目的 观察调督安神针刺治疗卒中后失眠的睡眠质量及情绪的影响。方法 2016年6月-2018年1月共招募卒中后失眠患者148例，按照随机数字表1:1分成治疗组(针刺组)74例与对照组(假针刺组)74例。治疗组取神庭、百会、印堂、双侧神门、双侧安眠及双侧三阴交。针刺治疗每次持续20 min，每周3次，共治疗4周，4周随访。对照组采用不破皮的假针刺治疗，选穴、治疗时间及频次与治疗组相同。两组治疗前、治疗2周、治疗4周及随访均予以评估失眠严重程度指数量表(Insomnia severity index，ISI)、医院焦虑抑郁量表(Hospital anxiety depression scale，HADS)及脑卒中专用生活质量量表(Stroke specific quality of life，SS-QoL)，并记录针刺的不良反应。结果 ①ISI评分:治疗2周、治疗4周及随访，治疗组的评分较对照组降低，组间差异具有明显统计学意义(P＜0。01)，与治疗前相比，治疗组的ISI评分在治疗4周后出现了下降(P＜0。05)。②HADS评分:治疗后的HADS-A分数和基线之间的分数差值，治疗组大于对照组，两组间对比具有统计学差异(P＜0。01);完成治疗后与基线、随访与基线的HADS-D评分差值，治疗组大于对照组，两组间差异有统计学意义(P＜0。01)。③SS-QoL评分:治疗中与基线、治疗后与基线、随访与基线的SS-QoL评分差值，治疗组高于对照组，两组差异有统计学意义(P＜0。01)。结论 针刺可显著改善卒中后失眠患者的失眠严重程度，针刺能有效改善患者的焦虑抑郁的情绪状态和生活质量，针刺可能是防治卒中后失眠的一种有效方法，且安全性较高。
Efficacy of Acupuncture in Treating Post-stroke Insomnia
Objective To explore the clinical efficacy of acupuncture on post-stroke insomnia.Methods 148 outpatients and inpatients with post-stroke insomnia were recruited in the Shanghai municipal Hospital of Traditional Chinese Medicine from June 2016 to January 2018.They were randomly divided into two groups,acupuncture group(n=74)and control group(n=74).The acupuncture group was treated with GV20,GV24,GV29,HN22,HT7 and SP6 20 minutes each time,3 times per week for 4 weeks.The follow-up was after 4 weeks.The control group was treated with sham acupuncture on the same acupoints.The needles did not pierce the skin.The Insomnia Severity Index Scale(ISI),the Hospital Anxiety and Depression Scale(HADS)and the Stroke Special Quality of Life Scale(SS-QoL)were used to evaluate the patients before treatment,after 2 weeks of treatment,after 4 weeks of treatment and follow-up.The occurrence of adverse events of acupuncture was also recorded.Results ① ISI:after 2 weeks of treatment,4 weeks of treatment and follow-up,the score of treatment group was decreased compared with the control group,and the difference was statistically significant(P＜0.01).Compared with baseline,the ISI score of the treatment group was decreased after 4 weeks of treatment(P＜0.05).② HADS score:The difference between 4-week treatment and baseline score of the HADS-A,the difference between the treatment group and the control group was statistically significant(P＜0.01);the difference between 4-week treatment and baseline,and between follow-up and baseline score of the HADS-D,the difference between the treatment group and the control group was statistically significant(P＜0.01).③SS-QoL score:The difference between 2-week treatment and baseline,between 4-week treatment and baseline,and between follow-up and baseline score of the SS-QoL,the difference between the treatment group and the control group was statistically significant(P＜0.01).Conclusion Acupuncture is an effective and safe therapy in improving the severity of insomnia of patients with post-stroke insomnia.Compared with sham acupuncture,acupuncture can improve the anxiety and depression status and quality of life of patients.
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