针刺调神组方对慢性失眠症患者过度觉醒状态的影响

Effect of acupuncture at Tiaoshen acupoints on hyperarousal state in chronic insomnia

目的:观察针刺调神组方治疗慢性失眠症的临床疗效及对过度觉醒状态的影响,并探讨其可能机制。方法:将60例慢性失眠症患者随机分为针刺组(30例,脱落1例)和假针刺组(30例,脱落1例)。两组均予基础睡眠健康宣教。针刺组采用针刺调神组方治疗,穴取百会、神庭、印堂、神门、三阴交;假针刺组采用非有效穴浅刺治疗。两组均隔日治疗1次,每周3次,连续治疗4周。比较两组治疗前后匹兹堡睡眠质量指数量表(PSQI)评分、入睡前觉醒量表(PSAS)评分、过度觉醒量表(HAS)评分及血清γ-氨基丁酸(GABA)含量的变化。结果:与治疗前比较,针刺组治疗后PSQI睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分及总分,PSAS各项评分及总分,HAS评分均下降(P<0.05,P<0.01);假针刺组治疗后PSQI入睡时间、日间功能障碍评分及总分,PSAS认知觉醒评分均下降(P<0.05)。针刺组治疗后PSQI睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分及总分,PSAS各项评分及总分,HAS评分均低于假针刺组(P<0.05,P<0.01)。与治疗前比较,针刺组治疗后血清GABA含量升高(P<0.05),针刺组治疗后血清GABA含量高于假针刺组(P<0.05)。结论:针刺调神组方可明显改善慢性失眠症患者睡眠状况及过度觉醒状态,上调血清GABA含量可能是其机制之一。

Objective To observe the clinical effect of acupuncture at Tiaoshen(regulating the spirit)acupoints on chronic insomnia and hyperarousal state,and explore its possible mechanism.Methods A total of 60 patients with chronic insomnia were randomly divided into an acupuncture group(30 cases,1 case dropped off)and a sham acupuncture group(30 cases,1 cases dropped off).Both groups were given basic sleep health education.The acupuncture group was treated with acupuncture at Tiaoshen acupoints including Baihui(GV 20),Shenting(GV 24),Yintang(GV 29),Shenmen(HT 7)and Sanyinjiao(SP 6).The sham acupuncture group was treated with non-effective point shallow acupuncture.Both groups were treated once every other day,3 times a week for 4 weeks.The Pittsburgh sleep quality index(PSQI)score,pre-sleep arousal scale(PSAS)score,hyperarousal scale(HAS)score,and serum gamma-aminobutyric acid(GABA)level before and after treatment were compared between the two groups.Results Compared before treatment,the sleep quality,time to fall asleep,sleep time,sleep efficiency,sleep disturbance,daytime dysfunction scores and total score of PSQI,various scores and total score of PSAS,and HAS score in the acupuncture group after treatment were decreased(P<0.05,P<0.01);in the sham acupuncture group,the time to fall asleep,daytime dysfunction scores and total score of PSQI,and cognitive arousal score of PSAS after treatment were decreased(P<0.05).After treatment,the sleep quality,time to fall asleep,sleep time,sleep efficiency,sleep disturbance,daytime dysfunction scores and total score of PSQI,various scores and total score of PSAS,and HAS score in the acupuncture group were lower than those in the sham acupuncture group(P<0.05,P<0.01).Compared before treatment,the serum GABA level in the acupuncture group were increased(P<0.05),and the serum GABA level in the acupuncture group was higher than that in the sham acupuncture group after treatment(P<0.05).Conclusions Acupuncture at Tiaoshen acupoints can obviously improve the sleep and hyperarousal state of patients with chronic insomnia,and up-regulating serum GABA content is one of its possible mechanisms.