低阻抗意念导入疗法联合针刺与口服中药治疗心肾不交型慢性失眠症临床研究

Clinical study of TIP technique combined with acupuncture and oral administration of Chinese medicine on chronic insomnia with syndrome of heart-kidney imbalance

目的评价低阻抗意念导入疗法(low resistance thought induction psychotherapy,TIP)联合针刺与口服中药治疗老年心肾不交型慢性失眠症的疗效。方法将符合入选标准的164例心肾不交型慢性失眠症患者采用随机数字表法分为4组,每组41例。对照组给予家庭医生签约+睡眠卫生健康宣教+口服中药干预,观察A组给予家庭医生签约+睡眠卫生健康宣教+口服中药+针刺干预,观察B组给予家庭医生签约+睡眠卫生健康宣教+口服中药+TIP技术干预,观察C组给予家庭医生签约+睡眠卫生健康宣教+口服中药+针刺+TIP技术干预。4组均连续治疗1个月。采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评价睡眠质量,并进行心肾不交证症状评分,评价中医症状疗效与睡眠效率疗效。结果治疗后,观察A组、观察B组、观察C组入睡时间、睡眠效率、睡眠时间、睡眠障碍、日间功能评分均低于对照组(F值分别为44.322、92.808、107.131、79.467、98.638,P值均<0.001),且观察C组低于观察A组、观察B组(P<0.001);心烦、头晕、耳鸣、潮热盗汗、手足心热、健忘、口舌生疮、大便干结评分均低于对照组(F值分别为103.32、135.91、93.35、77.61、57.514、92.283、126.097、53.217,P值均<0.001),且观察C组低于观察A组、观察B组(P<0.01)。观察A组、观察B组、观察C组中医证候总有效率高于对照组(χ^2=16.169,P<0.01),且观察C组高于观察A组、观察B组(χ^2=8.504,P<0.01)。观察A组、观察B组、观察C组睡眠效率总有效率高于对照组(χ^2=14.078,P<0.01),且观察C组高于观察A组、观察B组(χ^2=8.856,P<0.01)。结论TIP技术联合针刺与口服中药可改善老年心肾不交型慢性失眠症患者的睡眠质量,提高疗效。

Objective To evaluate the efficacy of low resistance thought induction psychotherapy(TIP)technique combined with acupuncture and oral Chinese medicine in treating chronic insomnia elderly patients with syndrome of heart-kidney imbalance.Methods One hundred sixty-four chronic insomnia patients with syndrome of heart-kidney imbalance were randomly divided into four groups with 41 cases in each group.The control group was treated with family doctor contract,sleep health education and Tianwang-Buxin decoction as the basic treatment,the group A was treated with acupuncture and the basic treatment,the group B was treated with TIP technique and the basic treatment,the group C was treated with the combination of acupuncture and TIP on the basic treatment.After one month'treatment,scores of Pittsburgh sleep quality index(PSQI)were used to evaluate sleep quality,sleep efficiency,and the clinical efficacy.Results After treatment,scores of sleep time,sleep efficiency,sleep time,sleep disturbance,daytime function of the group A,B,and C were significantly lower than those in the control group(F value were 44.322,92.808,107.131,79.467,98.638 respectively,all Ps<0.001),and the group C were significantly lower than those of the test group A and B(P<0.01).Scores of upset,dizziness,tinnitus,hot flashes,and night sweats,hand foot and heart fever,forgetfulness,sores on the tongue and dry stool of the group A,B,and C were significantly lower than those of the control group(F value were 103.32,135.91,93.35,77.61,57.514,92.283,126.097,53.217,respectively,all Ps<0.001),and the group C were significantly lower than those of the test group A and B(P<0.01).The total clinical efficacy of TCM syndrome and insomnia in group A,B and C was significantly higher than that in the control group(χ^2=16.169,P<0.01),and the group C was significantly higher than the group A and B(χ^2=8.504,P<0.01).The total clinical efficacy of sleep efficiency in group A,B and C was significantly higher than that in the control group(χ^2=14.078,P<0.01),and the group C was significantly higher than the group A and B(χ^2=8.856,P<0.01).Conclusions TIP technique combined with acupuncture and oral Chinese medicine can improve sleep quality of chronic insomnia elderly patients with syndrome of heart-kidney imbalance.