经筋解结联合涌泉贴敷治疗缺血性中风后失眠的效果及其对血清白介素6和肿瘤坏死因子α的影响研究  

Clinical,Interleukin-6 and Tumor Necrosis Factor-α Responses to Needling Posterior Neck Meridian Sinews Nodes and Herbal Ointment Externally Applied to Yongquan Acupoint in Patients with Post-ischemic Stroke Insomnia

作　　者：叶龙霖 王叶青[1] 蒋平平 林颖珣[1] 洪敏[1] YE Longlin;WANG Yeqing;JIANG Pingping;LIN Yingxun;HONG Min(Department of Traditional Chinese Medicine,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510000,China)

机构地区：[1]广东药科大学附属第一医院中医科,广东省广州市510000

出　　处：《中国全科医学》2022年第27期3422-3428,3442,共8页Chinese General Practice

基　　金：广东省中医药局科研项目(20212110)。

摘　　要：背景在老龄化背景下,缺血性中风发病呈年轻化、患病率呈逐年上升的趋势,而失眠是该病常见的并发症之一。目的探究经筋解结联合涌泉贴敷治疗缺血性中风后失眠的效果及其对血清白介素6(IL-6)、肿瘤坏死因子α(TNF-α)的影响。方法选取2020年5月至2021年5月在广东药科大学附属第一医院门诊就诊或住院的缺血性中风后失眠患者80例,采用完全随机分组方法将其分为中医治疗组、西药治疗组,各40例。中医治疗组采用经筋解结联合涌泉贴敷治疗,西药治疗组采用艾司唑仑治疗,均治疗2个疗程(10次为1个疗程)。比较两组治疗前、治疗1个疗程、治疗2个疗程匹兹堡睡眠质量指数(PSQI)总分及各维度(睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物和日间功能障碍)评分、阿森斯失眠量表(AIS)评分、血清IL-6与TNF-α水平,治疗后临床疗效。结果研究过程中中医治疗组脱落1例、西药治疗组脱落2例,最终中医治疗组39例、西药治疗组38例纳入研究。组别与时间对PSQI总分及各维度评分、AIS评分存在交互作用,组别及时间对PSQI总分及各维度评分、AIS评分主效应显著(P<0.05)。治疗1、2个疗程,两组患者PSQI总分及各维度评分、AIS评分均低于治疗前(P<0.05);治疗2个疗程,两组患者PSQI总分及各维度评分、AIS评分均低于治疗1个疗程(P<0.05)。治疗1、2个疗程中医治疗组患者PSQI总分及各维度评分、AIS评分均低于西药治疗组(P<0.05)。组别与时间对血清IL-6、TNF-α水平存在交互作用,组别及时间对血清IL-6、TNF-α水平主效应显著(P<0.05)。治疗1、2个疗程,两组患者血清IL-6、TNF-α水平均低于治疗前(P<0.05);治疗2个疗程,两组患者血清IL-6、TNF-α水平均低于组内治疗1个疗程(P<0.05)。中医治疗组患者治疗1、2个疗程血清IL-6、TNF-α水平低于西药治疗组(P<0.05)。中医治疗组患者治疗后临床疗效Background Against the backdrop of global aging,the onset age of ischemic stroke is getting younger and the prevalence is increasing,with insomnia as one of its complications.Objective To examine the clinical,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)responses to needling posterior neck meridian sinews nodes and herbal ointment externally applied to Yongquan acupoint in patients with post-ischemic stroke insomnia.Methods A total of 80 outpatients and inpatients with post-ischemic stroke insomnia were recruited from the First Affiliated Hospital of Guangdong Pharmaceutical University from May 2020 to May 2021,and equally divided into a Chinese medicine group(treated using needling posterior neck meridian sinews nodes and herbal ointment externally applied to Yongquan acupoint)and a Western medicine group(treated using estazolam)by complete randomization.Both groups were treated for two treatment cycles(10 times of treatment as one cycle).Comparisons of intergroup differences were made in terms of the total score and domain scores(subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,sleep disturbances,use of sleep medication,and daytime dysfunction)of Pittsburgh Sleep Quality Index(PSQI),Athens Insomnia Scale(AIS)score,and serum IL-6 and TNF-αlevels at baseline,and the end of the first and second cycles of treatment,as well as overall efficacy.Results All patients were included for analysis except for three dropouts(one was treated with Chinese medicine and the other two with Western medicine).The type and duration of treatment had significant interaction effects,and main effects on mean total score of PSQI and mean score of each of its domains as well as mean AIS score(P<0.05).After the end of the first or second treatment cycle,the mean total score and domain scores of PSQI as well as mean AIS score in both groups were lower than before treatment(P<0.05).After the end of the second treatment cycle,the mean total score and domain scores of PSQI as well as mean AIS score in

关 键 词：缺血性卒中 入眠和睡眠障碍 经筋解结 涌泉贴敷 白细胞介素类 肿瘤坏死因子Α 失眠症 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]