【摘要】：目的:以電針分別刺激單穴和配伍腧穴治療原發(fā)性失眠,觀察兩種方法對患者腦電超慢漲落圖(ET)和阿森斯失眠量表(AIS)的影響差異,從而對單穴與配伍腧穴治療原發(fā)性失眠進(jìn)行臨床療效的評價(jià),為腧穴配伍理論和臨床針灸治療原發(fā)性失眠的處方選穴提供科學(xué)依據(jù)。方法:以原發(fā)性失眠癥患者為研究對象,采用隨機(jī)對照試驗(yàn)研究方法,將符合納入標(biāo)準(zhǔn)的72例患者根據(jù)來訪順序隨機(jī)分為兩組,即單穴組與配穴組,每組各36例。治療方法:單穴組取神門穴(雙),配穴組取百會穴、神門穴(雙)、三陰交穴(雙);患者取仰臥位,針刺得氣后加電針,連續(xù)波60Hz,強(qiáng)度以患者耐受為度,時(shí)間為30min。5天為1個(gè)療程,療程間隔2天,連續(xù)治療5個(gè)療程,治療結(jié)束4周后隨訪。以腦電超慢漲落圖為客觀指標(biāo),阿森斯量表為主觀指標(biāo),通過采集治療前、治療后、隨訪期三個(gè)時(shí)點(diǎn)的相關(guān)療效指標(biāo)的數(shù)據(jù),總結(jié)臨床療效差異。結(jié)果:1、AIS療效評價(jià):(1)單穴組治療前與治療后,在入睡時(shí)間、夜間蘇醒、總睡眠時(shí)間、總睡眠質(zhì)量等各因子得分及總分與治療前相比有顯著差異(P0.05);單穴組治療后與隨訪期比較,AIS中的8個(gè)因子各項(xiàng)得分及總分皆無顯著差異(P0.05)。(2)配穴組治療前與治療后AIS中的8個(gè)因子各項(xiàng)得分及總分進(jìn)行比較,皆有顯著差異(P0.05);配穴組治療后與隨訪期AIS中8個(gè)因子各項(xiàng)得分及總分進(jìn)行比較,無顯著差異(P0.05)。(3)組間比較:兩組患者經(jīng)治療后,在入睡時(shí)間、夜間蘇醒頻次、總睡眠時(shí)間、總睡眠質(zhì)量、改善白天情緒狀態(tài)及身體功能等方面有顯著差異(P0.05),而在調(diào)整早醒、白天思睡程度等方面未見顯著差異(P0.05);兩組患者隨訪期,在入睡時(shí)間、夜間蘇醒頻次、總睡眠時(shí)間、總睡眠質(zhì)量、改善白天情緒狀態(tài)及身體功能等方面有所差異(P0.05),而在調(diào)整早醒狀態(tài)、改善白天思睡程度方面,配穴組與單穴組療效無顯著差別(P0.05)。2、ET檢測結(jié)果:(1)單穴組GABA、Glu、DA與治療前相比有顯著差異(P0.05),而5-HT、Ach、NE等神經(jīng)遞質(zhì)數(shù)值在治療前后無顯著差異(P0.05);(2)配穴組GABA、Glu、DA與治療前相比有顯著差異(P0.05),而5-HT、Ach、NE等神經(jīng)遞質(zhì)數(shù)值在治療前后無顯著差異(P0.05);(3)組間比較:兩組患者經(jīng)治療后進(jìn)行比較,僅5-HT有所差異(P0.05),而GABA、Glu、Ach、NE、DA含量未見顯著差異(P0.05)。3、組間總體臨床療效比較:單穴組30例,痊愈5例,顯效6例,有效12例,無效7例,總有效率為76.67%;配穴組32例,痊愈11例,顯效13例,有效5例,無效3例,總有效率為90.63%。兩組有效率存在顯著性差異(P=0.0260.05)。結(jié)論:針刺單穴與配伍腧穴治療原發(fā)性失眠均有效,且配伍腧穴療效優(yōu)于單穴。
[Abstract]:Objective: to observe the effect of electroacupuncture on the treatment of primary insomnia by stimulating single point and matching acupoint, and to observe the difference between the two methods on (ET) and (AIS) of Ascension Insomnia scale. Therefore, the clinical efficacy of single point and combined acupoint in treating primary insomnia was evaluated, which provided scientific basis for the theory of acupoint compatibility and the prescription selection of acupuncture and moxibustion for treating primary insomnia. Methods: 72 patients with primary insomnia were randomly divided into two groups according to the visiting order: single point group and matching point group with 36 cases in each group. Treatment methods: Shenmen points (double) in single point group, Baihui points (double points), Shenmen points (double points), Sanyinjiao points (double points) in matching points group, supine position, acupuncture after Qi acupuncture plus electroacupuncture, continuous wave 60Hz. the intensity is patient tolerance, time is 30min.5 day as a course of treatment. The duration of treatment was 2 days and followed up for 4 weeks after 5 consecutive courses of treatment. Taking EEG ultraslow fluctuation chart as objective index and Ascension scale as subjective index, the difference of clinical curative effect was summarized by collecting the data of relevant curative effects at three time points before and after treatment. Results: 1 Evaluation of AIS efficacy: (1) the time of falling asleep, waking up at night and total sleep time before and after treatment in single point group; The scores and total scores of all factors such as total sleep quality were significantly different from those before treatment (P0.05), and the scores and total scores of 8 factors in AIS were not significantly different from those before and after treatment (P0.05). (2) in the single point group after treatment and in the follow-up period (P0.05). The scores and total scores of the eight factors were compared. There were significant differences between the two groups (P0.05), the scores and total scores of 8 factors in AIS were not significantly different between the two groups after treatment (P0.05). (3): the time of falling asleep, the frequency of waking up at night, and the total sleep time after treatment were not significantly different between the two groups. There were significant differences in total sleep quality, improvement of daytime emotional state and body function (P0.05), but there was no significant difference in adjusting early wakefulness and daytime sleep level (P0.05). There were differences in total sleep time, total sleep quality, improvement of daytime emotional state and physical function (P0.05). There was no significant difference in therapeutic effect between the combined point group and the single point group (P0.05). 2the results of et: (1) the GABA,Glu,DA of the single point group was significantly different from that of before and after treatment (P0.05), while the value of neurotransmitters such as 5-HT-AchNE had no significant difference before and after treatment (P0.05); (2). There was no significant difference in the values of neurotransmitters such as 5-HTTH-AchNE before and after treatment (P0.05); (3). There was only difference in 5-HT (P0.05), but there was no significant difference in GABA,Glu,Ach,NE,DA content (P0.05). 3. The total clinical curative effect was compared between the two groups: 30 cases of single point group, 5 cases of cure, 6 cases of remarkable effect, 12 cases of effective and 7 cases of ineffective, the total effective rate was 76.6767%, 32 cases of combined acupoint group, 11 cases of cure, 13 cases of remarkable effect. The total effective rate was 90.63. There was a significant difference in the effective rate between the two groups (P0. 026. 05). Conclusion: acupuncture at single point and compatibility acupoint are effective in treating primary insomnia, and the curative effect of compatible acupoint is better than that of single point.
【學(xué)位授予單位】：長春中醫(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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