针刺调节心脾两虚型慢性失眠症过度觉醒状态的临床研究  

Acupuncture for regulating hyperarousal state in chronic insomnia with deficiency of heart and spleen:a clinical trial study

作　　者：张欣雨 张艺馨 刘璐[1] 郭静[1] 张帆[1] ZHANG Xinyu;ZHANG Yixin;LIU Lu;GUO Jing;ZHANG Fan(Department of Acu-moxibustion/Rehabilitation/Neurology,Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院针灸/康复/神经内科,北京100010

出　　处：《北京中医药》2024年第7期747-753,共7页Beijing Journal of Traditional Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号);第七批全国名老中医药专家传承工作建设项目(国中医药人教函〔2022〕76号);北京市医院管理局“扬帆”计划重点医学专业(重点扶持专业)-中西医结合康复项目(ZYLX202140);北京市属医院科研培育计划项目(PZ2022012);国家自然科学基金项目(82374568)。

摘　　要：目的观察针刺疗法对心脾两虚型慢性失眠症患者的过度觉醒状态、睡眠质量、疲劳状态和心率变异性(HRV)的影响。方法将120例慢性失眠症患者随机分为治疗组和对照组各60例。治疗组针刺百会,双侧心俞、脾俞、神门、照海、申脉、安眠、三阴交、足三里;对照组非经非穴浅刺。2组均隔日针刺1次,共针刺4周,总计治疗14次。记录患者治疗前、治疗4周结束时过度觉醒量表评分(HAS)、匹兹堡睡眠质量指标(PSQI)、疲劳量表评分(FS-14);记录患者24 h 12导动态心电图数据,以Kubios HRV version软件分析心率变异性指标。结果治疗后,2组HAS量表评分均低于治疗前(P<0.01),且治疗组低于对照组(P<0.01)。治疗后,治疗组PSQI各维度分数及总分均低于治疗前(P<0.01),对照组睡眠质量、日间功能障碍及PSQI总分均低于治疗前(P<0.05),治疗组睡眠质量、入睡时间、睡眠时间、日间功能障碍以及PSQI总分均低于对照组(P<0.01);2组FS-14量表评分均低于治疗前(P<0.01,P<0.05),且治疗组低于对照组(P<0.01);治疗组PNN50、RMSSD、HRV三角指数、VLF和LF/HF较治疗前均呈上升趋势(P<0.05),HF、LF较治疗前均呈下降趋势(P<0.05);对照组SDNN、VLF较治疗前呈下降趋势(P<0.05);治疗组PNN50、LF/HF高于对照组(P<0.05),LF低于对照组(P<0.05)。结论针刺可以改善过度觉醒和疲劳状态,提高慢性失眠症患者的睡眠质量,并通过调整心率变异性反映出其下调交感神经兴奋性,上调副交感神经调节的能力,进而平衡自主神经系统,提高人体适应性,其作用与经穴特异性有关。Objective To observe the effects of acupuncture therapy on hyperarousal state,sleep quality,fatigue state and heart rate variability(HRV)in patients with chronic insomnia due to deficiency of heart and spleen.Methods A total of 120 patients with chronic insomnia were randomly divided into treatment group and control group of 60 in each one.The treatment group was applied to bilateral Xinshu(BL 15),Pishu(BL 20),Shenmen(HT 7),Zhaohai(KI 6),Shenmai(BL 62),Anmian,Sanyinjiao(SP 6),Zusanli(ST 36)and unilateral Baihui(DU 20);the control group was given shallow acupuncture but not along the channel.Both groups were treated with acupuncture once every other day for 4 weeks,with a total of 14 treatments.The patients'Hyperarousal Scale score(HAS),Pittsburgh Sleep Quality Index(PSQI)and Fatigue Scale score(FS-14)were recorded before treatment and at the end of 4 weeks of treatment;ECGs of 24h 12 leads and Kubios HRV version software were used to analyze different parameters of HRV.Results Post-treatment HAS scale scores were highly significantly lower than pre-treatment in the treatment group(P<0.01);Post-treatment HAS scale scores were highly significantly lower than pre-treatment in the control group(P<0.01);Post-treatment HAS scale scores were highly significantly lower in the treatment group than in the control group(P<0.01);Post-treatment PSQI scores on all dimensions and total scores were highly significantly lower than pre-treatment in the treatment group(P<0.01);Sleep quality,daytime dysfunction and total PSQI scores were lower in the control group after treatment than before treatment(P<0.05);Post-treatment sleep quality,time to sleep,sleep duration,daytime dysfunction,and total PSQI scores were significantly lower in the treatment group than in the control group(P<0.01);Post-treatment FS-14 scale scores were highly significantly lower in the treatment group than pre-treatment(P<0.01);Post-treatment FS-14 scale scores were lower than pre-treatment in the control group(P<0.05);Post-treatment FS-14 scale scores were s

关 键 词：针刺 慢性失眠症 过度觉醒 心率变异性 

分 类 号：R246.6[医药卫生—针灸推拿学]