针灸结合头颈部经穴推拿、耳穴贴压技术治疗失眠36例疗效观察 罗国超?吴伟文摘要 目的 評价针灸结合头颈部经穴推拿、耳穴贴压技术对失眠症患者睡眠质量的改善作用。 方法 将2015年8月2016年8月在我院中医科和心理科的72例失眠患者作为研究对象。随机分为对照组和观察组，各36例，观察组给予针灸结合头颈部经穴推拿、耳穴贴压技术治疗；对照组单纯口服舒乐安定片。对比分析两组临床疗效、治疗前后匹兹堡睡眠质量指数（PSQI）及不良反应发生情况。 结果 观察组治疗有效率为94.44%，对照组治疗有效率为72.22%，两者比较差异有统计学意义（2=12.865，P关键词 针灸；头颈部；经穴推拿；耳穴贴压；失眠 R246.6 A 2095-0616（2017）09-45-04Observation of curative effect of acupuncture and moxibustion combined with meridian point massage of head and neck and auricular point sticking technique in treatment of insomnia in 36 casesLUO Guochao WU WeiwenMeixian Hospital of Traditional Chinese Medicine，Meizhou 514011，ChinaAbstract Objective To evaluate the effect of acupuncture and moxibustion combined with meridian point massage of head and neck and auricular point sticking technique on improving sleep quality of patients with insomnia. Methods 72 patients with insomnia who were treated in Department of Chinese Medicine and Psychological Department in our hospital from August 2015 to August 2016 were selected as research objects.They were randomly divided into the control group and the observation group，with 36 in each.The observation group was given acupuncture and moxibustion combined with meridian point massage of head and neck and auricular point sticking technique while the control group was only given oral estazolam tablets.Clinical curative effects，Pittsburgh sleep quality index （PSQI） before and after treatment and occurrence of adverse reactions of two groups were compared and analyzed. Results Effective rates of the observation group and the control group were 94.44% and 72.22% respectively.There was significant difference in comparison of two groups （2=12.865，P0.05）.Scores after treatment of the control group and the observation group were both significantly lower than those before treatment （8.762.05） vs （14.012.13），（5.122.56） vs （13.982.25）.The difference was significant （t=7.765，8.754，P0.05）.Scores after treatment of patients in the observation group was （5.122.56），significantly lower than that of the control group （8.762.05）.The difference was significant （t=9.686，P0.05）.The incidence of adverse reactions in the observation group was 5.56%，lower than that in the control group 27.78%.The difference was significant （2=10.863，P0.05）。具有可比性。诊断标准：以中国精神科学会精神疾病分类与诊断标准（第2版）5（试行）作为本课题失眠纳入及中医证型诊断标准。纳入标准：（1）符合失眠诊断且本人对研究内容知情同意；（2）病程30d以上；（3）年龄1872岁。剔除标准：（1）近30日内服用精神类药物或有感染征兆；（2）罹患精神障碍无法理解和沟通；（3）伴有严重的重要器官器质性变病。1.2 方法观察组患者采用针灸结合头颈部经穴推拿、耳穴贴压技术治疗。（1）针刺治疗：患者均用0.25mm40mm华佗牌一次性针灸针进行操作，进针前嘱患者平卧，安抚并消除其紧张及顾虑，以免发生晕针。针刺选穴百会、神庭、四神聪、安眠（双）、睡眠点（双）、内关（双）、神门（双）、中脘、足三里（双）、三阴交（双）、申脉（双）、照海（双）。根据患者情况随证加减，头痛者加刺镇静穴和风池；肝气不舒者加膻中、太冲；体弱乏力气虚者加气海、关元；形瘦眩晕阴虚者加肾俞、太溪；形胖体困痰湿者加天枢、丰隆；畏寒肢冷阳虚者加灸箱灸神阙。行针深度、角度因针刺部位而定，所有穴位均采用平补平泻手法，以得气为度，得气后留针30min。每天针灸一次。（2）头颈部经穴推拿方法：患者采用仰卧位，医者采用揉法或一指禅推法，从患者印堂开始逐渐向上到达神庭再到百会，然后再从神庭向两侧沿眉至太阳穴，往返推拿各67次；而后用双手的拇指分别推两侧前额、眉弓至太阳穴共35次，指振太阳穴10min；再用双手拇指指腹从患者的印堂穴沿着鼻两侧分别推至迎香穴，共推3min，然后用十指的指端在头两侧胆经循行部位进行掐法治疗23min，点按角孙穴和头维穴，推拿五经；最后用拇指指端或中指指端点揉安眠穴5min，拿捏风池穴和肩井穴35min。若颈部有疼痛、发僵等功能失调，可在龙氏正骨三步定位诊断法下行仰头摇正法等手法复位调节。头颈部经穴推拿治疗每天进行一次。（3）耳穴贴压技术：首先对贴压部位皮肤进行酒精或碘伏消毒，可以选择的穴位包括神门、内分泌、耳穴心、皮质下、交感、神经衰弱点，指腹贴压王不留行籽进行揉捏，力度以局部出现微疼、麻、热为宜，教会患者后可由本人实施，每个穴位1525s，35次/d，左右耳轮流交替。对照组给予口服舒樂安定（浙江医药股份有限公司新昌制药厂，H20056780），每晚12mg，睡前服。1.3 观察指标与疗效评价标准6-7比较两组患者的治疗有效率、匹兹堡睡眠质量指数量表（PSQI）评分情况以及不良反应的发生情况。痊愈：每晚安睡时间6h，并且持续时间30d，期间可有2d睡眠差；显效：每晚安睡时间46h，期间可有3d连续睡眠差，并且自我调节有效；好转：每晚安睡时间45h，期间可有5d连续睡眠差，患者难以自我调节或效果差；无效：治疗后睡眠时间与治疗前无异。有效率=（痊愈例数+显效例数+好转例数）/总例数100%。1.4 统计学方法将项目获得的原始数据输入Excel软件中，后用SPSS19.0数据包处理，计数资料如治疗有效率等以百分率表示，组间比较用2检验，计量资料以用（）表示，采用t检验。P0.05为差异有统计学意义。2 结果2.1 两组患者临床疗效比较观察组治疗有效率为94.44%，对照组治疗有效率为72.22%，两者比较差异有统计学意义（2=12.865，P0.05），对照组与观察组患者治疗后评分均显著低于治疗前（8.762.05）vs（14.012.13），（5.122.56）vs（13.982.25），差异有统计学意义（t=7.765，8.754，P0.05）。且治疗后观察组患者评分显著低于对照组（5.122.56 vs 8.762.05），差异有统计学意义（t=9.686，P0.05），见表2。