张镭潇 周思远 郑倩华 邓延莉 惠茹婷 胡幼平 罗荣 李瑛

摘要目的：比較针刺与安慰针刺对失眠伴焦虑情绪的临床疗效差异，为针刺治疗失眠症、改善受试者焦虑情绪及生命质量提供科学依据。方法：选取2014年2月至7月来自成都中医药大学附属医院、第三附属医院门诊患者和社会人士为受试者失眠伴焦虑情绪受试者67例，随机分为观察组和对照组。观察组即针刺组，观察病例33例；对照组即安慰针刺组，观察病例34例。2组受试者均采用Park Sham Placebo Acupuncture Device（PSD）针具配合针刺和安慰针刺，均选取主穴：神门、安眠、照海、申脉、内关、合谷、太冲，辨证配穴：心俞、脾俞、三阴交、胆俞、太溪、行间、侠溪、丰隆、内庭等，在10次治疗结束后和治疗后第1个月、第3个月进行临床疗效评价，包括匹兹堡睡眠质量指数（PSQI）、Zung焦虑自评量表（SAS）及针感量表的指标差异。结果：2组治疗结束后在PSQI各项指数、SAS标准分比较，针刺组改善明显，优于安慰针刺组（P<005）；在治疗后1个月、治疗后3个月发现PSQI各项指数、SAS标准分有不同程度的反弹，但针刺组的持续改善作用仍优于安慰针刺组（P<005）；针感量表评价中针刺组得气感强，安慰针刺组未获得有效针感（P<005），但2组均有较为明显的锐痛感（P>005）。结论：针刺并有效得气可大大改善受试者失眠症状及焦虑情绪，随着时间的推移，疗效有一定的持续性，且优于安慰针刺组。失眠越重，焦虑情绪也越重；针刺是改善失眠伴焦虑情绪的有效手段，能大大提高患者生命质量，可用于临床推广。

关键词失眠症；焦虑；针刺；安慰针刺

Clinical Randomized Control Study of Acupuncture Treatment for Insomnia with Anxiety

Zhang Leixiao1， Zhou Siyuan1， Zhen Qianhua1， Deng Yanli2， Hui Ruting3， Hu Youping1， Luo Rong1， Li Ying1

（Chengdu University of Traditional Chinese Medicine， Chengdu 610075， China； 2 The Second Hospital of Traditional Chinese Medicine in Sichuan， Chengdu 610031， China； 3 Chengdu Integrated Traditional Chinese and Western Medicine Hospital， Chengdu 610016， China）

AbstractObjective：To compare the clinical effects of acupuncture and placeboacupuncture on insomnia and anxiety， and to provide a scientific basis for acupuncture treatment of insomnia and improvement of anxiety and life quality. Methods：A total of 67 subjects with insomnia and anxiety were randomly divided into the experimental group and the control group， and they were randomly divided into experimental group and control group. The experimental group was acupuncture group with 33 cases. The control group was placeboacupuncture group with 34 cases. Both groups used Park Sham Placebo Acupuncture Device （PSD） needles with acupuncture and placeboacupuncture. The main points they selected such as Shenmen （HT7）， Anmian， Zhaohai （KI6）， Shenmai （BL62）， Neiguan （PC6）， Hegu （LI4）， Taichong （LV3） and the dialectical points：Xinshu （BL15）， Pishu （BL20）， Sanyinjiao （SP6）， Danshu （BL19）， Taixi （KI3）， Xingjian （LV2）， Xiaxi （GB43）， Fenglong （ST40）， Neiting （ST44） were clinically curative after 10 treatments and 1 month and 3 months after treatment. Assessments included Pittsburgh Sleep Quality Index （PSQI）， Zung Anxiety SelfRating Scale （SAS）， and acupuncture scales. Results：Compared with PSQI indexes and SAS standard scores after treatment， the acupuncture group was significantly better improved than the placeboacupuncture group （P<005）； 1 month after treatment and 3 months after treatment. it was found that PSQI indices and SAS scores rebounded to varying degrees， but the continuous improvement of the acupuncture group was better than that of the placeboacupuncture group （P<005）. In the acupuncture scale evaluation， the acupuncture group had a strong sense of needle sensation while the placeboacupuncture group did not obtain it （P<005）， and both groups had more sharp pain sensation （P>005）. Conclusion：Acupuncture and effective of needle sensation can greatly improve the symptoms of insomnia and anxiety of the subjects. The curative effect has a certain downward trend with the passage of time， but it is still better than the placeboacupuncture group. Acupuncture is an effective means to improve insomnia with anxiety and can greatly improve life quality， which is worthy of attention and promotion.

Key WordsInsomnia； Anxiety； Acupuncture； PlaceboAcupuncture

中图分类号：R245；R25623文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.07.003

失眠又称“目不瞑”“不得卧”“不寐”等，是以经常不能获得正常睡眠为特征的一种病证。临床主要表现为入睡困难，睡眠过程中易醒，以及醒后难以再入睡，患者睡眠质量低下，睡眠时间明显减少，严重者甚至彻夜不眠。……