摘要
目的 探讨经皮耳迷走神经电刺激(taVNS)联合电干针(EDN)治疗对颈型颈椎病患者睡眠、疼痛及焦虑抑郁的影响.方法 将符合纳入标准的74例患者采用随机数字表法分为试验组(T组)和对照组(C组),每组37例.所有患者均口服镇痛药物,T组予以持续1周的taVNS联合2次EDN治疗,C组予以持续1周的假刺激联合2次EDN治疗(2次EDN治疗间隔1周;taVNS和假刺激每日2次,单次持续30 min,连续刺激1周).比较两组患者治疗前1d(T0)以及治疗后4周(T2)、治疗后8周(T3)、治疗后12周(T4)时匹兹堡睡眠指数量表(PSQI)评分、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分及睡眠障碍、焦虑情绪、抑郁情绪情况;比较两组患者T0、治疗后ld(Tl)、T2、T3、T4时视觉模拟评分法(VAS)疼痛评分;分析两组患者T0、T1时心率变异性(HRV)中低频/高频(LF/HF)的测量结果;统计两组患者住院期间镇痛药物用量及不良反应发生情况.结果 70例患者完成研究,T组35例,C组35例.与T0比较,两组患者T2、T3、T4时PSQI评分、HAMA评分、HAMD 评分降低(均 P＜0.05);T1、T2、T3、T4 时 VAS 疼痛评分降低(均 P＜0.05);T1 时 LF/HF 降低(均 P＜0.05).T 组 T2、T3、T4 时PSQI评分,T1时LF/HF,T1、T2、T3、T4时VAS疼痛评分,T2、T3时HAMA评分、HAMD评分低于C组(均P＜0.05).T组艾瑞昔布用量少于C组(P＜0.05).两组患者其余指标差异无统计学意义(均P＞0.05).结论 taVNS联合EDN治疗可以提高颈型颈椎病患者的睡眠质量,改善疼痛及焦虑抑郁情绪,减少住院期间镇痛药物用量,调节自主神经功能.
Abstract
Objective To explore the effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with electro-dry needling(EDN)on sleep,pain,anxiety,and depression in patients with cervical spondylosis.Methods According to the random number table method,74 patients who met the inclusion criteria were divided into two groups(n=37):an experimental group(group T)and a control group(group C).All the patients were orally administered with analgesics.Group T received taVNS combined with two sessions of EDN over one week,while group C received sham stimulation combined with two sessions of EDN over the same pe-riod(there was a one-week internal between the two EDN sessions;taVNS and sham stimulation were administered twice daily,30 min each and continuously for one week).The Pittsburgh Sleep Quality Index(PSQI)scores,Hamilton Anxiety Scale(HAMA)scores,and Hamilton Depression Scale(HAMD)scores were recorded for assessment of sleep disturbances,anxiety,and depressive moods between the two groups before treatment(T0)and at post-treatment 4 weeks(T2),8 weeks(T3),and 12 weeks(T4).Their Visual Analog Scale(VAS)scores were recorded at T0,on post-treatment 1 day(T1),T2,T3,and T4.Then,low frequency/high frequency(LF/HF)measure-ments in heart rate variability(HRV)were analyzed at T0 and T1.The usage of analgesics and occurrence of adverse reactions during hospitalization were also recorded.Results A total of 70 patients completed the study,including 35 in group T and 35 in group C.Compared with those at T0,both groups showed reduced PSQI,HAMA,and HAMD scores at T2,T3,and T4(all P＜0.05);VAS scores decreased at T1,T2,T3,and T4(all P＜0.05);and LF/HF decreased at T1(all P＜0.05).Group T had lower PSQI scores at T2,T3,and T4,lower LF/HF at T1,lower VAS scores at T1,T2,T3,and T4,as well as lower HAMA and HAMD scores at T2 and T3 than group C(all P＜0.05).The dosage of etoricoxib used in group T was lower than that in group C(P＜0.05).No statistical differences were observed in other indicators between the two groups(all P＞0.05).Conclusions The combination of taVNS and EDN can improve sleep quali-ty,alleviate pain,and reduce anxiety and depression in patients with cervical spondylosis,decrease the usage of analgesics during hos-pitalization,and modulate autonomic nervous function.
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