本文選題：五花穴 + 鎮(zhèn)靜穴　； 參考：《廣州中醫(yī)藥大學》2016年博士論文

【摘要】：目的：本課題旨在通過臨床以及實驗室的隨機對照實驗,探討董氏奇穴之鎮(zhèn)靜穴和五花穴治療失眠的機制、臨床療效及起效規(guī)律,豐富臨床治療失眠的手段。方法：實驗研究方面,本研究選用40只SD大鼠,隨機分為空白組、模型組、實驗組及藥物組。空白組為正常對照組；模型組采用腹腔注射PCPA,以制備失眠大鼠模型；實驗組為造模后給予連續(xù)的五花穴配鎮(zhèn)靜穴針法治療；藥物組為西藥對照組。通過對比董氏奇穴組及藥物組大鼠治療后腦組織內(nèi)NE、5-HT和5-HIAA的含量,探討該法治療睡眠障礙的神經(jīng)機制。各組數(shù)據(jù)以均數(shù)±標準差(x±s)表示,采用SPSS20.0統(tǒng)計軟件進行統(tǒng)計學處理。臨床實驗方面,篩選出符合納入標準的60名患者進入臨床研究,隨機分配到治療組及對照組。治療組采用五花穴配合鎮(zhèn)靜穴針刺治療,對照組采用傳統(tǒng)針刺治療(參照石學敏主編的《針灸治療學》教材“不寐”的治療方法取穴)。每日1次,6次為一療程,療程間休息1天,連續(xù)治療2個療程,療程結(jié)束后于第4周隨訪。治療前后,采用失眠臨床癥狀積分、中醫(yī)證候積分、匹茲堡睡眠質(zhì)量指數(shù)量表、失眠嚴重程度指數(shù)量表對失眠患者的睡眠狀況進行評價,并結(jié)合治療后PSQI評分減分率進行療效評定。采用SPSS20.0統(tǒng)計軟件對數(shù)據(jù)加以分析。結(jié)果：一、動物實驗(一)針刺和藥物灌胃后,實驗組和藥物組大鼠日�；顒訙p少,進食及飲水頻率降低,睡眠時間延長,與模型組有明顯差別。(二)大鼠睡眠腦干網(wǎng)狀結(jié)構(gòu)中5-HT、5-HIAA和NE含量失眠大鼠5-HT和5-HIAA含量顯著降低；實驗組和藥物組在完成治療后均可明顯提高5-HT和5-HIAA含量,與模型組比較有顯著性差異(P0.05),兩種方法在提高5-HT和5-HIAA含量方面沒有顯著差異。失眠大鼠NE含量顯著升高；實驗組和藥物組分別與模型組比較有顯著性差異(P0.05),提示兩組在完成治療后均可明顯降低NE含量；實驗組和藥物組兩者差異具有統(tǒng)計學意義,提示兩種方法在降低NE含量方面具有可比性,實驗組比藥物組療效更顯著。二、臨床試驗(1)失眠臨床癥狀積分兩組治療前失眠臨床癥狀積分總分P0.05,具有可比性。2個療程結(jié)束后,兩組治療前后失眠臨床癥狀積分有顯著差異,提示兩組均治療有效。治療組評分下降幅度高于對照組,可以認為董氏奇穴五花穴配合鎮(zhèn)靜穴針刺對比常規(guī)針刺,在改善失眠臨床癥狀積分具有更好的療效。兩組治療后與隨訪比較有統(tǒng)計學意義,說明兩組具有一定的遠期療效,但對照組積分較治療后降低,治療組積分升高,可認為對照組在改善患者失眠癥狀方面的遠期療效優(yōu)于治療組。(2)中醫(yī)證候觀察指標兩組治療前中醫(yī)證候觀察量表總分P0.05,差異具有可比性。2個療程結(jié)束后,兩組治療前后對比,P=0.00000.05,有顯著差異,提示兩組治療對于改善中醫(yī)證候有效。治療組評分下降幅度高于對照組,可以認為董氏奇穴五花穴配合鎮(zhèn)靜穴針刺對比常規(guī)針刺,在改善中醫(yī)證候方面具有更好的療效。兩組治療后與隨訪比較有統(tǒng)計學意義,說明兩組具有一定的遠期療效,但對照組積分較治療后降低,治療組積分升高,可認為對照組在改善中醫(yī)證候方面的遠期療效優(yōu)于治療組。(3)匹茲堡睡眠質(zhì)量指數(shù)(PSQI)積分治療前兩組相比具有可比性。兩組治療后睡眠質(zhì)量、睡眠效率日間功能障礙有顯著差異,提示治療組在這些方面的療效比對照組突出。隨訪兩組PSQI各組成,其中睡眠質(zhì)量、睡眠效率和日間功能障礙均有顯著差異,提示治療組在這些方面的長期療效比對照組突出,而在入睡時間、睡眠時間、睡眠障礙、睡眠藥物方面對比沒有統(tǒng)計學意義,兩組遠期療效相當。兩組治療前評分結(jié)果,P0.05,差異無統(tǒng)計學意義,提示兩組具有可比性。兩組治療前后對比均有顯著差異,提示治療有效。兩組治療后差別具有統(tǒng)計學意義,說明治療組療效優(yōu)于對照組。在隨訪時兩組對比差別無統(tǒng)計學意義,治療組積分有所上升,而對照組積分下降,可以認為董氏奇穴五花穴配合鎮(zhèn)靜穴針刺對比常規(guī)針刺,在改善PSQI評分方面的遠期療效不如對照組。(4)失眠嚴重程度評分2個療程結(jié)束后,根據(jù)失眠嚴重程度指數(shù)評分結(jié)果統(tǒng)計,治療組和對照組治療前后的對照有顯著差異。兩組治療后評分有差異,治療組評分下降幅度高于對照組,可以認為董氏奇穴五花穴配合鎮(zhèn)靜穴針刺對比常規(guī)針刺,在改善失眠嚴重程度方面具有更好的療效。兩組治療后與隨訪的評分對照顯示,P0.05,差異有統(tǒng)計學意義,治療組積分有所上升,對照組積分下降,提示對照組的遠期療效優(yōu)于治療組。(5)兩組療效的比較根據(jù)療效評定標準,2個療程結(jié)束后,治療組對照組臨床痊愈13例,顯效10例,有效5例,無效2例,總有效率93.33%；對照組臨床痊愈8例,顯效5例,有效13例,無效4例,總有效率86.67%。兩組療效整體比較經(jīng)Ridit分析,u=2.1576,P=0.03100.05,差異有統(tǒng)計學意義,可以認為兩組療效不完全相同。治療組總要效率高于對照組,可以認為董氏奇穴五花穴配合鎮(zhèn)靜穴針刺對比常規(guī)針刺治療失眠有效率更高。結(jié)論：(1)董氏之五花穴配鎮(zhèn)靜穴對失眠大鼠有很好的療效。(2)董氏之五花穴配鎮(zhèn)靜穴能良性調(diào)節(jié)大鼠體內(nèi)影響睡眠的神經(jīng)遞質(zhì)的含量,能提高5-HT和5-HIAA含量,降低NE含量。(3)董氏之五花穴配鎮(zhèn)靜穴能較好地改善失眠患者的各類癥狀,具有一定的遠期療效,但這種療效比傳統(tǒng)針刺要差。(4)董氏之五花穴配鎮(zhèn)靜穴起效較快。
[Abstract]:Objective: this topic through randomized controlled trials and clinical laboratory, to explore the mechanism of acupuncture and acupoint Dong Qi acupuncture treatment of insomnia Wuhua sedation, clinical efficacy and effect of clinical treatment of insomnia, rich means. Methods: the experimental research, this study selected 40 SD rats were randomly divided into blank group, model group, experimental group and drug group. The blank group was normal control group; model group by intraperitoneal injection of PCPA, the model of insomnia rats in the experimental group; model is given after Wuhua pointacupuncture treatment continuous sedation with acupuncture point; drug group and control group of Western medicine. By comparing Dong Qi points group and drug group in the treatment of brain tissue in NE, the content of 5-HT and 5-HIAA, the neural mechanism of the treatment of sleep disorders. All the data were mean standard deviation (x + s) said, SPSS20.0 was used for statistical analysis. The clinical experiment The surface, selected into a clinical study of 60 patients included in the standard, were randomly assigned to treatment group and control group. The treatment group used five points with sedation acupuncture treatment, the control group used the traditional acupuncture therapy (treatment reference Shi Xuemin editor of the "acupuncture therapy > textbook" insomnia "acupoints) 1 times. Every day, 6 times for a course of treatment breaks 1 days, continuous treatment of 2 courses, after the end of treatment in fourth weeks. After treatment, the clinical symptoms of insomnia, TCM syndrome score, Pittsburgh sleep quality index, insomnia severity index of patients with insomnia sleep status were evaluated. And after treatment PSQI score reduction rate was evaluated. The data analyzed by SPSS20.0 statistical software. Results: 1. Animal experiment (1) Acupuncture and drugs after intragastric administration, the experimental group and the drug group rats decreased daily activities, Eating and drinking frequency decreased, sleep time prolonged, there was significant difference with the model group. (two) 5-HT sleep in the rat brain stem reticular structure, 5-HIAA and NE in the insomnia rats 5-HT and 5-HIAA were significantly reduced; the experimental group and the drug group in after completing treatment could significantly increase the content of 5-HIAA and 5-HT, there was significant difference compared with the model group (P0.05), there was no significant difference in the increase of 5-HT and 5-HIAA content of two kinds of methods. The content of NE in rat sleep increased significantly; the experimental group and the drug group were compared with the model group, there was significant difference (P0.05), suggesting that in the two groups after completing treatment could decrease the content of NE has statistical significance; the difference between the experimental group and the drug group, suggesting that the two methods in reducing the content of NE is comparable to that of the experimental group than the drug group, curative effect is more significant. Two clinical trials (1) insomnia clinical symptom score of two groups before treatment on insomnia The bed symptom score P0.05, comparable to.2 after the end of treatment, the two groups before and after treatment of insomnia clinical symptom scores were significantly different, suggesting that the two groups were effective therapy. Treatment group were decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in the improve insomnia symptom scores. The two groups after treatment and follow-up were statistically significant, indicating that the two groups have certain curative effect, but the control group scores decreased after therapy, the treatment group score increased, that the control group in the treatment group were better than those in long-term follow-up of patients with insomnia symptoms. (2) observation of syndromes index of the two groups before treatment, TCM syndrome score P0.05, the difference is comparable to that of.2 after the end of treatment, compared two groups before and after treatment of P=0.00000.05, there is a significant difference, suggesting that the treatment in the two groups for Improve the TCM syndrome. The treatment group was decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in improving the TCM. The two groups after treatment and follow-up were statistically significant, indicating that the two groups have certain curative effect, but the control group integral after treatment is reduced, the treatment group score increased, that the control group in the treatment group were better than those in the long-term curative effect of TCM syndrome. (3) Pittsburgh sleep quality index (PSQI) score before treatment in two groups were comparable. Two group after treatment, sleep quality, sleep efficiency and daytime dysfunction have significant differences. Effect of the treatment group in these areas than in the control group. The two groups were followed up PSQI highlight the quality of sleep, among them, significant differences in sleep efficiency and daytime dysfunction were the treatment group in the party The long-term curative effect than the control group in the prominent, sleep time, sleep time, sleep disorders, sleep medicine comparison was not statistically significant, a long-term curative effect in two groups. The two groups before treatment P0.05 score, the difference was not statistically significant, suggesting that the two groups were comparable. The two groups before and after treatment were significantly different. Prompt treatment is effective. The two groups were significant difference after treatment, the effect of the treatment group than the control group. In the follow-up between the two groups had no significant difference, the treatment group integral increased, while the control group scores decreased, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture, to improve the long-term effect of PSQI scores than the control group. (4) insomnia severity score after the 2 course of treatment, according to the results of insomnia severity index statistics, treatment group and control group before and after treatment of As there is a significant difference. The two groups after treatment score difference, treatment group were decreased than that of control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture has better curative effect in improving insomnia severity. The two groups after treatment and follow-up scores showed that P0.05 was statistically significant differences in scores of treatment group increased, the integral of control group than the treatment group decreased, the long-term curative effect that control group (5). The two groups were compared according to the evaluation standard, after the 2 course of treatment, clinical treatment group and control group 13 cases were cured, 10 cases markedly effective in 5 cases, 2 cases were invalid. The total efficiency of 93.33%; control group 8 cases were cured clinically, 5 cases were markedly effective, 13 cases effective, 4 cases ineffective, the total efficiency of the whole 86.67%. comparison of the two groups was analyzed by Ridit, u=2.1576, P=0.03100.05, the difference was statistically significant, that the efficacy of the two groups. All the same. The treatment group the total efficiency was higher than the control group, can think of Dong's extraordinary acupoints with acupuncture point five sedation compared with conventional acupuncture treatment of insomnia is more efficient. Conclusion: (1) the Dong Wuhua point with sedation acupuncture has good curative effect on insomnia rats. (2) the Dong Wuhua point and calm acupuncture can benignly regulate neurotransmitter content of sleep effect in rats, can improve 5-HT and 5-HIAA content, decreased the content of NE. (3) the Dong Wuhua point with sedation points can effectively improve the patients with insomnia symptoms, has certain curative effect, but the curative effect than traditional acupuncture to poor (4). The Dong Wuhua point with sedation points faster onset.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R245

【相似文獻】

相關(guān)期刊論文 前2條

1 熊云;楊宗保;;動穴的臨床應用探析[J];內(nèi)蒙古中醫(yī)藥;2013年03期

2 ;[J];;年期

相關(guān)博士學位論文 前1條

1 程希智;董氏之五花穴配鎮(zhèn)靜穴治療失眠的臨床與實驗研究[D];廣州中醫(yī)藥大學;2016年

，

本文編號：1739616