针刺加重复经颅磁刺激治疗脑卒中后失眠的临床观察

目的:评价“通督调神法”针刺加重复经颅磁刺激(rTMS)治疗脑卒中后失眠的临床疗效。方法:将72例脑卒中后失眠患者随机分为2组,每组36例。对照组采用频率1 Hz、运动阈值90%的rTMS治疗,观察组在对照组rTMS治疗基础上加“通督调神法”针刺治疗。穴位取百会、神庭、印堂、风府、四神聪、神门、三阴交、申脉和照海。每日治疗1次,每周治疗5d后休息2d,共治疗4周。现察两组治疗后匹兹堡睡眠质量指数(PSQI)、焦虑自测量表(SAS)和抑部自测量表(SDS)评分改善情况,并进行两组临床疗效比较。结果:治疗4周后,两组PSQK SAS及SDS评分均降低,组内差异均有统计学意义(均P<0.001);观察组治疗后三项评分均低于对照组,组间差异均有统计学意义(P<0.05,P<0.05,P<0.001),现察组和对照组临床疗效差异有统计学意义(P<0.05)。结论:“通督调神法”针刺加rTMS治疗脑卒中后失眠疗效优于单独rTMS治疗,且能更好地改善患者焦虑、抑耶情绪。

Clinical observation of acupuncture plus repetitive transcranial magnetic stimulation in the treatment of post-stroke insomnia

Objective:To evaluate the clinical efficacy of the Governor Vessel-unblocking and mind-regulating acupuncture method plus repetitive transcranial magnetic stimulation(rTMS)in the treatment of post-stroke insomnia.Methods:A total of 72 patients with post-stroke insomnia were randomly divided into 2 groups,with 36 cases in each group.The control group received rTMS treatment with a frequency of 1 Hz and a motion threshold value of 90%.The observation group received acupuncture with Governor Vessel-unblocking and mind-regulating method based on the rTMS treatment of the control group.The points were Baihui(GV 20),Shenting(GV 24),Yintang(GV 29),Fengfu(GV 16),Sishencong(EX-HN I),Shenmen(HT I),Sanyinjiao(SP 6);Shenmai(BL 62)and Zhaohai(Kl 6).The treatment was performed once a day for 5 d a week followed by 2 d of rest for 4 weeks.The improvements of Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)scores were observed after treatment,and the clinical efficacy was compared between the two groups.Results:After 4 weeks of treatment,the PSQI,SAS,and SDS scores of the two groups were all reduced,and the intra-group differences were statistically significant(all P<0.001).After treatment,the three scores in the observation group were all lower than those in the control group,and the differences between the two groups were statistically significant(P<0.05,P<0.05,P<0.001).There was a statistically significant difference between the observation group and the control group comparing the clinical efficacy(P<0.05).Conclusion:The therapeutic effect of the Governor Vessel-unblocking and mind-regulating acupuncture method plus rTMS in treating post-stroke insomnia is better than rTMS alone,and it can better improve the anxiety and depression of patients.