Page 98 - 2022-27-中国全科医学

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·3423·

outpatients and inpatients with post-ischemic stroke insomnia were recruited from the First Affiliated Hospital of Guangdong
Pharmaceutical University from May 2020 to May 2021，and equally divided into a Chinese medicine group（treated using
needling posterior neck meridian sinews nodes and herbal ointment externally applied to Yongquan acupoint） and a Western
medicine group（treated using estazolam） by complete randomization. Both groups were treated for two treatment cycles （10
times of treatment as one cycle）. Comparisons of intergroup differences were made in terms of the total score and domain
scores（subjective sleep quality，sleep latency，sleep duration，habitual sleep efficiency，sleep disturbances，use of sleep
medication，and daytime dysfunction） of Pittsburgh Sleep Quality Index（PSQI），Athens Insomnia Scale （AIS） score，
and serum IL-6 and TNF-α levels at baseline，and the end of the first and second cycles of treatment，as well as overall
efficacy. Results All patients were included for analysis except for three dropouts（one was treated with Chinese medicine and
the other two with Western medicine）. The type and duration of treatment had significant interaction effects，and main effects on
mean total score of PSQI and mean score of each of its domains as well as mean AIS score（P<0.05）. After the end of the first or
second treatment cycle，the mean total score and domain scores of PSQI as well as mean AIS score in both groups were lower than
before treatment(P<0.05). After the end of the second treatment cycle，the mean total score and domain scores of PSQI as well as
mean AIS score in both groups were lower than the end of the first treatment cycle（P<0.05）. After the end of the first or second
treatment cycle，the mean total score and domain scores of PSQI as well as mean AIS score in Chinese medicine group were lower
than those in Western medicine group（P<0.05）. The type and duration of treatment produced significant interaction effects，
and main effects on mean levels of serum IL-6 and TNF-α（P<0.05）. After the end of the second treatment cycle，the mean
levels of serum IL-6 and TNF-α in both groups were lower than the end of the first treatment cycle（P<0.05）. After the end of
the first or second treatment cycle，the mean levels of serum IL-6 and TNF-α in Chinese medicine group were lower than those
in Western medicine group（P<0.05）. The overall clinical efficacy of Chinese medicine group was better than that of Western
medicine group （Z=2.234，P<0.05）. Conclusion Compared to estazolam，needling posterior neck meridian sinews nodes in
combination with herbal ointment externally applied to Yongquan acupoint achieved more significantly improved sleep quality and
reduced serum IL-6 and TNF-α levels as well as higher overall efficacy in post-ischemic stroke insomnia patients.
【Key words】 Ischemic stroke；Sleep initiation and maintenance disorders；Meridian relieving knot；Yongquan
application；Interleukins；Tumor necrosis factor-alpha；Insomnia；Treatment outcome

在老龄化背景下，缺血性中风发病呈年轻化、患病 现炎性因子水平与缺血性中风后失眠的相关研究较为欠
率呈逐年上升趋势，而失眠是该病常见并发症之一。据 缺 ［5-6］ 。因此，有必要全面且深入地探讨缺血性中风
文献报道，脑血管疾病患者中约 95% 存在睡眠障碍 ［1］ 。 后失眠，寻找一种安全、高效的治疗手段。本研究探讨
缺血性中风后失眠以日间困乏、夜晚入睡困难、觉期易 经筋解结联合涌泉贴敷治疗缺血性中风后失眠患者的效
醒等为主要表现，可诱发抑郁、焦虑，同时影响缺血性 果，并分析其对血清 IL-6、TNF-α 水平的影响，现报
中风患者神经功能康复，严重危及生活质量。目前西医 道如下。
对该病主要采用药物（催眠药）与非药物（音乐治疗、 1 资料与方法
认知治疗等）干预治疗，前者可引起药物依赖、停药症 1.1 一般资料 选取 2020 年 5 月至 2021 年 5 月在广
状及并发症，后者复发率高 ［2］ 。近年来，中医疗法凭 东药科大学附属第一医院门诊就诊或住院的缺血性中风
借价格低廉、不良反应小、疗效确切等优势颇受青睐。 后失眠患者 80 例。本试验的设计方法为平行对照设计，
对于缺血性中风后失眠患者，中医在辨证论治的基 采用完全随机分组方法，把 1~80 的编号输入统计软件
础上采用传统针灸、推拿、中药内服外敷等方法进行治 SPSS 26.0，生成随机数字表，输出随机分组及随机号，
疗。鉴于治疗该病有长期的临床经验累积，在治疗思路 装信封备用，按病例纳入顺序拆开信封确定组别，按 1∶1
上常以头部取穴为主，讲求局部辨病，缺乏如“远道 的比例分为中医治疗组、西药治疗组，各 40 例。入组
刺”“上病下取”等配穴思路的应用。在治疗理论中， 时收集患者的一般资料，包括性别、年龄、体质指数、
关于“经筋结点”“解结针法”等研究较少，经筋论治 失眠病程、既往史（包括吸烟、饮酒、高血压、糖尿病、
该病的机制不够深入。此外相关研究发现，失眠可引起 高脂血症情况）。将平均吸烟≥ 1 支 /d，时间≥ 12 个
神经 - 内分泌 - 免疫系统血清标志物改变，其中白介 月定义为吸烟；将酒精摄入量≥ 50 g/d 定义为饮酒。本
素 6（interleukin- 6，IL-6）和肿瘤坏死因子 α（tumor 研究经广东药科大学附属第一医院伦理委员会批准，审
necrosis factor-α，TNF-α）是研究较多的炎性因子， 批编号：医伦审〔2020〕第（65）号，患者及家属均签
突出表现为炎性反应过度激活 ［3-4］ 。回顾既往文献，发 署知情同意书。