醒脑开窍针法联合耳迷走神经刺激治疗失眠的临床疗效及对睡眠结构、下丘脑-垂体-肾上腺轴相关激素的影响  

Clinical efficacy of brain resuscitation method combined with vagus nerve stimulation for insomnia and its influence on sleep structure and hypothalamus-pituitary-adrenal axis related hormone

作　　者：冯建杰 吕威 郑明明 孟欢欢 姜燕 FENG Jianjie;LV Wei;ZHENG Mingming;MENG Huanhuan;JIANG Yan(Department of Traditional Chinese Medicine,Bayingolin Mongolian Autonomous Prefecture People's Hospital,Korla,Xinjiang 841000)

机构地区：[1]新疆维吾尔自治区巴音郭楞蒙古自治州人民医院中医科,新疆库尔勒841000

出　　处：《河北中医》2024年第9期1506-1511,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：巴音郭楞蒙古自治州2022年科学技术研究计划项目(编号:202208)。

摘　　要：目的观察醒脑开窍针法联合耳迷走神经刺激治疗失眠的临床疗效及对睡眠结构、下丘脑-垂体-肾上腺(HPA)轴相关激素的影响。方法将80例失眠患者按照随机数字表法分为2组,2组均予艾司唑仑片治疗。对照组40例予耳迷走神经刺激,治疗组40例予醒脑开窍针法联合耳迷走神经刺激,2组均治疗4周。比较2组中医疗效;比较2组治疗前后中医证候评分变化;比较2组治疗前后HPA轴相关激素和神经递质[皮质醇(CORT)、促肾上腺皮质激素(ACTH)、5-羟色胺(5-HT)、5-羟吲哚醋酸(5-HIAA)]变化;比较2组治疗前后自主神经功能指标[正常心动周期标准差(SDNN)、相邻心动周期差值均方平方根(RMSSD)、窦性RR间期平均值(NNMean)]变化;比较2组治疗前后睡眠结构[快速眼球运动睡眠占总睡眠时间百分比(REM%)、非快速动眼睡眠相3占总睡眠时间百分比(S3%)、非快速动眼睡眠相2占总睡眠时间百分比(S2%)、非快速动眼睡眠相1占总睡眠时间百分比(S1%)]变化;比较2组治疗前后匹兹堡睡眠质量指数量表(PSQI)评分、汉密尔顿抑郁量表-17(HAMD-17)评分。结果治疗组总有效率90.00%(36/40),对照组总有效率70.00%(28/40),治疗组中医疗效优于对照组(P<0.05)。2组治疗后失眠多梦、胸闷胁痛、心烦易怒、口干舌燥评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后血清CORT、ACTH、5-HT、5-HIAA水平均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后SDNN、RMSSD、NNMean均较本组治疗前升高(P<0.05),且治疗组升高更明显(P<0.05)。2组治疗后REM%、S3%均较本组治疗前升高(P<0.05),S2%、S1%均较本组治疗前降低(P<0.05);治疗后治疗组REM%、S3%均高于对照组(P<0.05),S2%、S1%均低于对照组(P<0.05)。2组治疗后PSQI评分、HAMD-17评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。结论醒脑开窍针法联合耳迷走神经刺激能�Objective To observe the clinical efficacy of brain resuscitation method combined with vagus nerve stimulation(VNS)for insomnia and its influence on sleep structure and hypothalamus-pituitary-adrenal(HPA)axis related hormone.Methods Eighty patients with insomnia were randomly assigned into treatment group(n=40)and control group(n=40).All patients were managed by estazolam tablets and VNS,and those in treatment group were additionally treated with brain resuscitation method.Treated for 4 weeks,the aim was to compare curative effect of Chinese medicine,traditional Chinese medicine(TCM)syndrome score,HPA axis related hormones,neurotransmitter(cortisol[CORT],adrenocorticotropic hormone[ACTH],5-hydroxytryptamine[5-HT],5-Hydroxyindoleacetic acid[5-HIAA]),autonomic nerve function indexes(standard deviation of the normal-to-normal intervals[SDNN],root mean square of successive RR interval differences[rMSSD],mean value of sinus RR interval[NNMean]),sleep structure(rapid eye movement sleep percentage in total sleep time[REM%],non-REM sleep phase 3 percentage in total sleep time[S3%],non-REM sleep phase 2 percentage in total sleep time[S2%],non-REM sleep Percentage in total sleep time[S1%]),Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Rating Scale-17(HAMD-17).Results The overall effective rate of TCM in the treatment group was better than that in the control group(90.00%[36/40]vs 70.00%[28/40],P<0.05).After treatment,TCM symptom(insomnia and dreaminess,chest tightness and flank pain,annoyed and irritable,dry mouth)scores in the both groups were significantly decreased(P<0.05),which decreased notably in the treatment group compared with the control group(P<0.05).CORT,ACTH,5-HT,5-HIAA in the both groups were significantly decreased(P<0.05),which were significantly lower in the treatment group than in the control group(P<0.05).SDNN,RMSSD and NNMean in the both groups were significantly increased(P<0.05),the increase in the treatment group was more common than the control group(P<0.05).After treatment,significantly

关 键 词：入睡和睡眠障碍 针灸疗法 

分 类 号：R256.230.58[医药卫生—中医内科学] R245[医药卫生—中医学]