發(fā)布時(shí)間：2018-01-13 11:49

  本文關(guān)鍵詞：擇時(shí)針刺治療中風(fēng)后睡眠倒錯(cuò)的臨床觀察　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 針刺 辰時(shí) 酉時(shí) 中風(fēng)后睡眠倒錯(cuò) 臨床觀察

【摘要】：目的：觀察不同時(shí)間(酉時(shí)、辰時(shí))針刺對(duì)中風(fēng)后睡眠倒錯(cuò)(post-stroke sleep reversal,PSSR)的臨床療效,探討針灸治療PSSR的時(shí)效性問(wèn)題。方法：將60例診斷為PSSR的住院患者按照隨機(jī)數(shù)字表法分為辰時(shí)針刺組和酉時(shí)針刺組,每組30人。在中風(fēng)常規(guī)治療的基礎(chǔ)上,酉時(shí)針刺組予“醒腦開(kāi)竅針?lè)ā庇蠒r(shí)(17：00-19：00)治療,辰時(shí)針刺組予“醒腦開(kāi)竅針?lè)ā背綍r(shí)(7：00-9：00)治療。每天1次,6天為1個(gè)療程,兩個(gè)療程間隔1天,每個(gè)患者治療3個(gè)療程。分別在治療前、3個(gè)療程結(jié)束后采用阿森斯失眠量表(AIS)、匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI)評(píng)價(jià)患者的睡眠情況,用腦卒中患者臨床神經(jīng)功能缺損程度評(píng)分標(biāo)準(zhǔn)(MESSS)評(píng)價(jià)其神經(jīng)功能缺損程度,用漢密爾頓抑郁量表(HAMD)評(píng)價(jià)其抑郁程度。然后分別將各個(gè)量表的評(píng)分進(jìn)行組內(nèi)和組間比較,觀察兩組間的療效差異并進(jìn)行相關(guān)性分析,所有數(shù)據(jù)均使用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果：1.兩組治療前后的MESSS評(píng)分比較 兩組治療后MESSS評(píng)分均較治療前降低,差異皆有統(tǒng)計(jì)學(xué)意義(P0.01),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR患者神經(jīng)功能缺損均有改善。治療后兩組MESSS評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明辰時(shí)針刺和酉時(shí)針刺對(duì)PSSR患者的神經(jīng)功能缺損的療效相當(dāng)。2.兩組治療后神經(jīng)功能缺損療效比較 酉時(shí)針刺組治愈、顯效、有效、無(wú)效分別為0例、8例、21例、1例,愈顯率和總有效率分別為26.67%、96.7%；辰時(shí)針刺組治愈、顯效、有效、無(wú)效分別為0例、6例、22例、2例,愈顯率和總有效率分別為20.00%、93.33%。兩組神經(jīng)功能缺損愈顯率、總有效率的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR患者神經(jīng)功能缺損的療效相當(dāng)。3.兩組治療前后AIS評(píng)分比較 兩組治療后的AIS評(píng)分較治療前均下降,差異皆有統(tǒng)計(jì)學(xué)意義(P0.01),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR均有改善。治療后西時(shí)針刺組AIS評(píng)分比辰時(shí)針刺組顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01),表明酉時(shí)針刺對(duì)PSSR的療效優(yōu)于辰時(shí)針刺。4.兩組治療前后PSQI評(píng)分比較 兩組治療后PSQI評(píng)分均較治療前降低,差異皆有統(tǒng)計(jì)學(xué)意義(P0.01),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR均有改善。治療后酉時(shí)針刺組PSQI評(píng)分較辰時(shí)針刺組顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01),表明酉時(shí)針刺對(duì)PSSR的療效優(yōu)于辰時(shí)針刺。5.兩組治療前后PSQI量表6項(xiàng)因子評(píng)分比較 兩組治療后的PSQI量表6項(xiàng)因子評(píng)分皆較治療前降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.01),說(shuō)明酉時(shí)針刺和辰時(shí)針刺皆能有效降低PSSR患者的PSQI量表6項(xiàng)因子評(píng)分。治療后兩組主觀睡眠質(zhì)量、睡眠障礙及日間功能評(píng)分的差異皆無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),說(shuō)明辰時(shí)針刺和酉時(shí)針刺對(duì)PSSR患者的主觀睡眠質(zhì)量、睡眠障礙、日間功能的改善效果相當(dāng)。治療后酉時(shí)針刺組的入睡時(shí)間、睡眠時(shí)間及睡眠效率評(píng)分比辰時(shí)針刺組顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.01),提示西時(shí)針刺對(duì)于PSSR患者的入睡時(shí)間、睡眠時(shí)間、睡眠效率的改善優(yōu)于辰時(shí)針刺。6.兩組治療后睡眠倒錯(cuò)療效比較西時(shí)針刺組治愈、顯效、有效、無(wú)效分別為4例、19例、6例、1例,愈顯率和總有效率分別為76.67%、96.7%；辰時(shí)針刺組治愈、顯效、有效、無(wú)效分別為2例、12例、14例、2例,愈顯率和總有效率分別為46.67%、93.33%。兩組睡眠倒錯(cuò)的總有效率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但愈顯率差異有統(tǒng)計(jì)學(xué)意義(P0.05),表明西時(shí)針刺治療PSSR優(yōu)于辰時(shí)針刺。7.兩組治療前后的HAMD評(píng)分比較兩組治療后HAMD評(píng)分較治療前均降低,差異皆有統(tǒng)計(jì)學(xué)意義(P0.05),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR患者的抑郁程度均有改善。治療后兩組的HAMD評(píng)分的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。表明辰時(shí)針刺和西時(shí)針刺對(duì)PSSR患者抑郁的療效相當(dāng)。8.兩組治療后抑郁程度療效比較 酉時(shí)針刺組治愈、顯效、有效、無(wú)效分別為2例、9例、18例、1例,愈顯率和總有效率分別為36.67%、96.67%；辰時(shí)針刺組治愈、顯效、有效、無(wú)效分別為2例、6例、19例、3例,愈顯率和總有效率分別為26.67%、90.00%。兩組抑郁的總有效率、愈顯率差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),表明酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR患者抑郁的療效相當(dāng)。結(jié)論：1.酉時(shí)針刺治療PSSR較辰時(shí)針刺療效佳,酉時(shí)針刺更能有效改善PSSR患者的入睡時(shí)間、睡眠時(shí)間和睡眠效率。2.酉時(shí)針刺和辰時(shí)針刺對(duì)PSSR患者的神經(jīng)功能缺損和抑郁癥狀的療效相當(dāng)。
[Abstract]:Objective: To observe the effect of different time (Shi, Chen Shi) Acupuncture on post-stroke sleep perversion (post-stroke sleep reversal, PSSR) the clinical curative effect of prescription of acupuncture in the treatment of PSSR. Methods: 60 cases of hospitalized patients with PSSR were randomly divided into acupuncture group and Shi Chen hand acupuncture group. Each group of 30 people. On the basis of the routine treatment of stroke, when "XNKQ acupuncture group was given acupuncture treatment period (17:00-19:00), on the acupuncture group was treated with" XNKQ acupuncture "Chenshi (7:00-9:00) treatment. 1 times a day, 6 days for 1 courses, two courses, 1 days interval, 3 courses of treatment each of the patients. Respectively before treatment, 3 months after the Assens Insomnia Scale (AIS), Pittsburgh sleep quality index scale (PSQI) to evaluate the sleep situation of the patients, patients with stroke clinical nerve function defect degree standard for evaluation (MESSS). The price of the degree of neurological deficits, with Hamilton Depression Scale (HAMD) to evaluate the degree of depression. Then each scale scores were compared between and within groups, respectively, to observe the curative effect and the difference between the two groups and the correlation analysis, all data are used SPSS17.0 software for statistical analysis. Results: reduce around 1. two groups of treatment MESSS score of two groups were compared after treatment MESSS score was significantly higher than before treatment, the difference has statistical significance (P0.01), showed that when acupuncture and acupuncture on the neural function of patients with PSSR on improvee. There was no significant difference of MESSS scores of the two groups after treatment (P0.05), acupuncture and acupuncture nerve when that day the function defect of PSSR patients of the two groups after treatment.2. efficacy of nerve function defect and compare the curative effects of unitary needling group were cured, markedly effective, effective and invalid were 0 cases, 8 cases, 21 cases, 1 cases markedly effective rate and The total effective rate were 26.67%, 96.7%; Chen Shi acupuncture group cured, markedly effective, effective and invalid were 0 cases, 6 cases, 22 cases, 2 cases markedly effective rate and total effective rate were 20% 93.33%., two groups of nerve function defect rate, the total efficiency of the differences were not statistically significant (P0.05), showed that when the curative effect before and after acupuncture and acupuncture on nerve function in patients with PSSR on the defect of quite.3. treatment in the two groups of AIS score between the two groups after treatment than before treatment AIS score decreased, the difference has statistical significance (P0.01), showed that when acupuncture and acupuncture on PSSR were improved. On the west after needling treatment group AIS score than Chen needling group was significantly decreased, the difference was statistically significant (P0.01), showed better efficacy when acupuncture on PSSR in Chen PSQI score before and after acupuncture treatment in the two groups of.4. after treatment between the two groups PSQI scores were lower, the difference has statistical significance Yi (P0.01), showed that when acupuncture and Chenshi acupuncture on PSSR were improved. After treatment, the PSQI score was unitary needling group Calvin needling group was significantly decreased, the difference was statistically significant (P0.01), showed better efficacy when acupuncture on PSSR in PSQI scale 6 factors before and after acupuncture treatment in the two groups of.5. score Calvin two groups were compared after treatment of PSQI scale scores of 6 factors are lower than before treatment, the differences were statistically significant (P0.01), acupuncture and acupuncture is that when Chen Shi can effectively reduce PSSR in patients with PSQI scale scores of 6 factors. The two groups after treatment of subjective sleep quality, sleep disturbance and daytime function score no statistically significant difference (P0.05), that when acupuncture and acupuncture on subjective sleep quality, sleep disorder of PSSR patients, a daytime function improvement effect. After the treatment of needling group unitary sleep time, sleep time and sleep efficiency. Chen than needling group was significantly decreased, the difference was statistically significant (P0.01), suggesting that Western acupuncture for patients with PSSR sleep time, sleep time, sleep efficiency improvement is better than Chen acupuncture group after treatment.6. two perversion of sleep efficacy of West acupuncture group were cured, markedly effective, effective and invalid were 4 cases, 19 cases, 6 cases, 1 cases markedly effective rate and total effective rate were 76.67%, 96.7%; Chen Shi acupuncture group cured, markedly effective, effective and invalid were 2 cases, 12 cases, 14 cases, 2 cases markedly effective rate and total effective rate was 46.67%, two groups of 93.33%. sleep wrong there was no significant difference in efficiency (P0.05), but the cure rate difference was statistically significant (P0.05), indicating that the west when the acupuncture treatment of PSSR is superior to.7. when Chen before and after acupuncture treatment in the two groups of HAMD score between the two groups after treatment than before treatment HAMD score were decreased, the difference has statistical significance (P0.05), that when acupuncture and On the acupuncture on PSSR patients with depression were improved. No statistically significant differences between the two groups of HAMD score after treatment (P0.05). When the degree of depression that Chen and the west when the efficacy of Acupuncture Acupuncture on depression in patients with PSSR.8. comparable efficacy after treatment between two groups of unitary needling group were cured, markedly effective, effective and ineffective. In 2 cases, 9 cases, 18 cases, 1 cases markedly effective rate and total effective rate were 36.67%, 96.67%; Chen Shi acupuncture group cured, markedly effective, effective and invalid were 2 cases, 6 cases, 19 cases, 3 cases markedly effective rate and total effective rate was 26.67%, total efficiency 90.00%. two group depression rate, there were no significant differences (P0.05), showed that the curative effect is when acupuncture and acupuncture on depression Chenshi PSSR patients. Conclusion: 1. when PSSR is Chen acupuncture needling acupuncture curative effect is good, you can more effectively improve PSSR patients' sleep time, sleep time and sleep efficiency.2 Equal effect when acupuncture and acupuncture on patients with PSSR on neurological deficits and depressive symptoms.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.6

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7 甘肅省岷縣堡子衛(wèi)生院 周永紅;針刺可緩解闌尾術(shù)后疼痛[N];中國(guó)中醫(yī)藥報(bào);2012年

8 王改花;針刺一穴治咳嗽[N];農(nóng)村醫(yī)藥報(bào)（漢）;2007年

9 中國(guó)工程院院士 國(guó)醫(yī)大師 天津中醫(yī)藥大學(xué)教授 石學(xué)敏 本報(bào)記者 胡彬 實(shí)習(xí)記者 趙維婷 整理;針刺降壓有優(yōu)勢(shì)[N];中國(guó)中醫(yī)藥報(bào);2014年

10 鄭健剛；杜元灝；石學(xué)敏;針刺能增加腦缺血大鼠腦血流量[N];中國(guó)醫(yī)藥報(bào);2005年

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