方氏头皮针结合体针治疗心肾不交型失眠的临床疗效观察

发布时间：2018-06-05 22:22

本文选题：失眠 + 心肾不交型　；参考：《广州中医药大学》2016年博士论文

【摘要】：目的：本课题采用小样本随机对照的研究方法,通过与普通针刺治疗为对照组的比较,观察方氏头皮针治疗心肾不交型失眠的临床疗效。旨在探讨方氏头皮针治疗心肾不交型失眠的临床疗效及可能作用机理,为临床针灸疗法治疗心肾不交型失眠提供新临床思路和严谨的科研资料,并在广度和深度上进一步挖掘和扩展方氏头皮针的功效和适用范围。方法：本研究课题病例主要是来自广东省中医院病房和门诊以及广州中医药大学第一附属医院门诊在2014年12月至2015年12月期间就诊的病人,根据本研究的病例选择标准纳入60例研究病例,将合格病例按照随机分配原则平均分配至治疗组(方氏头皮针结合体针组)和对照组(普通针刺组),治疗组和对照组的病例分别都是30例,对照组参照王启才主编的《针灸治疗学》中失眠的治疗处方选取相关穴位进行常规针刺,治疗组则参照方云鹏的《头皮针》进行飞针针刺治疗,并加上对照组的常规针刺。方氏头皮针结合体针治疗组和普通针刺对照组的患者均接受每天1次的治疗,一周5次,2周为1个疗程,整个研究要求共4周,即两个疗程的治疗。本研究的临床总疗效标准采用现今可信度及效度较高的匹兹堡睡眠质量指数(PSQI)评定量表的评分自拟,根据患者治疗前及治疗后的PSQI评分利用减分率方式进行计算后,根据得出的结果进行评定治疗前后患者的临床总疗效,同时对两组患者的中医证候疗效进行比较。临床总疗效和中医证候疗效在第一疗程治疗后、第二疗程治疗后、两个疗程治疗结束后1个月的随访时对两组的病例进行评估,运用SPSS20.0对研究的数据进行统计分析。结果：本课题根据病例选取标准纳入的病例数为60例,纳入研究的全部心肾不交型失眠患者均接受了足够的治疗疗程,最后纳入统计学分析的病例数为60例,治疗组与对照组各30例。1、治疗前纳入方氏头皮针结合体针治疗组和普通针刺对照组的心肾不交型失眠症患者中,所有病例的基线资料如性别、年龄、病程、治疗前中医证候积分、治疗前PSQI各成分积分及总分进行组间比较,结果提示P0.05,说明两组基线特征差异均无统计意义,也就是说,在治疗前,方氏头皮针结合体针治疗组和普通针刺对照组的心肾不交型失眠症患者的基线特征具有可比性。2、临床总疗效的比较：比较治疗组和对照组治疗后的中医证候疗效,治疗组总有效率为93.33%,其中痊愈9例,显效9例,有效10例,无效2例。对照组总有效率为86.67%,其中痊愈4例,显效5例,有效17例,无效4例。在总有效率上,经秩和检验发现P值小于0.05,有统计学意义。比较治疗组和对照组治疗后的临床疗效,治疗组总有效率为90%,其中痊愈10例,显效13例,有效4例,无效3例。对照组总有效率为76.67%,其中痊愈5例,显效6例,有效12例,无效7例。在总有效率上,经秩和检验发现P值小于0.05,有统计学意义,结果说明方氏头皮针结合体针治疗组中医证候疗效和临床疗效高于普通针刺对照组。3、不同时段疗效指标的比较：分别将方氏头皮针结合体针治疗组和普通针刺对照组两组的心肾不交型失眠患者在第一疗程治疗后、第二疗程治疗后、两个疗程治疗后一个月随访时的3个不同时段的中医证候总评分(包括失眠多梦、心烦、健忘、头晕耳鸣、腰膝酸软、五心烦热、口干少津7项)、PSQI各成分积分(包括睡眠质量、入睡时间、睡眠效率、睡眠时间、睡眠障碍、催眠药物、日间功能障碍7项)及PSQI总分分别与治疗前的中医证候评分、PSQI各成分积分及总分作组内比较；将方氏头皮针结合体针治疗组和普通针刺对照组的两组患者在治疗后的3个不同时段的中医证候评分、PSQI各成分积分及总分作组间比较。方氏头皮针结合体针治疗组的组内比较：统计结果表明方氏头皮针结合体针治疗组在第一疗程治疗后、第二疗程治疗后、两个疗程治疗后一个月随访的不同时段的中医证候评分、PSQI各成分积分及PSQI总分与治疗前的中医证候评分、PSQI各成分积分及PSQI总分相比均降低,经独立样本t检验分析(P小于0.05),组内差异具有统计学意义,研究结果表明,经过治疗,方氏头皮针结合体针治疗组在改善患者的中医证候评分、PSQI各成分积分及PSQI总分方面均有效。普通针刺对照组的组内比较：统计结果表明普通针刺对照组在第一疗程治疗后、第二疗程治疗后、两个疗程治疗后一个月随访的不同时段的中医证候评分、PSQI各成分积分及PSQI总分与治疗前的中医证候评分、PSQI各成分积分及PSQI总分相比均降低,经独立样本t检验分析(P小于0.05),组内差异具有统计学意义,研究结果表明,经过治疗,普通针刺对照组在改善患者的中医证候评分、PSQI各成分积分及PSQI总分方面均有一定的疗效。方氏头皮针结合体针治疗组和普通针刺对照组两组的组间比较：治疗前方氏头皮针结合体针治疗组和普通针刺对照组的中医证候总评分、PSQI各成分积分及PSQI总分,经统计分析,P大于0.05,差异不具有统计学意义；方氏头皮针结合体针治疗组和普通针刺对照组两组的中医证候总评分在第一疗程治疗后、第二疗程后、两个疗程治疗后一个月随访的3个不同时段的组间差异经统计分析具有统计学意义,P小于0.05；方氏头皮针结合体针治疗组和普通针刺对照组两组的PSQI总分在第-疗程治疗后、第二疗程后、两个疗程治疗后一个月随访的不同时段的组间差异经统计分析可以具有统计学意义,P小于0.05；方氏头皮针结合体针治疗组和普通针刺对照组两组的PSQI各成分积分在第一疗程治疗后PSQI评分量表中的睡眠障碍和催眠药物经统计分析,差异不具有统计学意义,P大于0.05,说明第一疗程治疗后两组患者在改善睡眠障碍和催眠药物方面不具有可比性,也就是说第一疗程治疗后两组患者在改善睡眠障碍和催眠药物方面的疗效相当；第一疗程治疗后PSQI评分量表中的其他成分(包括睡眠质量、入睡时间、睡眠时间、睡眠效率日间功能障碍5项)经统计学分析,差异具有统计学意义,P小于0.05；方氏头皮针结合体针治疗组和普通针刺对照组在第二疗程治疗后、两个疗程治疗后一个月随访时的PSQI评分量表中的各成分积分(包括睡眠质量、入睡时间、睡眠效率、睡眠时间、睡眠障碍、催眠药物、日间功能障碍7项)经统计学分析,P均小于0.05,且各成分积分治疗组均低于对照组,所以总体来说方氏头皮针结合体针治疗组疗程结束后在改善心肾不交型失眠患者的睡眠质量、入睡时间、睡眠效率、睡眠时间、睡眠障碍、催眠药物、日间功能障碍方面优于对照组,而相对来说在改善睡眠障碍和催眠药物方面,两组治疗方法的起效时间偏慢一些。结论：方氏头皮针结合体针治疗组和普通针刺对照组治疗方法对治疗心肾不交型失眠均有一定临床疗效,但和普通针刺对照组的疗法相比,方氏头皮针结合体针治疗组的临床总疗效更好,主要体现在对中医证候的总评分、整体睡眠的改善和总有效率的差异,睡眠质量、入睡时间、睡眠效率、睡眠时间、睡眠障碍、催眠药物、日间功能障碍较对照组均改善明显。方氏头皮针结合体针治疗心肾不交型失眠的临床疗效显著,稳定持久,临床应用安全有效,值得推广应用和进行深入研究。
[Abstract]:Objective: To observe the clinical efficacy of Fang's scalp needle in the treatment of the heart and kidney non cross type insomnia by comparing the small sample randomized controlled study method and comparison with the common acupuncture treatment group. The purpose of this study is to explore the clinical curative effect and the mechanism of the effect of Fang's scalp needle in the treatment of the heart and kidney non cross type insomnia, and to treat the heart and kidney with clinical acupuncture and moxibustion therapy. Non cross type insomnia provides new clinical ideas and rigorous scientific research data, and further excavates and extends the efficacy and scope of the scalp needles in breadth and depth. Methods: the main cases of this study were from the Guangdong Province Traditional Chinese Medical Hospital ward and outpatient department and the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2014 to 201. During the December period of 5 years, 60 cases of study were included in the case selection criteria of this study. The eligible cases were assigned to the treatment group (square scalp needle combined with body acupuncture group) and the control group (common acupuncture group) according to the principle of random distribution. The cases in both the treatment group and the control group were 30 cases respectively, and the control group referred to Wang Qicai's chief editor. The therapeutic prescriptions of insomnia in acupuncture and moxibustion therapy selected related acupoints for routine acupuncture, and the treatment group referred to Fang Yunpeng's scalp needle for needle acupuncture and the conventional acupuncture in the control group. The patients of the Fang's scalp needle combined with the body acupuncture group and the common acupuncture control group were treated with 1 times a day, 5 times a week and 1 weeks for 2 weeks. The whole study required a total of 4 weeks, that is, a total of 4 weeks, or two courses of treatment. The total clinical efficacy standard of this study was made up of the Pittsburgh sleep quality index (PSQI) rating scale with high reliability and validity. The results were calculated on the basis of the reduction rate before and after the treatment and the PSQI score after the treatment. The total clinical curative effect of the patients before and after treatment was evaluated. At the same time, the curative effect of the TCM syndrome in the two groups was compared. After the first course of treatment, after the first course of treatment, the second course of treatment, and the follow-up of the two courses of treatment at the end of 1 months, the two groups of cases were evaluated, and the data of the study were carried out by SPSS20.0. Results: the number of cases included in this subject according to the case selection standard was 60 cases, and all the patients who were included in the study were treated with sufficient treatment course. The number of cases included in the statistical analysis was 60 cases, the treatment group and the control group were 30.1. The treatment group was included in the square scalp needle combined with the body acupuncture treatment group before treatment and the treatment group. In the common acupuncture control group, the baseline data such as sex, age, course of disease, TCM syndrome score before treatment, integral and total score of PSQI components before treatment were compared in all cases. The results showed P0.05, indicating that there was no statistical significance between the two groups of baseline characteristics, that is to say, before treatment, the scalp of Fang's scalp. The baseline characteristics of the patients with non cross type insomnia in the acupuncture group and the common acupuncture control group had comparable.2, and the total clinical effect was compared: the total effective rate of the treatment group was 93.33% compared with the treatment group and the control group. 9 cases were cured, 9 cases were markedly effective, 10 cases were effective and 2 cases were invalid. The total effective of the control group was effective. The rate was 86.67%, of which 4 cases were cured, 5 cases were markedly effective, 17 cases were effective and 4 cases were invalid. In total efficiency, the P value was less than 0.05 by rank sum test. Compared with the treatment group and the control group, the total effective rate was 90%, including 10 cases, 13 effective, 4 effective and 3 cases. The total effective rate of the control group was 76.67. %, of which 5 cases were cured, 6 cases were markedly effective, 12 cases were effective and 7 cases were invalid. In total efficiency, the P value was less than 0.05 by rank sum test. The results showed that the curative effect and clinical effect of traditional Chinese medicine syndrome of Fang's scalp needle combined with body acupuncture group were higher than that of ordinary acupuncture control group.3, and the comparison of curative effect indexes at different time periods: the square scalp needle respectively After the first course of treatment, after the first course of treatment combined with the two groups of the body acupuncture treatment group and the common acupuncture control group, the total score of TCM Syndromes of 3 different periods of two courses of treatment after the two course of treatment (including insomnia, annoyance, forgetfulness, dizziness tinnitus, low waist and knee soft, five heart irritated heat, and dry oral atrazine, 7 items) The scores of PSQI components (including sleep quality, sleep time, sleep efficiency, sleep time, sleep disorder, hypnotic drug, day dysfunction 7) and PSQI total scores were compared with the TCM syndrome scores before treatment, the integral and total score of PSQI were compared in groups, and the square scalp needle was combined with the body acupuncture treatment group and the common acupuncture control group of two. The score of TCM syndrome in 3 different periods after treatment, the scores of PSQI components and the total score were compared. The comparison of the group in the group with the square scalp needle combined with the body acupuncture group: the statistical results showed that after the first course of treatment, the square scalp needle combined with the body acupuncture treatment group was treated with the second course of treatment, and the two course of treatment was followed up for one month after the treatment. The score of TCM syndrome in different periods of time, the score of PSQI components and PSQI total score and the score of TCM syndrome before treatment, the scores of each component of PSQI and the total score of PSQI were reduced, and the independent sample t test analysis (P was less than 0.05), the difference in the group was statistically significant. The results of the study showed that after treatment, the scalp needle combined with the body acupuncture group was in the treatment group. The TCM syndrome score of the patients was improved, the integral of PSQI and the total score of PSQI were all effective. The comparison of the group in the common acupuncture control group: the statistical results showed that after the first course of treatment in the ordinary acupuncture control group, after the second course of treatment, the TCM Syndrome score of the different period of the two course of treatment after one month of treatment, and the integral of each component of PSQI was integrated. The total score of PSQI and the score of TCM syndrome before treatment, the score of each component of PSQI and the total score of PSQI were reduced, and the independent sample t test was analyzed (P is less than 0.05). The difference in the group was statistically significant. The results of the study showed that after treatment, the common acupuncture control group was improved in the score of TCM syndrome, the integral of PSQI components and the total score of PSQI. The comparison between the two groups of the two groups of Fang's scalp acupuncture combined with the body acupuncture treatment group and the common acupuncture control group: the total score of TCM syndrome in the front of the scalp needle combined with the body acupuncture treatment group and the common acupuncture control group, the integral and PSQI score of PSQI components and the statistical analysis, the difference is not statistically significant; the difference is not statistically significant. After the first course of treatment, the total score of TCM syndrome in two groups of two groups of the scalp needle combined with the body acupuncture group and the common acupuncture control group, after the second course of treatment, the difference between the 3 different periods after the two course of treatment was statistically significant, and the difference was less than 0.05; the square scalp needle combined with the body acupuncture treatment group and the common needle. After the second course of treatment, the total score of PSQI in the two groups of the acupuncture control group was statistically significant, and the P was less than 0.05 after two courses of treatment. The integral of the PSQI components in the two groups of the square scalp acupuncture combined with the body acupuncture group and the common acupuncture group were treated with the first treatment course. The difference of sleep disorders and hypnotic drugs in the PSQI scale was not statistically significant, P was greater than 0.05, indicating that the two groups were not comparable in improving sleep disorders and hypnotic drugs after the first course of treatment, that is, two groups of patients after the first course of treatment were improving sleep disorders and hypnotic drugs. The other components in the PSQI scale after the first course of treatment (including 5 items of sleep quality, sleep time, sleep time, and sleep efficiency day dysfunction) were statistically analyzed, the difference was statistically significant and P was less than 0.05; the square scalp needle combined with the body acupuncture treatment group and the common acupuncture control group in second courses of treatment. After two courses of treatment, the scores of all components in the PSQI scale (including sleep quality, sleep time, sleep efficiency, sleep time, sleep time, sleep disorder, hypnotic drug, and daytime dysfunction 7) were statistically analyzed, all of which were less than 0.05, and all the components of the integral treatment group were lower than those of the control group, so the overall head of Fang's head was in general. The skin needle combined with body acupuncture treatment group was better than the control group in improving sleep quality, sleep time, sleep time, sleep time, sleep disorder, hypnotic drugs and daytime dysfunction in improving the sleep quality of the patients with heart and kidney uncross type insomnia, while the two groups were relatively slow in the onset time of the treatment methods in improving sleep disorders and hypnotic drugs. Conclusion: the treatment of square scalp acupuncture combined with body acupuncture group and common acupuncture control group has a certain clinical effect on the treatment of non heart and kidney type insomnia, but compared with the common acupuncture control group, the total clinical effect of the square scalp needle combined with the body acupuncture treatment group is better, and the main should be reflected in the total score of TCM syndromes and the overall sleep. The difference of improvement and total efficiency, sleep quality, sleep time, sleep time, sleep time, sleep disorder, hypnotic drug, and daytime dysfunction are better than those of the control group. The clinical efficacy of Fang's scalp needle combined with body acupuncture in the treatment of heart and kidney failure insomnia is significant, stable and lasting, the clinical application is safe and effective, it is worth popularizing and carrying out. Study in depth.
【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】：R246.6

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