芒针透刺督脉组穴配合隔姜灸治疗脑卒中后睡眠障碍疗效及机制研究

目的:以芒针透刺督脉组穴配合隔姜灸对脑卒中后睡眠障碍患者进行干预治疗,观察患者睡眠改善情况及血清5-羟色胺(5-HT)、去甲肾上腺素(NA)和乙酰胆碱(Ach)水平变化,并分析其机制。方法:将同期收治的76例脑卒中后睡眠障碍患者采用随机数字表法分为观察组与对照组各38例。两组均给予脑卒中后常规西医康复治疗,在此基础上对照组辅以传统针灸治疗,观察组采用芒针透刺督脉组穴配合隔姜灸治疗,均连续治疗8周。治疗前后分别测定两组匹兹堡睡眠质量指数(PSQI)、睡眠状况自评量表(SSRS)、美国国立卫生研究院卒中量表(NIHSS)评分,据以计算睡眠障碍治疗总有效率;检测两组血清5-HT、NA和Ach水平,并观察有无不良反应。结果:两组治疗后PSQI、SSRS、NIHSS评分均较治疗前明显降低(P<0.05),且观察组治疗后各评分均明显低于对照组(P<0.05);观察组和对照组睡眠障碍治疗总有效率分别为92.11%、76.38%,两组比较差异有统计学意义(P<0.05);两组治疗后血清5-HT、NA、Ach水平均较治疗前明显提高(P<0.05),且观察组治疗后各指标均明显高于对照组(P<0.05);两组在治疗期间均未发生明显不良反应。结论:芒针透刺督脉组穴配合隔姜灸治疗脑卒中后睡眠障碍安全有效,可明显改善患者预后,机制可能与上调神经递质水平有关。

Effect and Mechanism of Elongated Needle Penetrating Acupoint Group of Dumai Combined with Ginger-separated Moxibustion in Treating Post-stroke Sleep Disorder

Objective:To treat patients with post-stroke sleep disorder and observe the improvement of sleep and the changes of serum 5-hydroxytryptamine(5-HT),noradrenaline(NA) and acetyl choline(Ach) and to analyze its mechanism by elongated needle penetrating acupoint group of Dumai combined with ginger-separated moxibustion. Methods:A total of 76 patients with post-stroke sleep disorders in the same period were selected and randomly divided into the observation group(n= 38) and control group(n= 38) according to random number table method. Both groups were given conventional western medicine rehabilitation after stroke. The control group was treated with conventional acupuncture and moxibustion,while the observation group was treated with elongated needle penetrating acupoint group of Dumai combined with ginger-separated moxibustion for continuous 8 weeks. Pittsburgh sleep quality index(PSQI),sleep state self-rating scale(SSRS),and national institutes of health stroke scale(NIHSS)scores were determined before and after treatments so as to calculate the effectiveness of the treatment of sleep disorders. The serum levels of 5-HT,NA and Ach were detected in both groups,and observed for adverse reactions. Results:After treatment,PSQI,SSRS,and NIHSS in the two groups were significantly lower than before treatment(P< 0.05),and the scores in the observation group were significantly lower than those in the control group(P< 0.05). The effective rates of the observation group and the control group were 92.11%%and 76.38%% respectively,the difference between the two groups was statistically significant(P< 0.05);the levels of 5-HT,NA,and Ach in the serum of the two groups were significantly higher than those before the treatment(P< 0.05),and after treatment,all indicators were significantly higher in the observation group than those in the control group(P< 0.05). No significant adverse reactions occurred during the treatment in both groups.Conclusions:Elongated needle penetrating acupoint group of Dumai combined with ginger-separated moxibustion in treating post-stroke sleep disorder is safe and effective,which can significantly improve the prognosis of patients. The mechanism may be related to the upregulation of neurotransmitter levels.