针刺调理阴阳跷脉联合百会穴压灸治疗心脾两虚型失眠的效果观察

Observation on effect of acupuncture regulating Yin Yang qiaomai combined with Baihui acupoint pressure moxibustion in treatment of heart and spleen both deficiency type insomnia

目的研究针刺调理阴阳跷脉联合百会穴压灸治疗心脾两虚型失眠的效果。方法选择黑龙江省中医药科学院2021年9月至2023年4月收治的心脾两虚型失眠患者80例作为研究对象,根据治疗方法不同分为西药组和中医组,每组40例。西药组采取常规西药治疗,中医组在西药组的基础上采取针刺调理阴阳跷脉联合百会穴压灸。比较两组的总有效率、不良反应、中医证候积分、匹兹堡睡眠质量指数(PSQI)评分、脑动脉血流速度、睡眠潜伏时长(SOL)、觉醒时长(WASO)、睡眠总时长(TST)及丙二醛(MDA)、同型半胱氨酸(Hcy)、谷胱甘肽过氧化物酶(GSH-Px)水平。结果中医组总有效率为90.00%,高于西药组的72.50%(P<0.05)。治疗前,两组心悸健忘、失眠多梦、四肢倦怠、头晕目眩、神疲食少各项中医证候积分比较,差异均无统计学意义(P>0.05);治疗后中医组心悸健忘、失眠多梦、四肢倦怠、头晕目眩、神疲食少各项中医证候积分均低于西药组(P<0.05)。治疗前,两组PSQI各项评分比较,差异均无统计学意义(P>0.05);治疗后中医组PSQI各项评分均低于西药组(P<0.05)。治疗前,两组大脑中动脉、前动脉、后动脉的血流速度比较,差异均无统计学意义(P>0.05);治疗后中医组大脑中动脉、前动脉、后动脉的血流速度均大于西药组(P<0.05)。治疗前,两组SOL、WASO、TST比较,差异均无统计学意义(P>0.05);治疗后中医组SOL、WASO均低于西药组,TST高于西药组,差异均有统计学意义(P<0.05)。中医组不良反应发生率(7.50%)与西药组(20.00%)相比,差异无统计学意义(P>0.05)。治疗前,两组MDA、Hcy、GSH-Px水平比较,差异均无统计学意义(P>0.05);治疗后中医组MDA、Hcy水平均低于西药组,GSH-Px水平高于西药组,差异均有统计学意义(P<0.05)。结论针刺调理阴阳跷脉联合百会穴压灸治疗心脾两虚型失眠的效果更为理想,可促进患者症状快速消失,并改善其睡眠情况,使其脑动脉血流速度恢复,不良反应少,同时减轻氧化应激反应,值得临床推广使用。

Objective To study the effect of acupuncture regulating the Yin Yang Qiaomai combined with Baihui acupoint pressure moxibustion in the treatment of heart and spleen both deficiency type insomnia.Methods Eighty patients with heart and spleen both deficiency type insomnia admitted and treated in Heilongjiang Provincial Academy of Traditional Chinese Medicine Sciences from September 2021 to April 2023 were selected as the research subjects.They were divided into the Western medicine group and Chinese medicine group according to different treatment methods,40 cases in each group.The Western medicine group adopted the conventional Western medicine,while the Chinese medicine group adopted acupuncture to regulate the Yin Yang Qiaomai combined with Baihui acupoint pressure moxibustion on the basis of the Western medicine group.The total effective rate,adverse reactions,traditional Chinese medicine syndrome score,Pittsburgh Sleep Quality Index(PSQI)score,cerebral artery blood flow velocity,sleep latency duration(SOL),wakefulness duration(WASO),total sleep duration(TST),malondialdehyde(MDA),homocysteine(Hcy)and glutathione peroxidase(GSH Px)levels were compared between two groups.Results The total effective rate in the traditional Chinese medicine group was 90.00%,which was higher than 72.50%in the Western medicine group′s(P<0.05).Before treatment,there was no statistically significant difference in the scores of traditional Chinese medicine syndromes such as palpitations,forgetfulness,insomnia,excessive dreaming,limb fatigue,dizziness,and lack of appetite between the two groups;after treatment,the scores of various traditional Chinese medicine syndromes such as palpitations,forgetfulness,insomnia,excessive dreaming,limb fatigue,dizziness,and lack of appetite in the traditional Chinese medicine group were lower than those in the western medicine group(P<0.05).Before treatment,there was no statistically significant difference in the scores of PSQI various items between the two groups(P>0.05);after treatment,the scores of PSQI various items in the traditional Chinese medicine group were lower than those in the Western medicine group(P<0.05).Before treatment,there was no statistically significant difference in the blood flow velocities of middle cerebral artery,anterior cerebral artery and posterior cerebral artery between the two groups(P>0.05);after treatment,the blood flow velocities of the middle cerebral artery,anterior cerebral artery and posterior cerebral artery in the traditional Chinese medicine group were higher than those in the Western medicine group(P<0.05).Before treatment,there was no statistically significant difference in SOL,WASO and TST between the two groups(P>0.05);after treatment,SOL and WASO in the traditional Chinese medicine group were lower than those in the Western medicine group,but TST was higher than that in the Western medicine group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence rate of adverse reactions between the traditional Chinese medicine group and the Western medicine group(7.50%vs.20.00%,P>0.05).Before treatment,there was no statistically significant difference in the MDA,Hcy and GSH-Px levels between the two groups(P>0.05);after treatment,the MDA and Hcy levels in the traditional Chinese medicine group were lower than those in the Western medicine group,while the GSH Px level was higher than that in the Western medicine group,and the differences were statistically significant(P<0.05).Conclusion The acupuncture regulating Yin Yang Qiaomai combined with Baihui acupoint pressure moxibustion in the treatment of heart and spleen both deficiency type insomnia has a more ideal effect,which could promote the rapid disappearance of symptoms in the patients,improve the sleep conditions,restore the cerebral artery blood flow velocity,reduce the adverse reactions,meanwhile alleviate the oxidative stress reactions.It is worth promoting.