浅针疗法对精神分裂症睡眠障碍干预:随机对照研究

Sleep disorder of schizophrenia treated with shallow needling:a randomized controlled trial

目的:比较浅针疗法与药物对精神分裂症患者睡眠障碍干预的临床疗效差异。方法:将96例精神分裂症伴睡眠障碍的患者随机分为浅针组和药物组,每组48例(浅针组脱落1例,药物组脱落2例)。两组均口服统一剂量的帕利哌酮片,浅针组取百会、山根穴、额中线为主穴,根据辨证辅以配穴,施以浅针手法治疗,每天1次,每周5次;药物组口服右旋佐匹克隆片治疗,于每晚睡前1次(3mg)。两组均治疗6周,分别于治疗前后以匹兹堡睡眠质量指数(PSQI)评定睡眠状况,治疗前及治疗2、4、6周末采用阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定临床疗效及不良反应,并比较两组临床疗效。结果:治疗后两组PSQI及PANSS总分及各因子分均较前有显著下降(P<0.05,P<0.01),PSQI量表中,浅针组治疗后日间功能障碍因子分较药物组下降更显著(P<0.05),而药物组入睡时间较浅针组下降更显著(P<0.05);在PANSS中,浅针组的病理因子改善优于药物组(P<0.05),而药物组的阳性因子改善优于浅针组(P<0.05);两组PSQI及PANSS总分及其因子分差异均无统计学意义(均P>0.05)。治疗6周末,浅针组愈显率为63.9%(30/47),总有效率为95.8%(45/47);药物组愈显率为58.7%(27/46),总有效率为91.3%(42/46),两组疗效差异无统计学意义(P>0.05)。浅针组TESS评分明显低于药物组(P<0.01,P<0.05)。结论:浅针法辅助治疗精神分裂症睡眠障碍疗效确切,与右旋佐匹克隆相当,改善日间功能障碍与病理因子作用明显,同时无创伤,无疼痛,安全性明显优于药物右旋佐匹克隆。

Objective To compare the clinical effective differences between shallow needling and medication for the sleep disorder of schizophrenia.Methods Ninety-six patients with the sleep disorder of schizophrenia were randomly divided into a shallow needling group and a medication group,48 cases in each one（one case dropping in the shallow needling group and two cases dropping in the medication group）.The same dose paliperidone tablets were adopted in the two groups.In the shallow needling group,the main acupoints were Baihui（GV 20）,Shangenxue（Extra）and Ezhongxian（MS 1）,and the acupoints based on syndrome differentiation were selected.The shallow needling manipulation was used once a day,5times a week.In the medication group,3 mg eszopiclone tablets were prescribed orally before sleep once every night.The patients were treated for 6weeks in the two groups.Sleep condition was evaluated by Pittsburgh sleep quality index（PSQI）before and after treatment,and the clinical efficacy and the adverse reaction were assessed by positive and negative symptoms scale（PANSS）and treatment emergent symptom scale（TESS）before and after 2-week,4-week and 6-week treatment.The clinical effects between the two groups were compared.Results After treatment in the two groups,both the total scores and the each factor score of the PSQI and the PANSS were apparently decreased（P〈0.05,P〈0.01）.As for the PSQI scale,after treatment the daytime dysfunctional score of the shallow needling group was reduced more obviously than that of the medication group（P〈0.05）,and the falling asleep time in the medication group was declined more markedly compared with that in the shallow needling group（P〈0.05）.Regarding the PANSS,the improvement of the pathological factor in the shallow needling group was better than that in the medication group after treatment（P〈0.05）,and the improvement of the positive factor in the medication group was superior to that in the shallow needling group after treatment（P〈0.05）.The total scores and each factor score of the PSQI and the PANSS were not statistically different between the two groups after treatment（P〈0.05）.At the end of the 6th week,the curative and effective rate was 63.9%（30/47）and the total effective rate was 95.8%（45/47）in the shallow needling group;the curative and effective rate was 58.7%（27/46）and the total effective rate was91.3%（42/46）in the medication group.The difference of the effect was not statistically significant between the two groups（P〈0.05）.The scores of TESS in the shallow needling group were lower than those in the medication group（P〈0.01,P〈0.05）.Conclusion The effect of shallow needling for assisting the sleeping disorder of schizophrenia is reliable and it is similar with the efficacy of eszopiclone.Also,the shallow needling can improve the daytime dysfunction and the pathological factor apparently without adverse reaction and pain.Its safety is obviously better than that of eszopiclone.