耳穴贴压联合经皮穴位电刺激干预戒烟:随机对照试验

Auricular point sticking combined with transcutaneous electrical acupoint stimulation for smoking cessation:a randomized controlled trial

目的:比较耳穴贴压联合经皮穴位电刺激与尼古丁贴片干预戒烟的临床疗效。方法:将200例自愿戒烟患者随机分为联合组和尼古丁贴片组,每组100例。联合组予耳穴贴压联合经皮穴位电刺激治疗,选取神门、内分泌、皮质下、交感等进行耳穴贴压,隔日1次;于列缺、足三里行经皮穴位电刺激(连续波,频率20Hz,电流强度1 mA),每次30 min,每日1次。尼古丁贴片组给予尼古丁贴片治疗。两组均治疗8周。比较两组患者治疗8周后及治疗后16周随访时点戒断率、持续戒断率;于治疗前、治疗8周后及治疗后16周随访时采用尼古丁依赖检测量表(FTND)评价尼古丁依赖程度;于治疗1周后、治疗8周后及治疗后16周随访时采用明尼苏达尼古丁戒断症状量表(MNWS)评价戒断症状及吸烟渴求程度;评估两组安全性与依从性(脱落率与治疗完成度)。结果:两组患者治疗8周后及随访时点戒断率及持续戒断率比较,差异均无统计学意义(P>0.05)。两组患者治疗8周后及随访时FTND评分均较治疗前降低(P<0.01);随访时,联合组FTND评分低于尼古丁贴片组(P<0.05)。治疗8周后及随访时两组患者MNWS评分均较治疗1周后降低(P<0.05),联合组降低幅度大于尼古丁贴片组(P<0.05,P<0.01)。两组均未出现严重不良反应。治疗8周后及随访时,联合组脱落率均为16.0%(16/100),尼古丁贴片组脱落率分别为20.0%(20/100)和23.0%(23/100),两组比较差异无统计学意义(P>0.05)。联合组治疗完成度与尼古丁贴片组比较,差异无统计学意义(P>0.05)。结论:耳穴贴压联合经皮穴位电刺激可有效降低戒烟患者尼古丁依赖程度,改善烟草戒断症状,疗效优于尼古丁贴片治疗。

Objective To compare the clinical efficacy between auricular point sticking combined with transcutaneous electrical acupoint stimulation(TEAS) and nicotine patch for smoking cessation. Methods Two hundred patients who voluntarily quit smoking were randomly divided into a combination group and a nicotine patch group, 100 cases in each group. In the combination group, auricular point sticking(Shenmen [TF], Neifenmi [CO], Pizhixia [AT], Jiaogan [AH],etc., once every other day) combined with TEAS(Lieque [LU 7] and Zusanli [ST 36], with continuous wave, 20 Hz in frequency, 1 mA in current intensity, 30 min each time, once a day) were applied. In the nicotine patch group, nicotine patch was applied. Both groups were treated for 8 weeks. The immediate withdrawal rate and persistent withdrawal rate 8 weeks into treatment and in follow-up of 16 weeks after treatment in the two groups were compared;before treatment, 8 weeks into treatment and in follow-up of 16 weeks after treatment, the degree of nicotine dependence was evaluated by using Fagerstr?m test for nicotine dependence(FTND);1 week into treatment, 8 weeks into treatment and in follow-up of 16 weeks after treatment, the withdrawal symptoms and smoking craving were evaluated by using Minnesota nicotine withdrawal scale(MNWS);the safety and compliance(dropped off rate and treatment completeness) were evaluated in the two groups. Results There was no statistical significance of the differences in the immediate withdrawal rate and persistent withdrawal rate 8 weeks into treatment and during follow-up between the two groups(P>0.05). The FTND scores were decreased 8 weeks into treatment and during follow-up in the two groups compared with those before treatment(P<0.01);the FTND score during follow-up in the combination group was lower than the nicotine patch group(P<0.05). The MNWS scores were decreased 8weeks into treatment and during follow-up in the two groups compared with those 1 week into treatment(P<0.05);the changes of MNWS scores 8 weeks into treatment and during follow-up in the combination group were greater than the nicotine patch group(P<0.05, P<0.01). There were no serious adverse reactions in either group. Eight weeks into treatment and during follow-up, the dropped off rates were all 16.0%(16/100) in the combination group, which were 20.0%(20/100)and 23.0%(23/100) in the nicotine patch group, there was no statistical significance of the differences in the two groups(P>0.05). There was no significant difference in treatment completeness between the two groups(P>0.05) Conclusion Auricular point sticking combined with TEAS could effective decrease the degree of nicotine dependence, improve withdrawal symptoms in smokers, its effect is superior to nicotine patch.