncture group in other ways (P<0.017). Compared with the Tai Chi Group, the test group was better in all ways (P<0.017). Compared with the Tai Chi group, the acupuncture group was better in improving the quality of life (P<0.017), but they had no significant difference in sleep quality, sleep time, sleep efficiency, sleep disorders, daytime function, PSQI score, depression and anxiety (P>0.017).3. Comparison of each score among groupsIn the comparison of the PSQI score, after2weeks of treating, the test group and the acupuncture group had no significant difference for the effect on the treatment of insomnia (P>0.017), but they were all better than Tai Chi group(P<0.017). After4weeks of treating, the test group for insomnia therapy was better than acupuncture group and Taijiquan group (P<0.017), and there was no significant difference between acupuncture group and Taijiquan group (P>0.017).In the depression score comparison, there was no significant difference among the three groups after2weeks of treating (P>0.017). After4weeks of treating, The test group for depression was better than the acupuncture group and Tai Chi group (P<0.017), the acupuncture group and Tai Chi group had no significant difference for the improvement of depression (P>0.017).In the anxiety score comparison, there was no significant difference among the three groups after2weeks of treating (P>0.017). After4weeks of treating, the test group for anxiety was better than the acupuncture group and Tai Chi group (P<0.017), the acupuncture group and Tai Chi group had no significant difference for the improvement of anxiety (P>0.017).In the life quality score comparison, there was no significant difference among the three groups after2weeks of treating (P>0.017). After4weeks of treating, the test group for life quality was better than the acupuncture group and Tai Chi group (P<0.017), the acupuncture group was better than Tai Chi group in improving the quality of life (P<0.017).4. Self comparison of scores in each group after treatingBy the self comparison of scores in each group after treating, they all had P<0.05. It can be said three groups all had therapeutic effect on insomnia.5. Long term effectBy the comparison between scores after treating and scores after following up, three groups all had P<0.05, it can be said, they all had Long term effect for insomnia treatment.By the comparison among three groups with the scores after following up, the test group was better than the acupuncture group in all ways (P<0.017), and better than Tai Chi group in PSQI score (P<0.017), but there was no significant difference in improving depression, anxiety and quality of life between the test group and Tai Chi group (P>0.017). The Tai Chi group was better than the acupuncture group in improving depression, anxiety and quality of life (P<0.017), and there was no significant difference in PSQI score between them (P>0.017).GonelusionAcupuncture combined with Tai Chi has clinical curative effect and long-term effect of treating for insomnia, better than simple acupuncture and simple Tai Chi exercise. Tai Chi exercise has a certain improving effect for insomnia. It can improve insomnia patients’s depression, anxiety and quality of life, and strengthen clinical therapeutic effect of acupuncture.更多还原