不同针灸戒烟方案戒断效果及疗效影响因素：多中心随机对照研究  

Effect of the different smoking cessation regimens with acupuncture on smoking withdrawal and their influence factors: a multi-center randomized controlled trial

作　　者：柴欣 杨金生 刘朝[3] 陈枫[4] 袁桂洪 吴远 张璐 王莹莹[8] CHAI Xin;YANG Jin-sheng;LIU Zhao;CHEN Feng;YUAN Gui-hong;WU Yuan;ZHANG Lu;WANG Ying-ying(School of Acupuncture,Moxibustion and Tuina,Shaanxi University of CM,Xianyang 712046,China;Exchange and Cooperation Center of TCM Toward Taiwan,Hong Kong and Macao,State Administration of TCM,Beijing 100027;China-Japan Friendship Hospital;Wangjing Hospital,China Academy of Chinese Medical Sciences;Jintan District TCM Hospital,Changzhou City,Jiangsu Province;China Association of Acupuncture-Moxibustion;Beijing Haidian Hospital;Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700)

机构地区：[1]陕西中医药大学针灸推拿学院,咸阳712046 [2]国家中医药管理局对台港澳中医药交流合作中心,北京100027 [3]中日友好医院 [4]中国中医科学院望京医院 [5]江苏省常州市金坛区中医院 [6]中国针灸学会 [7]北京市海淀医院 [8]中国中医科学院针灸研究所,北京100700

出　　处：《中国针灸》2019年第12期1255-1261,共7页Chinese Acupuncture & Moxibustion

基　　金：国家中医药行业科研专项基金项目：201307014;北京市中医药科技发展资金项目：JJ2018-97

摘　　要：目的:评价针灸戒烟及对戒断症状的临床疗效,探讨针灸戒烟疗效的影响因素。方法:将500例烟草依赖受试者随机分为针刺组、耳穴组、针刺+耳穴组、经皮神经电刺激组(TENS组)、尼古丁替代疗法组(NRT组),每组100例。针刺组采用针刺百会、列缺、合谷、足三里等穴,第1~2周每周5次,每天1次;第3~4周每周3次,隔日1次;第5~8周每周2次,3 d 1次。耳穴组选取神门、内分泌、皮质下、交感等穴进行耳穴贴压,每周治疗3次。针刺+耳穴组采用针刺和耳穴贴压治疗,取穴及操作同上,针刺治疗每周3次,耳穴治疗每周2次。TENS组选取SDZ-ⅡB型电子针治疗仪在列缺、足三里进行治疗,每日1次。NRT组选取尼古丁贴片贴于受试者胸、背及上臂等部位,每日1次。各组均8周为一疗程,治疗1个疗程,随访16周。应用尿液可替宁含量检测评价5组受试者治疗8周及随访时的点戒断率,应用受试者自我报告评价5组受试者治疗8周及随访时的持续戒断率,比较各组戒断疗效、尼古丁依赖程度量表(FTND)与吸烟强度指数量表(HSI)评分。选取20个指标作为可能的影响因素,以治疗8周及随访时基于尿液可替宁含量的72h点戒断率作为因变量,使用二项分类Logistic回归分析法,筛选出针灸戒烟疗效的影响因素。结果:各组受试者治疗8周后点戒断率比较,NRT组>针刺+耳穴组>耳穴组>针刺组>TENS组;随访时各组点戒断率比较,针刺+耳穴组>NRT组>针刺组>TENS组>耳穴组,但差异均无统计学意义(P>0.05);各组受试者治疗8周后持续戒断率比较,耳穴组>TENS组>针刺组>针刺+耳穴组>NRT组;随访时各组持续戒断率比较,耳穴组>TENS组>针刺+耳穴组>针刺组>NRT组,耳穴组均优于其他4组(P<0.05)。除随访时针刺组FTND评分低于耳穴组(P<0.05)外,治疗8周及随访时各组FTND评分、HSI评分差异均无统计学意义(P>0.05)。经回归分析,民族、教育程度、饮酒频率、治疗前Objective To evaluate the clinical effect of acupuncture on smoking cessation and withdrawal symptoms and to explore the influence factors of acupuncture on smoking cessation.Methods A total of 500 subjects with tobacco dependence were randomized into an acupuncture group,an auricular therapy group,an acupuncture plus auricular therapy group,a TENS group and a nicotine replacement therapy group(NRT group),100 cases in each one.In the acupuncture group,acupuncture was applied at Baihui(GV 20),Lieque(LU 7),Hegu(LI 4)and Zusanli(ST 36).The treatment was given 5 times a week,once a day in the first 2 weeks.The treatment was given once every 2 days in the week 3 and 4,3 times a week,and twice a week,once every 3 days in the week 5 to 8.In the auricular therapy group,the ear point pressure therapy was used at shenmen(TF4),neifenmi(CO18),pizhixia(AT4)and jiaogan(AH6 a),3 times a week.In the acupuncture plus auricular therapy group,acupuncture and auricular therapy were adopted with the same points and manipulation as the previous two groups.Acupuncture was given 3 times a week and the auricular therapy was given twice a week.In the TENS group,SDZ-ⅡB type electric acupuncture apparatus was used to stimulate Lieque(LU 7)and Zusanli(ST 36),once a day.In the NRT group,the nicotine patch was used on the chest,back and the upper arms of the subjects,once a day.The duration of treatment was8 weeks as one course in every group.Afterwards,the 16-week follow-up was conducted.The time-point withdrawal rate was evaluated by the level of urine cotinine in 8 weeks of treatment and in the follow-up in the subjects of 5 groups.The persistent withdrawal rate was evaluated by the self-report of the subjects in 8 weeks of treatment as well as in the follow-up in the5 groups.The withdrawal effect,the score of the fagerstrom test for nicotine dependence(FTND)and the score of the heaviness of smoking index(HSI)were compared among the groups.Twenty indexes were selected as the potential influence factors,the72 h withdrawal rate based on the

关 键 词：戒烟 耳穴贴压 针灸 影响因素 尼古丁依赖 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]