【摘要】：目的:通過觀察通督調(diào)神針刺法治療卒中后失眠的臨床療效和安全性,并與西藥組的治療進(jìn)行對比,為本療法的臨床可行性提供依據(jù)。方法:首先將腦三科門診和病房收入的,符合受試條件的60例卒中后失眠患者,隨機(jī)把他們分為:通督調(diào)神針刺組(治療組30例)與佐匹克隆藥物組(對照組30例)兩組。治療組,針灸一天一次,每次要求留針30分鐘,在留針期間,10分鐘行1次針。如此,連續(xù)治療4周。對照組,要求口服佐匹克隆,每日睡前半小時服用7.5 mg,連續(xù)服用4周。全部患者在治療前后,進(jìn)行匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI)評分和日常生活活動能力(ADL)評分的評定。最后,將這兩種評分的結(jié)果進(jìn)行計(jì)算和對比,比較出兩組的臨床有效率。并且在整個治療過程中,密切觀察治療組和對照組在用藥期間的患者反應(yīng),進(jìn)而比較出這兩種不同的治療方法他們各自的優(yōu)、劣勢。結(jié)果:(1)組內(nèi)對比結(jié)果:從匹茲堡睡眠質(zhì)量量表(PSQI)的評分上看,經(jīng)統(tǒng)計(jì)學(xué)分析,治療后,治療組各因子及總分的評分都較治療前有顯著差異(P0.01);而對照組中僅有入睡時間、睡眠時間、睡眠效率及總分較治療前有顯著差異(P0.01),其中睡眠質(zhì)量和睡眠障礙有統(tǒng)計(jì)學(xué)意義(P0.05),在日間功能方面無統(tǒng)計(jì)學(xué)意義(P0.05)。從整體上看,無論是治療組還是對照組,在治療中風(fēng)后失眠的方法上都是有效的。從日常生活活動能力(ADL)評分的比較看,經(jīng)統(tǒng)計(jì)學(xué)分析,治療后,無論是治療組的總分還是對照組的總分都較治療前有顯著差異(P0.01)。這足以說明兩組的方法對于治療中風(fēng)后后失眠都有顯著效果。(2)治療前后總分進(jìn)行對比:從匹茲堡睡眠質(zhì)量量表(PSQI)評分上看,治療后,治療組的分?jǐn)?shù)比對照組的分?jǐn)?shù)更低,經(jīng)統(tǒng)計(jì)學(xué)分析,具有統(tǒng)計(jì)學(xué)差異(P0.05或P0.01),說明治療組治療中風(fēng)后失眠的方法更優(yōu)于對照組。從日常生活活動能力(ADL)評分上看,治療后,治療組的分?jǐn)?shù)明顯高于對照組,經(jīng)統(tǒng)計(jì)學(xué)分析,具有統(tǒng)計(jì)學(xué)差異(P0.05或P0.01),這就說明治療組的療效明顯要優(yōu)于對照組。(3)治療后兩組睡眠有效率的對比:治療組的總有效率高達(dá)86.67%,而對照組的總有效率僅為63.33%。經(jīng)統(tǒng)計(jì)學(xué)的分析,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。這就說明治療組相較于對照組的療效要更好。(4)不良反應(yīng)方面的比較:治療組在整個治療期間,并未出現(xiàn)有任何的不良反應(yīng)(包括滯針、暈針等)。而對照組在治療過程中,出現(xiàn)了2例不良反應(yīng)(包括口干、口苦、頭暈、乏力等)。結(jié)論:(1)運(yùn)用通督調(diào)神針刺法來治療中風(fēng)后失眠,其臨床療效顯著。(2)運(yùn)用通督調(diào)神針刺法來治療中風(fēng)后的失眠,無論從匹茲堡睡眠質(zhì)量量表(PSQI)的評分還是日常生活活動能力(ADL)的評分上看,都要比對照組效果好。(3)運(yùn)用通督調(diào)神針刺法來治療中風(fēng)后的失眠,其在臨床治療、安全性等方面優(yōu)于對照組,方治療法安全可行,值得我們臨床推廣與應(yīng)用。
[Abstract]:Objective: to observe the clinical efficacy and safety of TongduTiaoshen acupuncture in treating insomnia after stroke, and compare it with the treatment of western medicine group, so as to provide the basis for the clinical feasibility of this therapy. Methods: at first, 60 patients with insomnia after stroke were randomly divided into two groups: 30 cases in the treatment group (treatment group) and 30 cases in the Zopicron drug group (control group). Treatment group, acupuncture once a day, each time required to keep the needle 30 minutes, 10 minutes during the needle. Thus, the treatment lasted 4 weeks. In the control group, Zopicron was taken orally for 4 weeks, half an hour before bedtime. All patients were evaluated with Pittsburgh Sleep quality Index (Pittsburgh Sleep quality Index) (PSQI) and ADL (ADL) before and after treatment. Finally, the results of the two scores were calculated and compared to compare the clinical efficacy of the two groups. And in the whole treatment process, the treatment group and the control group during the treatment period of the patient response, and then compared the two different treatment methods, their respective advantages and disadvantages. Results: (1) comparison results: according to the (PSQI) score of Pittsburgh Sleep quality scale, the scores of all factors and total scores in the treatment group were significantly different from those before the treatment (P0.01), while in the control group there was only sleep time. Sleep time, sleep efficiency and total score were significantly different compared with before treatment (P0.01), sleep quality and sleep disorders were statistically significant (P0.05), no statistical significance in daytime function (P0.05). Overall, both the treatment group and the control group are effective in treating insomnia after stroke. From the comparison of the (ADL) score of ADL, after the treatment, the total scores of both the treatment group and the control group were significantly different (P0.01). This indicated that the two groups had significant effects on post-stroke insomnia. (2) the total scores before and after treatment were compared: from the (PSQI) score of Pittsburgh Sleep quality scale, the scores of the treatment group were lower than those of the control group. After statistical analysis, there was statistical difference (P0.05 or P0.01), indicating that the treatment group is better than the control group in the treatment of insomnia after stroke. From the (ADL) score of daily living ability, the scores of the treatment group were significantly higher than those of the control group after treatment. The difference was statistically significant (P0.05 or P0.01), which indicated that the curative effect of the treatment group was obviously better than that of the control group. (3) the comparison of the two groups' sleep effective rate after treatment: the total effective rate of the treatment group was as high as 86.67 and the total effective rate of the control group was only 63.33. By statistical analysis, the difference was statistically significant (P0.05). This shows that the therapeutic effect of the treatment group is better than that of the control group. (4) adverse reactions: the treatment group did not have any adverse reactions (including acupuncture stagnation, halo needle, etc.) during the whole treatment period. In the control group, there were 2 adverse reactions (including dry mouth, bitter mouth, dizziness, fatigue and so on). Conclusion: (1) the acupuncture method of Tongdu regulating the mind was used to treat the insomnia after stroke, and the clinical effect was remarkable. (2) the acupuncture method of Tongdu regulating the mind was used to treat the insomnia after stroke. No matter from the score of Pittsburgh Sleep quality scale (PSQI) or the score of activity of Daily living (ADL), it was better than the control group. (3) the acupuncture method of Tongdu regulating the mind was used to treat the insomnia after stroke, which was treated clinically. The safety is better than the control group, and the prescription therapy is safe and feasible.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.6

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