中药足浴治疗肝郁气滞型脑梗死后失眠临床研究

Clinical Study on Chinese Medicine Foot Bath in Treating Insomnia After Cerebral Infarction Differentiated as Liver Depression and Qi Stagnation Syndrome

【目的】观察柴胡加龙骨牡蛎汤加减方足浴疗法治疗肝郁气滞型脑梗死后失眠患者的临床疗效。【方法】将68例肝郁气滞型脑梗死后失眠患者随机分为试验组和对照组,每组各34例。两组均给予脑梗死及原有慢性疾病治疗,试验组给予柴胡加龙骨牡蛎汤加减方足浴治疗,对照组给予温开水足浴治疗,疗程为7 d。观察2组患者治疗前后中医证候积分、匹兹堡睡眠质量指数(PSQI)评分、美国国立卫生院卒中量表(NIHSS)神经功能缺损评分的变化情况,评价2组患者的睡眠改善疗效。【结果】(1)试验过程中,试验组脱落2例,对照组无脱落病例,最终共66例患者完成试验,其中试验组32例,对照组34例。(2)治疗后,试验组的总有效率为65.6%(21/32),对照组为26.5%(9/34),组间比较(Pearsonχ^(2)检验),试验组的睡眠改善疗效优于对照组,差异有统计学意义(P<0.01)。(3)治疗后,试验组PSQI的睡眠质量、入睡时间、睡眠时间、睡眠效率、催眠药物、日间功能障碍等评分及总分均较治疗前改善(P<0.05),而对照组仅睡眠质量、入睡时间评分及总分较治疗前改善(P<0.05)。组间比较,试验组在改善PSQI的睡眠质量、催眠药物、日间功能障碍评分及总分方面优于对照组,差异均有统计学意义(P<0.05)。(4)治疗后,2组患者NIHSS评分均无明显变化(P>0.05),治疗后组间比较,差异也无统计学意义(P>0.05)。(5)治疗后,试验组的中医证候积分较治疗前明显降低(P<0.01),而对照组无明显变化(P>0.05);治疗后组间比较,试验组对中医证候积分的降低作用明显优于对照组,差异有统计学意义(P<0.05)。【结论】柴胡加龙骨牡蛎汤加减方足浴疗法治疗肝郁气滞型脑梗死后失眠患者疗效确切,能有效改善患者的睡眠状况,减轻患者肝郁气滞状态所引发的临床诸症。

Objective To observe the clinical effect of foot bath with Chaihu Decoction with Longgu and Muli Added in the treatment of insomnia after cerebral infarction differentiated as liver depression and qi stagnation syndrome.Methods Sixty-eight insomnia patients after cerebral infarction differentiated as liver depression and qi stagnation syndrome were randomly divided into the trial group and the control group,and each group had 34 cases.The two groups were given treatment for cerebral infarction and previous chronic diseases.And additioncly,the trial group was given foot bath with Chaihu Decoction with Longgu and Muli Added,and the control group was given foot bath with warm water.The treatment for the two groups lasted for 7 days.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndromes,Pittsburgh sleep quality index(PSQI)scores,and National Institute of Health stroke scale(NIHSS)neurological deficit scores in the two groups were observed for the evaluation of efficacy for the improvement of sleep quality.Results(1)During the trial,2 cases from the trial group while none case from the control group dropped out,and a total of 66 cases(32 cases of the trial group and 34 case of the control group)completed the trial.(2)After treatment,the total effective rate of the trial group was 65.6%(21/32)and that of the control group was 26.5%(9/34).The intergroup comparison by Pearson Chi-square test showed that the efficacy for the improvement of sleep quality in the trial group was superior to that in the control group,and the difference was statistically significant(P<0.01).(3)After treatment,the scores of PSQI items of sleep quality,time for falling asleep,sleep time,sleep efficiency,the usage of hypnotics and daily functional disorders as well as the overall PSQI scores in the trial group were obviously improved(P<0.05),while in the control group,only the item scores of sleep quality and time for falling asleep as well as the overall PSQI scores were obviously improved(P<0.05).The intergroup comparison showed that the trial group had stronger effect on improving the scores of PSQI items of sleep quality,the usage of hypnotics and daily functional disorders as well as the overall PSQI scores than the control group,and the differences were statistically significant(P<0.05).(4)After treatment,no significant difference of NIHSS scores in the two groups was present in comparison with those before treatment(P>0.05).The difference of NIHSS scores between the two groups after treatment was not statistically significant either(P>0.05).(5)After treatment,TCM syndrome scores in the trial group were obviously decreased(P<0.01),while no obvious changes of TCM syndrome scores were shown in the control group in comparison with those before treatment(P>0.05).The intergroup comparison showed that the trial group had stronger effect on decreasing the TCM syndrome scores than the control group,and the differences were statistically significant(P<0.05).Conclusion The clinical effect of foot bath with Chaihu Decoction with Longgu and Muli Added is definite in the treatment of insomnia after cerebral infarction differentiated as liver depression and qi stagnation syndrome.The foot bath therapy can effectively improve the sleep quality of patients and can relieve the clinical manifestations of liver depression and qi stagnation syndrome.