毫火针留针五心穴联合重复经颅磁刺激治疗卒中后失眠的随机对照研究

A Randomized Controlled Study on Treatment of Post-Stroke Insomnia with Filiform Fire Retaining Needling Wuxin Points Combined with rTMS

目的:观察毫火针留针五心穴联合重复经颅磁刺激(r TMS)治疗缺血性脑卒中后失眠患者的临床疗效以及对血清γ-氨基丁酸(GABA)、5-羟色胺(5-HT)水平的影响。方法:将64例缺血性脑卒中后失眠患者随机分为观察组(32例,脱落2例)与对照组(32例,脱落1例)。两组患者均给予常规内科康复治疗,对照组采用低频重复经颅磁刺激(r TMS)治疗,观察组采用毫火针留针五心穴联合r TMS治疗,疗程均为4周。观察并比较两组患者治疗前、治疗4周后匹兹堡睡眠质量指数(PSQI)、失眠严重程度指数(ISI)、广泛焦虑量表(GAD-7)、汉密尔顿抑郁量表(HAMD-17)、脑卒中专门化生活质量量表(SS-QOL)评分及血清γ-氨基丁酸(GABA)、5-羟色胺(5-HT)水平,并评估两组临床疗效及安全性。结果:与治疗前比较,治疗4周后两组的PSQI、ISI、GAD-7及HAMD-17评分均明显下调,SS-QOL评分及GABA、5-HT水平明显上调,差异具有统计学意义(P<0.05);治疗4周后组间比较,观察组PSQI、ISI、GAD-7、HAMD-17及SS-QOL评分改善程度更大,GABA、5-HT水平提升更明显,差异具有统计学意义(P<0.05)。观察组的临床愈显率76.67%(23/30)及总有效率96.67%(29/30)明显优于对照组愈显率41.94%(13/31)及总有效率80.65%(25/31),差异具有统计学意义(P<0.05)。结论:毫火针留针五心穴联合r TMS能有效改善缺血性脑卒中后失眠患者的睡眠质量,减轻焦虑抑郁程度,提升生活质量,调节神经递质水平,方法简便廉验,临床疗效显著。

Objective:To observe the clinical efficacy of filiform fire retaining needling Wuxin points combined with repetitive transcranial magnetic stimulation(rTMS)in treatment of post-stroke insomnia,and to explore its influence to serum levels of GABA and 5-HT.Methods:64 patients with post-stroke insomnia were randomly divided into the observation group(32 cases,2 cases of loss)and the control group(32 cases,1 case of loss).Both groups were given routine medical rehabilitation;on which basis,the control group was treated with rTMS,and the observation group was treated with filiform fire retaining needling Wuxin points combined with rTMS.The course of treatment was 4 weeks.The scores of PSQI,ISI,GAD-7,HAMD-17 and SS-QOL,as well as the serum levels of GABA and 5-HT were observed and compared between the two groups before the treatment and after 4 weeks of the treatment.The clinical efficacy and safety were evaluated in the two groups.Results:Compared with those before the treatment,the scores of PSQI,ISI,GAD-7 and HAMD-17 were significantly down-regulated,and the score of SS-QOL and the levels of GABA and 5-HT were significantly up-regulated in the two groups after 4 weeks of the treatment(P<0.05);of which the improvements were more significant in the observation group(P<0.05).The clinical cure rate was 76.67%(23/30)and the total effective rate was 96.67%(29/30)in the observation group,which were significantly higher than 41.94%(13/31)and 80.65%(25/31)respectively in the control group(P<0.05).Conclusion:Filiform fire retaining needling Wuxin points combined with rTMS can effectively improve sleep quality of post-stroke insomnia,reduce the degree of anxiety and depression,improve the quality of life,and regulate the level of neurotransmitters.The method is easy to operate and cost-effective,and has a significant clinical efficacy.