电针单穴与配伍腧穴治疗原发性失眠的临床疗效观察

Clinical observation on treatment of primary insomnia with electroacupuncture at single point or compatibility of acupoints

目的:观察电针单穴与配伍腧穴治疗原发性失眠的临床疗效差异,为针刺治疗失眠的选穴处方提供科学依据,并为腧穴配伍优效性研究奠定基础。方法:腧穴将符合纳入标准的62例原发性失眠患者随机分为单穴组(30例)与腧穴配伍组(32例),单穴组取神门穴(双),腧穴配伍组取百会穴、神门穴(双)、三阴交穴(双),以阿森斯量表(AIS)为主观指标,脑电超慢涨落图(ET)为客观指标,采集治疗前、治疗后、随访期3个时间点的数据并进行统计分析。结果:AIS评价结果:①单穴组治疗后与治疗前相比,入睡时间、夜间苏醒频次、比期望的时间早醒、总睡眠时间、总睡眠质量及总分的评分降低(P<0.05),随访期与治疗后相比,AIS各因子得分及总分皆无显著差异;②配伍组治疗后与治疗前相比,入睡时间、夜间苏醒频次、比期望的时间早醒、总睡眠时间、总睡眠质量、白天情绪、白天身体功能及总分的评分降低(P<0.05),随访期与治疗后相比,AIS各因子得分及总分皆无显著差异;③治疗后,配伍组与单穴组相比,入睡时间、夜间苏醒频次、总睡眠时间、总睡眠质量、白天情绪状态及身体功能的评分更低(P<0.05),随访期,配伍组与单穴组相比,入睡时间、夜间苏醒频次、总睡眠时间、总睡眠质量、白天情绪状态及身体功能的评分更低(P<0.05)。ET检测结果:①单穴组治疗后与治疗前相比,GABA、Glu升高(P<0.05),DA降低(P<0.05);②配伍组治疗后与治疗前相比,GABA、Glu升高(P<0.05),DA降低(P<0.05);③治疗后,配伍组与单穴组相比,5-HT含量更低(P<0.05)。总体临床疗效比较:单穴组总有效率为76.67%;配伍组总有效率为90.63%,两组有效率存在显著性差异(P<0.05)。结论:针刺单穴与配伍腧穴治疗原发性失眠均有效,但腧穴配伍的临床疗效及远期疗效皆优于单穴。

Objective:To observe the difference of clinical efficacy between electroacupuncture at single acupoint and compatible acupoints in the treatment of primary insomnia,and to provide a scientific basis for acupuncture treatment of insomnia,and to lay a foundation for the study of compatibility of acupoints.Methods:A total of 62 patients with primary insomnia who met the inclusion criteria were randomly divided into single-point group(30 cases)and compatible acupoints group(32 cases).The single-point group was treated with Shenmen acupoint(double),the compatible group was treated with Baihui acupoint,Shenmen acupoint(double),Sanyinjiao acupoint(double).The AIS was used as the subjective index,and the ET was used as objective index to collect data before treatment,after treatment and during follow-up.Results:①The scores of sleep time,wake-up frequency at night,wake-up earlier than expected time,total sleep time,total sleep quality and total score in single-point group decreased after treatment compared with before treatment(P<0.05).There was no significant difference in AIS factor scores and total score during follow-up period compared with after treatment.②After treatment,compared with before treatment,the scores of sleep time,wake-up frequency at night,wake-up earlier than expected,total sleep time,total sleep quality,daytime mood,daytime body function and total score in the compatibility group decreased(P<0.05).During the follow-up period,compared with after treatment,the scores of AIS factors and total score were not significantly different.③After treatment,the scores of sleep time,wake-up frequency at night,total sleep time,total sleep quality,daytime emotional state and physical function in the compatibility group were lower than those in the single-point group(P<0.05).During the follow-up period,the scores of sleep time,wake-up frequency at night,total sleep time,total sleep quality,daytime emotional state and physical function in the compatibility group were lower than those in the single-point group(P<0.05).ET test results:①GABA and Glu increased(P<0.05)and DA decreased(P<0.05)in single point group after treatment compared with before treatment.②After treatment,GABA and Glu increased(P<0.05)and DA decreased(P<0.05)in compatibility group compared with before treatment.③After treatment,the content of5-HT in compatibility group was lower than that in single point group(P<0.05).The total effective rate was 76.67%in the singlepoint group and 90.63%in the compatibility group.There was a significant difference in the effective rate between the two groups(P<0.05).Conclusion:Acupuncture at single acupoint and compatible acupoints are both effective in the treatment of primary insomnia,but the clinical efficacy and long-term efficacy of acupoint compatibility are better than single acupoint.