择时针刺治疗中风后睡眠倒错的临床观察

发布时间：2018-01-13 11:49

本文关键词：择时针刺治疗中风后睡眠倒错的临床观察　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：观察不同时间(酉时、辰时)针刺对中风后睡眠倒错(post-stroke sleep reversal,PSSR)的临床疗效,探讨针灸治疗PSSR的时效性问题。方法：将60例诊断为PSSR的住院患者按照随机数字表法分为辰时针刺组和酉时针刺组,每组30人。在中风常规治疗的基础上,酉时针刺组予“醒脑开窍针法”酉时(17：00-19：00)治疗,辰时针刺组予“醒脑开窍针法”辰时(7：00-9：00)治疗。每天1次,6天为1个疗程,两个疗程间隔1天,每个患者治疗3个疗程。分别在治疗前、3个疗程结束后采用阿森斯失眠量表(AIS)、匹兹堡睡眠质量指数量表(PSQI)评价患者的睡眠情况,用脑卒中患者临床神经功能缺损程度评分标准(MESSS)评价其神经功能缺损程度,用汉密尔顿抑郁量表(HAMD)评价其抑郁程度。然后分别将各个量表的评分进行组内和组间比较,观察两组间的疗效差异并进行相关性分析,所有数据均使用SPSS17.0软件进行统计学分析。结果：1.两组治疗前后的MESSS评分比较两组治疗后MESSS评分均较治疗前降低,差异皆有统计学意义(P0.01),表明酉时针刺和辰时针刺对PSSR患者神经功能缺损均有改善。治疗后两组MESSS评分的差异无统计学意义(P0.05),说明辰时针刺和酉时针刺对PSSR患者的神经功能缺损的疗效相当。2.两组治疗后神经功能缺损疗效比较酉时针刺组治愈、显效、有效、无效分别为0例、8例、21例、1例,愈显率和总有效率分别为26.67%、96.7%；辰时针刺组治愈、显效、有效、无效分别为0例、6例、22例、2例,愈显率和总有效率分别为20.00%、93.33%。两组神经功能缺损愈显率、总有效率的差异均无统计学意义(P0.05),表明酉时针刺和辰时针刺对PSSR患者神经功能缺损的疗效相当。3.两组治疗前后AIS评分比较两组治疗后的AIS评分较治疗前均下降,差异皆有统计学意义(P0.01),表明酉时针刺和辰时针刺对PSSR均有改善。治疗后西时针刺组AIS评分比辰时针刺组显著降低,差异有统计学意义(P0.01),表明酉时针刺对PSSR的疗效优于辰时针刺。4.两组治疗前后PSQI评分比较两组治疗后PSQI评分均较治疗前降低,差异皆有统计学意义(P0.01),表明酉时针刺和辰时针刺对PSSR均有改善。治疗后酉时针刺组PSQI评分较辰时针刺组显著降低,差异有统计学意义(P0.01),表明酉时针刺对PSSR的疗效优于辰时针刺。5.两组治疗前后PSQI量表6项因子评分比较两组治疗后的PSQI量表6项因子评分皆较治疗前降低,差异均有统计学意义(P0.01),说明酉时针刺和辰时针刺皆能有效降低PSSR患者的PSQI量表6项因子评分。治疗后两组主观睡眠质量、睡眠障碍及日间功能评分的差异皆无统计学意义(P0.05),说明辰时针刺和酉时针刺对PSSR患者的主观睡眠质量、睡眠障碍、日间功能的改善效果相当。治疗后酉时针刺组的入睡时间、睡眠时间及睡眠效率评分比辰时针刺组显著降低,差异有统计学意义(P0.01),提示西时针刺对于PSSR患者的入睡时间、睡眠时间、睡眠效率的改善优于辰时针刺。6.两组治疗后睡眠倒错疗效比较西时针刺组治愈、显效、有效、无效分别为4例、19例、6例、1例,愈显率和总有效率分别为76.67%、96.7%；辰时针刺组治愈、显效、有效、无效分别为2例、12例、14例、2例,愈显率和总有效率分别为46.67%、93.33%。两组睡眠倒错的总有效率差异无统计学意义(P0.05),但愈显率差异有统计学意义(P0.05),表明西时针刺治疗PSSR优于辰时针刺。7.两组治疗前后的HAMD评分比较两组治疗后HAMD评分较治疗前均降低,差异皆有统计学意义(P0.05),表明酉时针刺和辰时针刺对PSSR患者的抑郁程度均有改善。治疗后两组的HAMD评分的差异无统计学意义(P0.05)。表明辰时针刺和西时针刺对PSSR患者抑郁的疗效相当。8.两组治疗后抑郁程度疗效比较酉时针刺组治愈、显效、有效、无效分别为2例、9例、18例、1例,愈显率和总有效率分别为36.67%、96.67%；辰时针刺组治愈、显效、有效、无效分别为2例、6例、19例、3例,愈显率和总有效率分别为26.67%、90.00%。两组抑郁的总有效率、愈显率差异均无统计学意义(P0.05),表明酉时针刺和辰时针刺对PSSR患者抑郁的疗效相当。结论：1.酉时针刺治疗PSSR较辰时针刺疗效佳,酉时针刺更能有效改善PSSR患者的入睡时间、睡眠时间和睡眠效率。2.酉时针刺和辰时针刺对PSSR患者的神经功能缺损和抑郁症状的疗效相当。
[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.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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