基于“胃不和则卧不安”理论探讨“胃十针”对脾胃湿热型失眠症患者睡眠感知的影响

The effect of"ten needles in the stomach"treatment on sleep perception for the patients with spleen-gastric damp-heat insomnia based on the theory of"stomach upset,sleep restlessness"

目的基于"胃不和则卧不安"理论,探讨"胃十针"对脾胃湿热型失眠症患者睡眠感知的影响。方法将符合入选标准的2019年3月-2021年3月石家庄市中医院300例失眠症患者,按随机数字表法分为3组,每组100例。胃十针组给予"胃十针"针刺治疗,安定组口服地西泮片,联合组给予"胃十针"针刺+口服地西泮片。3组均治疗4周。采用匹兹堡睡眠质量指数量表(PSQI)评估患者睡眠质量,症状自评量表(SCL-90)评估患者心理健康程度;采用多次睡眠潜伏期试验(multiple sleep latency test,MSLT)评测患者的平均睡眠潜伏期(mean sleep latency,MSL),采用多导睡眠图(PSG)监测系统监测患者的睡眠效率(SE)、总睡眠时间(TST)、觉醒次数(NWAK)、睡眠潜伏期(SOL)、快速眼动期(REM),计算N1/N2/N3期占TST的百分比;评价临床疗效。结果联合组总有效率为94.0%(94/100)、安定组为77.0%(77/100)、胃十针组为85.0%(85/100),3组比较差异有统计学意义(χ^(2)=11.56,P<0.01)。联合组治疗后日间功能障碍、催眠药物、睡眠障碍、睡眠效率、睡眠时间、入睡时间、睡眠质量评分及总分均低于安定组与胃十针组(F值分别为5.70、3.65、5.23、6.37、3.66、6.19、7.54、6.40,P值均<0.01);SCL-90评分及MSL值均低于安定组与胃十针组(F值分别为8.97、7.53,P值均<0.01)。联合组治疗后NWAK[(1.36±0.87)次比(2.69±1.15)次、(2.11±1.05)次,F=5.88]、SOL[(13.62±5.85)min比(25.06±9.42)min、(19.78±7.63)min,F=6.49]、N1/TST[(5.69±1.09)%比(12.65±2.58)%、(8.49±2.45)%,F=5.13]、N2/TST[(51.07±2.06)%比(58.36±2.18)%、(55.61±2.04)%,F=9.86]值均低于安定组与胃十针组(P<0.01),SE[(90.33±2.89)%比(85.39±2.75)%、(87.53±2.69)%,F=8.36]、TST[(449.32±23.65)min比(421.66±25.33)min、(431.26±25.98)min,F=8.26]、REM/TST[(23.87±4.52)%比(14.52±3.87)%、(18.36±3.25)%,F=5.34]、N3/TST[(18.69±2.02)%比(10.31±1.64)%、(14.89±1.74)%,F=7.69]值均高于安定组与胃十针组(P<0.01)。结论基于"胃不和则卧不安"理论的胃十针具有清利中焦湿热、调节中焦气机升降之效,与地西泮片联用可改善脾胃湿热型失眠症患者心理状态和睡眠质量。

Objective To explore the effect of"ten needles in the stomach"on sleep perception of patients with spleen-gastric damp-heat insomnia based on the theory of"stomach discord,then sleep restlessness",to provide references for clinical diagnosis and treatment.Methods The study subjects were 300 patients with insomnia from the sleep department and outpatient department of Shijiazhuang Traditional Chinese Medicine Hospital.According to the random number method,they were divided into the stomach ten needle group,the diazepam group,and the stomach ten needle plus diazepam group,with 100 in each group.Among them,the stomach ten needles group received"stomach ten needles"acupuncture treatment,the diazepam group was given diazepam therapy,and the stomach ten needles plus diazepam group was given diazepam combined with"stomach ten needles"acupuncture treatment.The Pittsburgh Sleep Quality Index(PSQI)scores,the self-rating disease symptom scale(SCL-90)scores,nighttime polysomnography(PSG)monitoring indicators,and the mean sleep latency(MSL)values were compared before and after treatment in the three groups.The difference in clinical efficacy between the two groups were observed.Results The total effective rate was 94.0%(94/100)in the combined group,77.0%(77/100)in the diazepam group,and 85.0%(85/100)in the stomach ten needle group.There were significant differences among the three groups(χ^(2)=11.56,P<0.01).After treatment,the daytime dysfunction,hypnotic drugs,sleep disturbance,sleep efficiency,sleep time,sleep time,sleep quality score and total score of the combined group were significantly lower than those in the diazepam group and the stomach ten needle group(F=5.70,3.65,5.23,6.37,3.66,6.19,7.54,6.40,all Ps<0.01);The scores of SCL-90 and MSL were significantly lower than those in the diazepam group and stomach ten needle group(F=8.97,7.53,all Ps<0.01).In the combined group,NWAK[(1.36±0.87)times vs.(2.69±1.15)times,(2.11±1.05)times,F=5.88],SOL[(13.62±5.85)min vs.(25.06±9.42)min,(19.78±7.63)min,F=6.49],N1/TST[(5.69±1.09)%vs.(12.65±2.58)%,(8.49±2.45)%,F=5.13],N2/TST[(51.07±102.06)%vs.(58.36±2.18)%,(55.61±2.04)%,F=9.86]were significantly lower than those in the diazepam group and stomach ten needle group(P<0.01),SE[(90.33±2.89)%vs.(85.39±2.75)%,(87.53±2.69)%,F=8.36],TST[(449.32±23.65)min vs.(421.66±25.33)min,(431.26±25.98)min,F=8.26],REM/TST[(23.87±4.52)%vs.(14.52±3.87)%,(18.36±3.25)%,F=5.34],N3/TST[(18.69±2.02)%vs.(10.31±1.64)%,(14.89±1.74)%,F=7.69]were significantly higher than those in the diazepam group and stomach ten needle group(P<0.01).Conclusion Based on the"stomach discord,sleep restlessness"theory,the ten needles on the stomach can treat insomnia and improve psychological state and sleep quality,with the functions of clearing the damp and heat of the middle joker,regulating the lifting and lowering of qi in the middle.