低频电穴位刺激治疗脑卒中后失眠患者的疗效及对血浆多巴胺含量的影响

aThe effect of low-frequency electrical stimulation at acupoints on the plasma DA of stroke survivors with insomnia： A clinical trial

目的 比较低频电穴位刺激与常规西药治疗脑卒中后失眠患者的临床疗效，并探讨其作用机制。 方法 采用随机数字表法将120例脑卒中后失眠患者分为低频电刺激组、药物组及安慰剂组，每组40例。低频电刺激组采用低频脉冲电治疗仪对大椎穴、肾俞穴进行电刺激，每天治疗1次；药物组患者口服艾司唑仑，每次1mg；安慰剂组患者口服淀粉胶囊，每次1粒，均于每晚睡前服用。上述患者均治疗15d为1个疗程。于治疗前、治疗2个疗程后进行临床疗效评定，同时检查上述时间点3组患者血浆多巴胺（DA）含量。 结果 治疗2个疗程后低频电刺激组、药物组及安慰剂组总有效率分别为95.0%（38/40）、92.5%（37/40）和17.9%（7/39），经统计学比较发现低频电刺激组、药物组疗效均明显优于安慰剂组（均P〈0.05），低频电刺激组与药物组疗效组间差异无统计学意义（P〉0.05）。治疗前、后安慰剂组患者血浆DA含量无明显变化（P〉0.05）；治疗后低频电刺激组和药物组血浆DA含量均较治疗前及对照组明显增加（P〈0.05），低频电刺激组与药物组血浆DA含量组间差异无统计学意义（P〉0.05）。 结论 低频电穴位刺激治疗脑卒中后失眠安全有效，其疗效与口服艾司唑仑相当，提高血浆中DA含量可能是其重要作用机制之一。

Objective To compare the therapeutic effect of low-frequency electrical stimulation at the acupoints with that of conventional Western medication among patients with post-stroke insomnia, and explore the underlying mechanism. Methods Totally 120 stroke survivors with insomnia were randomly divided into an intervention group, a medication group and a placebo group, each of 40. The intervention group received low-frequency electrical stimulation at the Dazhui and Shenshu acupoints once a day for 30 consecutive days. The medication group received 1mg estazolam capsules and the placebo group took 1mg starch capsules. The average levels of plasma dopamine （DA） of the 3 groups were compared before and after the intervention and therapeutic efficacy was estimated. Results After the intervention, the total effective rate of the intervention group was 95% （38/40）. For the medication group it was 92.5% （37/40） and for the placebo group it was 17.9% （7/39）. The former two treatments were significantly more effective than no treatment （the placebo）. There was no significant change in the average level of plasma DA before and after the treatment in the placebo group, but significant improvement was observed in the other two groups. There was no significant difference in plasma DA between the two treatment groups after the treatment. Conclusion Low-frequency electrical stimulation at acupoints is safe and equally as effective as estazolam for treating post-stroke insomnia. Both may alleviate post-stroke insomnia by increasing plasma DA levels.