神门、三阴交穴位配伍改善失眠症患者焦虑、抑郁状态:随机对照研究

Combined use of Shenmen(HT 7)and Sanyinjiao(SP 6)to improve the anxiety and depression in patients with insomnia:a randomized controlled trial

目的:观察电针神门、三阴交对失眠症患者焦虑、抑郁状态的影响,并探索其配伍效应的作用机制。方法:将90例失眠症患者随机分为配伍组、神门组和三阴交组,每组30例,并进一步筛选出37例焦虑状态患者(配伍组12例、神门组13例、三阴交组12例)和42例抑郁状态患者(配伍组14例、神门组14例、三阴交组14例)。配伍组、神门组、三阴交组分别予电针神门-三阴交、神门单穴及三阴交单穴,疏密波,频率5 Hz/25 Hz,治疗每次30 min,每天1次,连续治疗5 d为一疗程,共治疗2个疗程。分别于治疗前后评定各组患者失眠严重程度指数(ISI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分,检测血清多巴胺(DA)和去甲肾上腺素(NE)含量。结果:与治疗前比较,治疗后3组患者ISI、SAS、SDS评分均降低(P<0.05),配伍组ISI评分低于神门组(P<0.05)。治疗后,3组失眠症焦虑状态患者ISI、SAS评分及血清DA含量均较治疗前下降(P<0.05),配伍组、神门组患者血清NE较治疗前下降(P<0.05);配伍组、神门组患者SAS评分、血清NE含量及配伍组ISI评分低于三阴交组(P<0.05)。治疗后,3组失眠症抑郁状态患者ISI、SDS评分及血清DA含量均较治疗前下降(P<0.05),神门组、配伍组患者血清NE含量较治疗前下降(P<0.05);配伍组ISI评分、SDS评分、血清NE含量及神门组SDS评分均低于三阴交组(P<0.05)。结论:电针神门-三阴交较电针三阴交单穴在改善失眠程度及焦虑、抑郁状态方面具有优势,神门在改善焦虑、抑郁方面起主要作用,神门-三阴交可能通过降低患者血清NE水平发挥调神安眠的穴位配伍效应。

Objective To observe the effect of electroacupuncture(EA)at Shenmen(HT 7)and Sanyinjiao(SP 6)on anxiety and depression in patients with insomnia,and to explore the mechanism of its compatibility effect.Methods Ninety patients of insomnia were randomly divided into a combination group,a Shenmen group and a Sanyinjiao group,30 cases in each group.In addition,37 cases with anxiety(12 cases in the combination group,13 cases in the Shenmen group and 12 cases in the Sanyinjiao group)and 42 cases with depression(14 cases in the combination group,14 cases in the Shenmen group and 14 cases in the Sanyinjiao group)were identified.The patients in the combination group,Shenmen group and Sanyinjiao group were treated with EA(dilatational wave,frequency of 5 Hz/25 Hz)at Shenmen(HT 7)-Sanyinjiao(SP 6),Shenmen(HT 7)and Sanyinjiao(SP 6),respectively,30 min each treatment,once a day.The consecutive 5 days of treatments were taken as a course of treatment,and 2 courses of treatment were given.The insomnia severity index(ISI),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores were evaluated before and after treatment,and the serum contents of dopamine(DA)and norepinephrine(NE)were measured.Results Compared before treatment,the ISI,SAS and SDS scores in the three groups were all decreased after treatment(P<0.05),and the ISI score in the combination group was lower than that in the Shenmen group(P<0.05).Among the patients with anxiety,compared before treatment,the ISI,SAS scores and serum contents of DA were all decreased after treatment in the three groups(P<0.05),and the serum contents of NE in the combination group and Shenmen group were decreased after treatment(P<0.05);the SAS score and serum contents of NE in the combination group and Shenmen group as well as the ISI score in the combination group were lower than those in the Sanyinjiao group(P<0.05).Among the patients with depression,compared before treatment,the ISI,SDS scores and serum contents of DA were all decreased after treatment in the three groups(P<0.05),and the serum contents of NE in the combination group and Shenmen group were decreased after treatment(P<0.05);the ISI,SDS scores and serum contents of NE in the combination group as well as SDS score in the Shenmen group were lower than those in the Sanyinjiao group(P<0.05).Conclusion EA at Shenmen(HT 7)and Sanyinjiao(SP 6)has advantages over EA at Sanyinjiao(SP 6)on improving insomnia,anxiety and depression.Shenmen(HT 7)plays a major role in improving anxiety and depression.Shenmen(HT 7)and Sanyinjiao(SP 6)may play a compatibility effect of regulating consciousness and sleeping by reducing the level of serum NE.