养血化痰通络法针药联合治疗缺血性卒中后失眠疗效观察  

Efficacy of combination of acupuncture and Chinese herbs for nourishing blood,resolving phlegm and unblocking collaterals on insomnia after ischemic stroke

作　　者：游晓艳 李玲 董璐 高赫 张珣 成立 YOU Xiaoyan;LI Ling;DONG Lu;GAO He;ZHANG Xun;CHENG Li(The First Affiliated Hospital of Hebei College of Traditional Chinese Medicine,Shijiazhuang 050010,Hebei,China)

机构地区：[1]河北中医学院第一附属医院,河北石家庄050010

出　　处：《现代中西医结合杂志》2023年第5期609-614,675,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省中医药管理局科研计划项目(2020002)。

摘　　要：目的观察养血化痰通络法针药联合治疗缺血性卒中后失眠的疗效及对前列腺素D2(PGD2)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、血黏度、血脂的影响。方法选取2020年9月—2021年9月就诊于河北省中医院气血亏虚、痰瘀阻络型缺血性卒中后失眠患者70例,随机分为实验组与对照组各35例。对照组给予缺血性卒中常规治疗及右佐匹克隆片口服,实验组在对照组治疗基础上给予基于养血化痰通络法拟定的中药汤剂口服及针刺治疗,2组疗程均为4周。观察并比较2组治疗前后SPIEGEL睡眠量表评分,PSG睡眠进程参数,血清PGD2、5-HT、NE水平,血黏度,血脂水平,NIHSS评分,比较2组治疗后临床疗效和主要不良反应发生情况。结果2组患者治疗后SPIEGEL评分,PSG睡眠进程参数睡眠潜伏期(SL)、觉醒时间(AT),血黏度各项指标,血总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及NIHSS评分均较治疗前明显降低(P均<0.05),且除SL外,实验组以上各指标均明显低于对照组(P均<0.05);2组患者治疗后PSG睡眠进程参数睡眠效率(SE)、睡眠总时间(TST),血清PGD2、5-HT、NE、高密度脂蛋白胆固醇(HDL-C)水平均较治疗前明显升高(P均<0.05),且实验组以上各指标均明显高于对照组(P均<0.05);实验组总有效率为94.29%(33/35),明显高于对照组的77.14%(27/35),差异有统计学意义(P<0.05);实验组不良反应发生率为5.71%(2/35),明显低于对照组的25.71%(9/35),差异有统计学意义(P<0.05)。结论养血化痰通络法针药联合治疗缺血性卒中后失眠疗效显著,可显著改善患者睡眠质量,调节睡眠觉醒周期,提高血清PGD2、5-HT、NE水平,降低血黏度,调节血脂水平,改善神经功能缺损情况,且不良反应少。Objective It is to observe the efficacy of the combination of acupuncture and Chinese herbs for nourishing blood,resolving phlegm and unblocking collaterals in the treatment of insomnia after ischemic stroke,and its effects on prostaglandin D2(PGD2),5-hydroxytryptamine(5-HT),norepinephrine(NE),blood viscosity and blood lipids.Methods Seventy patients with insomnia after ischemic stroke with syndrome of Qi-blood deficiency and phlegm-stagnation obstructing collaterals treated in Hebei Provincial Hospital of Traditional Chinese Medicine were selected from September 2020 to September 2021 and randomly divided into experimental group and control group,with 35 cases in each group.The control group was given conventional treatment for ischemic stroke and dexzopiclone tablets orally,while the experimental group was given herbal decoction orall and acupuncture based on the method of nourishing blood,resolving phlegm and unblocking collaterals on the basis of treatment of the control group,and both groups were treated for 4 weeks.The SPIEGEL sleep scale scores,PSG sleep process parameters,the levels of serum PGD2,5-HT,NE,blood viscosity and blood lipid,NIHSS scores before and after treatment in the two groups were observed and compared,and the clinical efficacy and the occurrence of major adverse effects after treatment were compared between the two groups.Results After treatment,the SPIEGEL scores,PSG sleep process parameters sleep latency(SL),awakening time(AT),blood viscosity indexes,blood total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C)and NIHSS scores were significantly lower than those before treatment in the two groups(all P<0.05),and the above indexes except for SL in the experimental group were significantly lower than those in the control group(all P<0.05);The PSG sleep process parameters sleep efficiency(SE)and total sleep time(TST),the levels of serum PGD2,5-HT,NE and high-density lipoprotein cholesterol(HDL-C)were significantly higher than those before treatment in the two

关 键 词：缺血性卒中后失眠 养血化痰通络法 PSG多导睡眠图 前列腺素D2 5-羟色胺 去甲肾上腺素 血黏度 血脂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]