针刺与艾司唑仑对慢性失眠患者情景记忆及睡眠结构的影响:随机对照研究

Effect of acupuncture and estazolam on episodic memory and sleep structure in patients with chronic insomnia disorder: a randomized controlled trial

目的:比较针刺与艾司唑仑治疗慢性失眠(CID)患者的疗效及对情景记忆和睡眠结构的影响。方法:将140例CID患者随机分为经穴组(46例,脱落1例)、非经非穴组(47例,脱落2例)和药物组(47例,脱落2例)。经穴组穴取百会、神门、三阴交、照海、申脉,行常规针刺;非经非穴组选取非经非穴点,操作同经穴组,均每日1次,治疗4周。药物组口服艾司唑仑片,每晚1~2 mg,连续治疗4周。观察各组治疗前后失眠严重指数量表(ISI)评分、听觉词语记忆测验(AVMT)评分及睡眠结构相关指标[总睡眠时间(TST)、睡眠潜伏期(SOL)、入睡后清醒时间(WASO)、睡眠效率(SE),非快速眼动1、2、3期(N1、N2、N3)和快速眼动期(REM)时间占TST的百分比]的变化。结果:治疗后,经穴组、药物组ISI评分降低(P<0.01),且经穴组低于药物组与非经非穴组(P<0.01),药物组低于非经非穴组(P<0.01)。治疗后,经穴组、药物组AVMT即刻记忆、短延迟回忆、长延迟回忆、延迟再认各项评分均升高(P<0.01,P<0.05),且经穴组AVMT各项评分均高于药物组与非经非穴组(P<0.01,P<0.05),药物组即刻记忆、延迟再认方面评分高于非经非穴组(P<0.01)。治疗后,经穴组、药物组SOL、WASO及N1%值均降低(P<0.01),TST、SE及N3%、REM%值均升高(P<0.01,P<0.05),经穴组N2%值亦降低(P<0.01);治疗后,经穴组N1%、N2%值低于药物组(P<0.01),N3%、REM%值高于药物组(P<0.01);治疗后,经穴组与药物组TST、SE、N3%值高于非经非穴组(P<0.01,P<0.05),SOL、WASO、N1%值低于非经非穴组(P<0.01),经穴组REM%值亦高于非经非穴组(P<0.01)、N2%值亦低于非经非穴组(P<0.01)。结论:针刺较艾司唑仑治疗能更好地改善CID患者的睡眠质量、情景记忆功能,其机制可能与针刺调节CID患者的睡眠结构有关。

Objective To compare the effect on chronic insomnia disorder(CID)and influences on episodic memory and sleep structure between acupuncture and estazolam tablets.Methods A total of 140 CID patients were randomized into a meridian-point group(46 cases,1 case dropped off),a non-meridian-and-non-acupoint group(47 cases,2 cases dropped off)and a medication group(47 cases,2 cases dropped off).In the meridian-point group,Baihui(GV 20),Shenmen(HT 7),Sanyinjiao(SP 6),Zhaohai(KI 6)and Shenmai(BL 62)were selected and the routine acupuncture was applied.In the non-meridian-and-non-acupoint group,the needling technique was same as the meridian-point group.Acupuncture was given once daily for 4 weeks in the above two groups.In the medication group,estazolam tablets were administered orally,taken 1 to 2 mg per night,consecutively for 4 weeks.Before and after treatment,the changes in the following indexes were observed in each group,i.e.the score of insomnia severity index(ISI),the score of auditory verbal memory test(AVMT)and the relevant indexes of sleep structure[total sleep time(TST),sleep onset latency(SOL),wake after sleep onset(WASO),sleep efficiency(SE)and the percentage of non rapid eye movement phase 1,2 and 3(N1,N2 and N3)and rapid eye movement time(REM)in TST].Results After treatment,ISI scores were reduced in the meridian-point group and the medication group(P<0.01),the score in the meridian-point group was lower than the medication group and the non-meridian-and-nonacupoint group respectively(P<0.01)and that in the medication group was lower than the non-meridian-and-non-acupoint group(P<0.01).After treatment,the score of each of immediate recall,short-term delayed recall,long-term delayed recall and delayed recognition of AVMT was increased in the meridian-point group and the medication group respectively(P<0.01,P<0.05)and the score of each item of AVMT in the meridian-point group was higher than the medication group and the non-meridian-and-non-acupoint group respectively(P<0.01,P<0.05).The scores of immediate memory and delayed recognition in the medication group were higher than the non-meridian-and-non-acupoint group respectively(P<0.01).After treatment,SOL,WASO and N1%were all reduced(P<0.01)and TST,SE,N3%and REM%were all increased(P<0.01,P<0.05)in the meridian-point group and the medication group,N2%in the meridian-point group was reduced(P<0.01).After treatment,N1%and N2%in the meridian-point group were lower than the medication group(P<0.01)and N3%and REM%were higher than the medication group(P<0.01).After treatment,TST,SE and N3%in the meridian-point group and the medication group were all higher than the non-meridian-and-non-acupoint group respectively(P<0.01,P<0.05)and SOL,WASO and N1%were lower than the non-meridian-and-non-acupoint group respectively(P<0.01).REM%in the meridian-point group was also higher than the non-meridion-and-non-acupoint group(P<0.01),and N2%in the meridian-point group was also lower than the non-meridian-and-non-acupoint group(P<0.01).Conclusion Compared with estazolam,acupuncture much better improves sleep quality and episodic memory in patients with chronic insomnia disorder,which is possibly related to the regulation of sleep structure of patients in treatment with acupuncture.