董氏之五花穴配镇静穴治疗失眠的临床与实验研究

发布时间：2018-04-12 11:53

本文选题：五花穴 + 镇静穴　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：本课题旨在通过临床以及实验室的随机对照实验,探讨董氏奇穴之镇静穴和五花穴治疗失眠的机制、临床疗效及起效规律,丰富临床治疗失眠的手段。方法：实验研究方面,本研究选用40只SD大鼠,随机分为空白组、模型组、实验组及药物组。空白组为正常对照组；模型组采用腹腔注射PCPA,以制备失眠大鼠模型；实验组为造模后给予连续的五花穴配镇静穴针法治疗；药物组为西药对照组。通过对比董氏奇穴组及药物组大鼠治疗后脑组织内NE、5-HT和5-HIAA的含量,探讨该法治疗睡眠障碍的神经机制。各组数据以均数±标准差(x±s)表示,采用SPSS20.0统计软件进行统计学处理。临床实验方面,筛选出符合纳入标准的60名患者进入临床研究,随机分配到治疗组及对照组。治疗组采用五花穴配合镇静穴针刺治疗,对照组采用传统针刺治疗(参照石学敏主编的《针灸治疗学》教材“不寐”的治疗方法取穴)。每日1次,6次为一疗程,疗程间休息1天,连续治疗2个疗程,疗程结束后于第4周随访。治疗前后,采用失眠临床症状积分、中医证候积分、匹兹堡睡眠质量指数量表、失眠严重程度指数量表对失眠患者的睡眠状况进行评价,并结合治疗后PSQI评分减分率进行疗效评定。采用SPSS20.0统计软件对数据加以分析。结果：一、动物实验(一)针刺和药物灌胃后,实验组和药物组大鼠日常活动减少,进食及饮水频率降低,睡眠时间延长,与模型组有明显差别。(二)大鼠睡眠脑干网状结构中5-HT、5-HIAA和NE含量失眠大鼠5-HT和5-HIAA含量显著降低；实验组和药物组在完成治疗后均可明显提高5-HT和5-HIAA含量,与模型组比较有显著性差异(P0.05),两种方法在提高5-HT和5-HIAA含量方面没有显著差异。失眠大鼠NE含量显著升高；实验组和药物组分别与模型组比较有显著性差异(P0.05),提示两组在完成治疗后均可明显降低NE含量；实验组和药物组两者差异具有统计学意义,提示两种方法在降低NE含量方面具有可比性,实验组比药物组疗效更显著。二、临床试验(1)失眠临床症状积分两组治疗前失眠临床症状积分总分P0.05,具有可比性。2个疗程结束后,两组治疗前后失眠临床症状积分有显著差异,提示两组均治疗有效。治疗组评分下降幅度高于对照组,可以认为董氏奇穴五花穴配合镇静穴针刺对比常规针刺,在改善失眠临床症状积分具有更好的疗效。两组治疗后与随访比较有统计学意义,说明两组具有一定的远期疗效,但对照组积分较治疗后降低,治疗组积分升高,可认为对照组在改善患者失眠症状方面的远期疗效优于治疗组。(2)中医证候观察指标两组治疗前中医证候观察量表总分P0.05,差异具有可比性。2个疗程结束后,两组治疗前后对比,P=0.00000.05,有显著差异,提示两组治疗对于改善中医证候有效。治疗组评分下降幅度高于对照组,可以认为董氏奇穴五花穴配合镇静穴针刺对比常规针刺,在改善中医证候方面具有更好的疗效。两组治疗后与随访比较有统计学意义,说明两组具有一定的远期疗效,但对照组积分较治疗后降低,治疗组积分升高,可认为对照组在改善中医证候方面的远期疗效优于治疗组。(3)匹兹堡睡眠质量指数(PSQI)积分治疗前两组相比具有可比性。两组治疗后睡眠质量、睡眠效率日间功能障碍有显著差异,提示治疗组在这些方面的疗效比对照组突出。随访两组PSQI各组成,其中睡眠质量、睡眠效率和日间功能障碍均有显著差异,提示治疗组在这些方面的长期疗效比对照组突出,而在入睡时间、睡眠时间、睡眠障碍、睡眠药物方面对比没有统计学意义,两组远期疗效相当。两组治疗前评分结果,P0.05,差异无统计学意义,提示两组具有可比性。两组治疗前后对比均有显著差异,提示治疗有效。两组治疗后差别具有统计学意义,说明治疗组疗效优于对照组。在随访时两组对比差别无统计学意义,治疗组积分有所上升,而对照组积分下降,可以认为董氏奇穴五花穴配合镇静穴针刺对比常规针刺,在改善PSQI评分方面的远期疗效不如对照组。(4)失眠严重程度评分2个疗程结束后,根据失眠严重程度指数评分结果统计,治疗组和对照组治疗前后的对照有显著差异。两组治疗后评分有差异,治疗组评分下降幅度高于对照组,可以认为董氏奇穴五花穴配合镇静穴针刺对比常规针刺,在改善失眠严重程度方面具有更好的疗效。两组治疗后与随访的评分对照显示,P0.05,差异有统计学意义,治疗组积分有所上升,对照组积分下降,提示对照组的远期疗效优于治疗组。(5)两组疗效的比较根据疗效评定标准,2个疗程结束后,治疗组对照组临床痊愈13例,显效10例,有效5例,无效2例,总有效率93.33%；对照组临床痊愈8例,显效5例,有效13例,无效4例,总有效率86.67%。两组疗效整体比较经Ridit分析,u=2.1576,P=0.03100.05,差异有统计学意义,可以认为两组疗效不完全相同。治疗组总要效率高于对照组,可以认为董氏奇穴五花穴配合镇静穴针刺对比常规针刺治疗失眠有效率更高。结论：(1)董氏之五花穴配镇静穴对失眠大鼠有很好的疗效。(2)董氏之五花穴配镇静穴能良性调节大鼠体内影响睡眠的神经递质的含量,能提高5-HT和5-HIAA含量,降低NE含量。(3)董氏之五花穴配镇静穴能较好地改善失眠患者的各类症状,具有一定的远期疗效,但这种疗效比传统针刺要差。(4)董氏之五花穴配镇静穴起效较快。
[Abstract]:Objective: this topic through randomized controlled trials and clinical laboratory, to explore the mechanism of acupuncture and acupoint Dong Qi acupuncture treatment of insomnia Wuhua sedation, clinical efficacy and effect of clinical treatment of insomnia, rich means. Methods: the experimental research, this study selected 40 SD rats were randomly divided into blank group, model group, experimental group and drug group. The blank group was normal control group; model group by intraperitoneal injection of PCPA, the model of insomnia rats in the experimental group; model is given after Wuhua pointacupuncture treatment continuous sedation with acupuncture point; drug group and control group of Western medicine. By comparing Dong Qi points group and drug group in the treatment of brain tissue in NE, the content of 5-HT and 5-HIAA, the neural mechanism of the treatment of sleep disorders. All the data were mean standard deviation (x + s) said, SPSS20.0 was used for statistical analysis. The clinical experiment The surface, selected into a clinical study of 60 patients included in the standard, were randomly assigned to treatment group and control group. The treatment group used five points with sedation acupuncture treatment, the control group used the traditional acupuncture therapy (treatment reference Shi Xuemin editor of the "acupuncture therapy > textbook" insomnia "acupoints) 1 times. Every day, 6 times for a course of treatment breaks 1 days, continuous treatment of 2 courses, after the end of treatment in fourth weeks. After treatment, the clinical symptoms of insomnia, TCM syndrome score, Pittsburgh sleep quality index, insomnia severity index of patients with insomnia sleep status were evaluated. And after treatment PSQI score reduction rate was evaluated. The data analyzed by SPSS20.0 statistical software. Results: 1. Animal experiment (1) Acupuncture and drugs after intragastric administration, the experimental group and the drug group rats decreased daily activities, Eating and drinking frequency decreased, sleep time prolonged, there was significant difference with the model group. (two) 5-HT sleep in the rat brain stem reticular structure, 5-HIAA and NE in the insomnia rats 5-HT and 5-HIAA were significantly reduced; the experimental group and the drug group in after completing treatment could significantly increase the content of 5-HIAA and 5-HT, there was significant difference compared with the model group (P0.05), there was no significant difference in the increase of 5-HT and 5-HIAA content of two kinds of methods. The content of NE in rat sleep increased significantly; the experimental group and the drug group were compared with the model group, there was significant difference (P0.05), suggesting that in the two groups after completing treatment could decrease the content of NE has statistical significance; the difference between the experimental group and the drug group, suggesting that the two methods in reducing the content of NE is comparable to that of the experimental group than the drug group, curative effect is more significant. Two clinical trials (1) insomnia clinical symptom score of two groups before treatment on insomnia The bed symptom score P0.05, comparable to.2 after the end of treatment, the two groups before and after treatment of insomnia clinical symptom scores were significantly different, suggesting that the two groups were effective therapy. Treatment group were decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in the improve insomnia symptom scores. The two groups after treatment and follow-up were statistically significant, indicating that the two groups have certain curative effect, but the control group scores decreased after therapy, the treatment group score increased, that the control group in the treatment group were better than those in long-term follow-up of patients with insomnia symptoms. (2) observation of syndromes index of the two groups before treatment, TCM syndrome score P0.05, the difference is comparable to that of.2 after the end of treatment, compared two groups before and after treatment of P=0.00000.05, there is a significant difference, suggesting that the treatment in the two groups for Improve the TCM syndrome. The treatment group was decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in improving the TCM. The two groups after treatment and follow-up were statistically significant, indicating that the two groups have certain curative effect, but the control group integral after treatment is reduced, the treatment group score increased, that the control group in the treatment group were better than those in the long-term curative effect of TCM syndrome. (3) Pittsburgh sleep quality index (PSQI) score before treatment in two groups were comparable. Two group after treatment, sleep quality, sleep efficiency and daytime dysfunction have significant differences. Effect of the treatment group in these areas than in the control group. The two groups were followed up PSQI highlight the quality of sleep, among them, significant differences in sleep efficiency and daytime dysfunction were the treatment group in the party The long-term curative effect than the control group in the prominent, sleep time, sleep time, sleep disorders, sleep medicine comparison was not statistically significant, a long-term curative effect in two groups. The two groups before treatment P0.05 score, the difference was not statistically significant, suggesting that the two groups were comparable. The two groups before and after treatment were significantly different. Prompt treatment is effective. The two groups were significant difference after treatment, the effect of the treatment group than the control group. In the follow-up between the two groups had no significant difference, the treatment group integral increased, while the control group scores decreased, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture, to improve the long-term effect of PSQI scores than the control group. (4) insomnia severity score after the 2 course of treatment, according to the results of insomnia severity index statistics, treatment group and control group before and after treatment of As there is a significant difference. The two groups after treatment score difference, treatment group were decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in improving insomnia severity. The two groups after treatment and follow-up scores showed that P0.05 was statistically significant differences in scores of treatment group increased, the integral of control group than the treatment group decreased, the long-term curative effect that control group (5). The two groups were compared according to the evaluation standard, after the 2 course of treatment, clinical treatment group and control group 13 cases were cured, 10 cases markedly effective in 5 cases, 2 cases were invalid. The total efficiency of 93.33%; control group 8 cases were cured clinically, 5 cases were markedly effective, 13 cases effective, 4 cases ineffective, the total efficiency of the whole 86.67%. comparison of the two groups was analyzed by Ridit, u=2.1576, P=0.03100.05, the difference was statistically significant, that the efficacy of the two groups. All the same. The treatment group the total efficiency was higher than the control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture treatment of insomnia is more efficient. Conclusion: (1) the Dong Wuhua point with sedation acupuncture has good curative effect on insomnia rats. (2) the Dong Wuhua point and calm acupuncture can benignly regulate neurotransmitter content of sleep effect in rats, can improve 5-HT and 5-HIAA content, decreased the content of NE. (3) the Dong Wuhua point with sedation points can effectively improve the patients with insomnia symptoms, has certain curative effect, but the curative effect than traditional acupuncture to poor (4). The Dong Wuhua point with sedation points faster onset.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R245

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