不同穴位组合对女性更年期失眠症的疗效比较：随机对照研究

Efficacy comparison of different points combination in the treatment of menopausal insomnia: a randomized controlled trial

目的:评价不同穴位组合针刺对女性更年期失眠症的疗效差异。方法:将女性更年期失眠症患者96例随机分为3组,交通心肾组(32例)取穴心俞、肾俞、四神聪、神门、三阴交;针刺跷脉组(32例)取穴照海、交信、申脉、仆参;耳穴刺激组(32例)取穴耳神门及耳迷走神经分布区敏感点,6天为一疗程,各组针刺4个疗程结束治疗。分别于治疗前后采用多导睡眠图(PSG)监测法和匹兹堡睡眠质量指数(PSQI)量表法对失眠改善情况进行评估。结果:3组患者治疗后睡眠潜伏期(SL)、快波睡眠潜伏期(RL)以及睡眠效率(SE)均有显著改善,差异有统计学意义(P<0.05,P<0.01)。耳穴刺激组SL[(40.08±16.54)min]和觉醒次数AT[(4.87±2.64)次]较其他两组[SL(50.36±18.47)min、(54.87±20.92)min,AT(5.98±2.11)次、(6.13±3.04)次]显著改善(均P<0.05),慢波睡眠的S3+4比例也显著高于其他两组(均P<0.05);匹兹堡睡眠质量指数显示,耳穴刺激组睡眠质量(0.78±0.12)显著优于针刺跷脉组(1.32±0.29),而总积分(4.34±1.43)则显著优于交通心肾组(7.48±3.09);耳穴刺激组愈显率[68.8%(22/32)]显著高于交通心肾组[53.1%(17/32)](均P<0.05)。结论:耳穴刺激比交通心肾针法和针刺跷脉法疗效更优,值得临床推广。

Objective To compare the efficacy of different points combination in the treatment of menopausal insom- nia. Methods Ninety-six cases of menopausal insomnia were randomized into 3 groups, Xinshu （BL 15 ）, Shenshu （BL 23）, Sishencong （EX-HN 1）, Shenmen （HT 7）, Sanyinjiao （SP 6） were chosen in the restore interaction between the heart and the kidney group （group A, 32 cases） ; Zhaohai （KI 6）, Jiaoxin （KI 8）, Shenmai （BL 62）, Pucan （BL 61） were chosen in the acupuncturing qiao mai group （group B, 32 cases） ; auricular Shenmen （TF4） and sensitive spot at the distribution area of auricular vagus nervus were chosen in the ear acupuncture group （group C, 32 cases）. Six days made one session and the treatments were finished after 4 courses. The polysomnography （PSG） and Pittsburgh sleep quality index （PSQI） were employed before and after treatment to evaluate the alleviation of insomnia. Results The parameters of the sleep latency （SL）, rapid wave sleep latency （RL） and sleep efficiency （SE） were significantly improved in the three groups, and the differences were statistically significant （P〈0.05, P〈0.01）. The SL and awaking time （AT） in group C [SL（40.08±16.54） min and AT （4.87±2.64） times] were significantly superior to those in the other two groups [SL（50.36±18.47）min, （54. 87±20.92） min, AT （5. 98±2.11） times, （6.13±3.04） times, all P〈0.05]. The S3＋4 （%） in group C was also significantly higher than those in the other two groups （both P〈0.05）. It was indicated by PSQI that the sleep quality of group C （0.78±0.12）was significantly superior to that in group B （1.32±0.29）, the total score and cured and markedly effective rate in group C [ （4.34±1.43）, 68.8 % （22/32） ] were superior to those in group A [（7.48±3.09）, 53.1% （17/32）, both P〈0.05]. Conclusion Ear acupuncture has a better curative effect than the restore interaction between the heart and the kidney group and aeupuncturing qiao mai group, it is worth of being promoted.