张晶莹 王睿 孙戴 陈珺

[關键词] 八段锦;辨证习功;平秘脏腑推拿;轮班睡眠障碍;医护人员

[中图分类号] R471;R212          [文献标识码] B          [文章编号] 1673-9701（2021）29-0171-05

Clinical observation of Baduanjin exercises on improving the fatigue state of female nurses with shift work sleep disorder

ZHANG Jingying   WANG Rui   SUN Dai   CHEN Jun

Department of Tuina， Hangzhou Traditional Chinese Medicine Hospital， Hangzhou   310007， China

[Abstract] Objective To observe the clinical efficacy and safety of Baduanjin exercises in improving the fatigue status of female nurses with shift work sleep disorder. Methods A total of 55 patients recruited from many hospitals in our city from January 2015 to December 2019 were selected and randomly divided into the treatment group and the control group. The control group was given sleep health education and Tuina for Pingmi Viscera. The treatment group was guided for low-intensity Baduanjin "syndrome differentiation exercises" self-gong exercises before going to bed， based on the control group's treatment. Before and after treatment， the Flinders fatigue scale was used to assess the daytime fatigue status of the two groups. The VAS fatigue score was used to dynamically observe the fatigue of the patients during the treatment cycle. The Pittsburgh sleep scale was used to observe the sleep quality. The sleep quality and daytime fatigue VAS score were used for follow-up after the treatment. Results After the treatment， the Flinders fatigue score of the treatment group was better than that of the control group， the difference was statistically significant（P<0.05）. However， there was no advantage in the treatment group in the multiple observation node of the VAS fatigue score between groups. And there was no statistically significant difference（P>0.05）. Only the downward trend of the mean value of the VAS score in the treatment group was relatively noticeable compared with the control group. There was no statistically significant difference in the Pittsburgh sleep scale score between the two groups（P>0.05）. There was no significant difference in sleep quality and daytime fatigue status VAS score during follow-up （P>0.05）. Conclusion The main advantage of Baduanjin combined with Pingmi Viscera Tuina is that it can more effectively improve the daytime fatigue symptoms of patients with shift work sleep disorders. Although the long-term effect is not good， the exercises focus on "easy to learn"， which is suitable for long-term regular use， and can maintain the adaptability of medical staff to night shift work， which has specific clinical promotion value.

[Key words] Baduanjin; Syndrome differentiation exercises; Tuina for Pingmi Viscera; Shift work sleep disorder; Medical staff

临床护理人员作为需要长期从事夜班工作的特殊职业群体，频繁的处于昼夜轮班状态，将可能导致睡眠剥夺，扰乱了人体正常的生物钟，出现以失眠或日间工作思睡为主症的轮班工作睡眠障碍（Shift work disorders，SWD）[1]。随之而来的疲劳感、慢性疼痛、焦虑等兼夹症状[2-3]，使SWD成为了一种非特异性的临床疾病综合征，给患者带来日趋严重的职业伤害[4]，已然成为影响医疗队伍不稳定的一个重要因素[5]。

相较于长时间运用药物所带来的副作用[6]，多数患者更趋向于选择非药物疗法。以八段锦为代表的健身气功，是拥有祖国传统医学特色的身心干预方案，既往研究证实对睡眠障碍有明确疗效[7-8]。但功法锻炼方案过于程序化，习练时间较长，缺少中医个体化辨证论治特色等不足之处，可能是其在中青年群体中普及欠佳的原因之一。因此，本研究采用八段锦“辨证习功”联合平秘脏腑推拿的综合方案治疗SWD，取得一定疗效，现报道如下。

1 资料与方法

1.1 一般资料

研究对象来源于2015年1月至2019年12月本市范围内多家医院招募的SWD女性护理人员，试验方案已经本院医学伦理委员会批准。使用计算机软件生成随机数字表，将患者随机分为八段锦“辨证习功”联合平秘脏腑推拿组（以下简称治疗组）及平秘脏腑推拿组（以下简称对照组）。经过后续干预及随访期观测后，部分纳入对象因治疗依从性较差、八段锦功法练习欠佳、工作科室轮换等原因予以剔除，最终收集到55例患者的完整数据。……