观察调神针法对慢性失眠症患者过度觉醒状态的影响＊

目的 观察调神针法治疗慢性失眠症的疗效,并基于“过度觉醒”探讨针刺治疗慢性失眠症的潜在机制。方法 将60例慢性失眠症（Chronic insomnia, CI）患者,随机分为调神针刺组（试验组）30例和假针刺组（对照组）30例。调神针刺组选用百会、印堂、神门（双）、三阴交（双）,假针刺组采用非病症相关穴位浅刺的方法。两组均隔日治疗1次,每周3次,连续4周。比较两组患者治疗前后及结束治疗1月随访时匹兹堡睡眠指数量表（Pittsburgh sleep quality index, PSQI）总积分及各因子积分、过度觉醒量表（Hyperarousal scale, HAS）积分、血清皮质醇（Cortisol, CORT）浓度变化。结果 治疗后与随访时比较,调神针刺组各量表积分较治疗前均明显下降（P < 0.01）;治疗后血清CORT较治疗前明显下降（P < 0.01）。治疗后,假针刺组PSQI总分及血清CORT与治疗前比,均明显下降（P < 0.05）;随访时假针刺组各量表积分与治疗前比较,均无统计学意义（P > 0.05）。调神针刺组各量表积分及血清CORT降低均明显优于假针刺组（P < 0.01）。结论 调神针法可明显改善慢性失眠症患者睡眠质量、过度觉醒状态,降低血清CORT浓度可能是潜在作用机制之一。

To Observe the Effect of Tiaoshen Acupuncture on Hyperarousal in Patients with Chronic Insomnia

Objective To observe the therapeutic effect of acupuncture therapy on chronic insomnia, and to explore the potential mechanism of the Tiaoshen acupuncture therapy on chronic insomnia based on hyperarousal.Methods A total of 60 chronic insomnia patients were randomly divided into the Tiaoshen acupuncture group and the sham acupuncture group, with 30 patients in each group. The Tiaoshen acupuncture group selected Baihui (DU20), Yintang (EX-HN3), Shenmen (TF4) (bilateral), Sanyinjiao (SP6) (bilateral). Sham acupuncture group used non-meridian non-acupoint shallow acupuncture. All patients were treated once every other day, three times a week, for 4 weeks. The PSQI score and HAS score were compared before and after treatment and during follow-up. Serum cortisol concentrations were measured before and after treatment and adverse reactions were recorded.Results After treatment, there was no statistically significant difference in scores of all scales between the Tiaoshen acupuncture group and the follow-up group (P > 0.05), and the difference was significantly lower than that before treatment (P < 0.01). Serum CORT decreased significantly after treatment compared with before treatment (P < 0.01). After treatment, the PSQI total score, daytime dysfunction score and serum CORT in the sham acupuncture group were statistically significant compared with those before treatment (P < 0.05). There was no statistically significant difference between the scores of all scales in the sham acupuncture group and those before treatment (P > 0.05). The scores of all scales and the reduction of serum CORT in the Tiaoshen acupuncture group were significantly better than that in sham acupuncture group (P < 0.01).Conclusion The method of Tiaoshen acupuncture can significantly improve the sleep status and the state of overarousal in CI patients, and it has a stable long-term efficacy. Reducing the serum CORT concentration may be one of the potential mechanisms.