基于PSG探析针刺联合耳穴压豆治疗肝脾不和型原发性失眠临床疗效

Clinical Efficacy of PSG-based Exploration of Acupuncture Combined with Auricular Pressure Bean in the Treatment of Primary Insomnia of Liver-Spleen Disharmony Type

目的应用多导睡眠监测仪探析针刺联合耳穴压豆治疗肝脾不和型失眠的临床疗效。方法将216例肝脾不和型失眠的患者随机分为针刺组、耳穴压豆组、联合组,每组各72例。针刺组选神门、安眠、百会等穴针刺,耳穴压豆组选心、交感、神门、皮质下等耳穴压豆,联合组为针刺及耳穴压豆方法联合使用。4周后,观察3组治疗前后在临床疗效、中医证候评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分、焦虑自评量表(selfrating anxiety scale,SAS)评分、抑郁自评量表(self-rating depression scale,SDS)评分、多导睡眠监测结果等方面的变化。结果(1)治疗后,3组患者中医证候评分较治疗前均明显改善,且联合组优于针刺组和耳穴压豆组,差异有统计学意义(P<0.05)。(2)治疗后,3组患者PSQI评分较治疗前均明显改善,差异有统计学意义(P<0.05),且联合组优于针刺组和耳穴压豆组,差异有统计学意义(P<0.05)。(3)治疗后,3组患者SAS评分、SDS评分较治疗前均明显改善,差异有统计学意义(P<0.05),且联合组改善优于针刺组和耳穴压豆组,差异有统计学意义(P<0.05)。(4)治疗后,3组患者多导睡眠监测结果中总睡眠时间(TST)、睡眠潜伏期(RL)及N1、N3期较治疗前均明显改善,且联合组明显优于针刺组和耳穴压豆组,差异具有统计学意义(P<0.05)。(5)针刺组总有效率77.78%(56/72),耳穴压豆组总有效率79.17%(57/72),联合组总有效率95.83%(69/72),联合组分别与针刺组、耳穴压豆组相比,差异均有统计学意义(P<0.05)。结论针刺联合耳穴压豆能显著提高患者睡眠质量,缓解焦虑、抑郁等情绪,同时又能改善患者肝脾不和的临床症状,为临床治疗肝脾不和型失眠的非药物治疗提供客观、可量化依据。

Objective Through applying polysomnography to explore the clinical efficacy of acupuncture combined with auricular acupoint pressure beans in the treatment of insomnia of liver-spleen disharmony type.Methods 216 patients with insomnia of liver-spleen disharmony type were randomly divided into acupuncture group,auricular acupoint pressure bean group and combined group,with 72 cases in each group.The acupuncture group selected Shenmen(HT7),Anmian and Baihui(DU20)points,the auricular pressure bean group selected heart,sympathetic,Shenmen and subcortical points,and the acupuncture combined with auricular pressure bean group was a combination of the above two groups.After 4 weeks,the changes in clinical efficacy,traditional Chinese medicine(TCM)evidence scores,the Pittsburgh sleep quality index(PSQI)scores,the self-rating anxiety scale(SAS)scores,the self-rating depression scale(SDS)scores,and the results of polysomnography before and after the treatment were observed in the three groups.Results(1)After treatment,the TCM evidence scores of the three groups improved significantly compared with before treatment,and the combined group was higher than the acupuncture group and the auricular acupoint pressure bean group,and the difference was statistically significant(P<0.05).(2)After treatment,the PSQI scores of the three groups improved significantly compared with before treatment,and the difference was statistically significant(P<0.05),and the combined group were higher than acupuncture shoup and auricular acupoint pressure bean group,and the difference was statistically significant(P<0.05).(3)After treatment,SAS scores and SDS scores of patients in the three groups improved significantly compared with before treatment,and the difference was statistically significant(P<0.05),and the combined group were significantly higher than the acupuncture group and the auricular acupoint pressure bean group,and the difference was statistically significant(P<0.05).(4)After treatment,the total sleep time(TST),sleep latency(RL),N1 and N3 stage in polysomnography results of the three groups improved significantly,and the combined group were significantly higher than the acupuncture group and the auricular acupoint pressure bean group,with statistically significant differences(P<0.05).(5)The total effective rate of the acupuncture group was 77.78%(56/72),and the effective rate of the auricular acupoint pressure bean group was 79.17%(57/72),the total effective rate of the combined group was 95.83%(69/72),and the difference between the combined group and the acupuncture group and the auricular pressure bean group,respectively,was statistically significant(P<0.05).Conclusion Acupuncture combined with auricular acupoint pressure beans can significantly improve the sleep quality of patients,relieve anxiety,depression and other emotions,and at the same time improve the clinical symptoms of patients with liver-spleen disharmony type,which provides an objective and quantifiable basis for the clinical treatment of non-pharmacological treatment of liver-spleen disharmony type insomnia.