机构地区:[1]中国人民解放军总医院第七医学中心,北京100700 [2]湖北中医药大学针灸骨伤学院,武汉430061
出 处:《上海针灸杂志》2023年第8期784-790,共7页Shanghai Journal of Acupuncture and Moxibustion
基 金:国家自然科学基金青年科学基金项目(81704188);湖北省教育厅科学研究计划资助项目(D20192005)。
摘 要:目的观察平衡针联合低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对缺血性卒中后失眠患者睡眠质量及血清5-羟色胺(5-hydroxytryptamine,5-HT)、去甲肾上腺素(noradrenaline,NE)和褪黑素(melatonin,MLT)水平的影响。方法将180例缺血性卒中后失眠患者随机分为4组,对照组、平衡针组、低频rTMS组和联合组,每组45例。对照组予口服艾司唑仑片治疗,平衡针组予平衡针特定穴治疗,低频r TMS组予1 Hz的r TMS治疗,联合组予平衡针联合低频r TMS治疗。治疗前后分别采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分以及总睡眠时间(total sleep time,TST)、睡眠觉醒(sleep awake,SA)和睡眠效率(sleep efficiency,SE)评估4组患者的睡眠质量。比较4组治疗前后血清5-HT、MLT和NE水平的变化。观察治疗过程中4组不良反应发生情况。结果4组治疗后PSQI评分、睡眠监测指标以及血清5-HT、MLT和NE水平与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗后,平衡针组和低频r TMS组PSQI评分均高于对照组(P<0.05),TST和SE均低于对照组(P<0.05);联合组PSQI评分、TST和SE与对照组比较,差异均无统计学意义(P>0.05)。治疗后,平衡针组和低频r TMS组比较,PSQI评分、TST、SE和SA的差异均无统计学意义(P>0.05)。治疗后,平衡针组和低频r TMS组血清5-HT和MLT水平均高于对照组(P<0.05),血清NE水平低于对照组(P<0.05);联合组血清5-HT、MLT和NE水平与对照组比较,差异均无统计学意义(P>0.05)。治疗后,平衡针组和低频r TMS组比较,血清5-HT、MLT和NE水平的差异均无统计学意义(P>0.05)。结论平衡针联合低频r TMS治疗对缺血性卒中后失眠患者的睡眠改善作用与口服艾司唑仑片相当,且优于单纯平衡针治疗或低频r TMS治疗,其作用可能与调节血清5-HT、MLT和NE水平有关。Objective To observe the effects of balancing acupuncture plus low-frequency repetitive transcranial magnetic stimulation(rTMS)on sleep quality and the levels of serum 5-hydroxytryptamine(5-HT),noradrenaline(NE),and melatonin(MLT)in post-stroke patients with insomnia.Method A total of 180 patients of ischemic stroke with insomnia were randomly allocated to four groups,control,balancing acupuncture,low-frequency rTMS,and integrated groups,with 45 cases in each group.The control group was given oral administration of Estazolam tablets,the balancing acupuncture group received balancing acupuncture at specific points,the low-frequency rTMS group received 1 Hz rTMS treatment,and the integrated group was intervened by balancing acupuncture and low-frequency rTMS treatments.The sleep quality in all four groups was evaluated before and after the treatment using the Pittsburgh sleep quality index(PSQI)score,total sleep time(TST),sleep awake(SA),and sleep efficiency(SE).Changes in the levels of serum 5-HT,MLT,and NE were compared among the four groups.Adverse reactions during the treatment were also observed.Result The PSQI score,sleep monitoring indexes,and the levels of serum 5-HT,MLT,and NE changed significantly after the treatment in all four groups(P<0.05).After the treatment,the PSQI score in the balancing acupuncture and low-frequency rTMS groups was higher than that in the control group(P<0.05),and the TST and SE were lower than those in the control group(P<0.05);there was no statistical significance in comparing the PSQI score,TST,and SE between the integrated group and the control group(P>0.05).After the intervention,there were no significant differences in the PSQI score,TST,SE,and SA between the balancing acupuncture group and rTMS group(P>0.05).The levels of serum 5-HT and MLT were higher in the balancing acupuncture and rTMS groups than in the control group after the treatment(P<0.05),and the serum NE level was lower than that in the control group(P<0.05);there were no significant differences in the levels of
关 键 词:针刺疗法 低频重复经颅磁刺激 脑梗死 中风 睡眠障碍 失眠 睡眠质量
分 类 号:R246.6[医药卫生—针灸推拿学]
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