刘一然 周薇

〔摘要〕 目的 觀察腹针联合艾灸治疗对心脾两虚型失眠症患者睡眠质量的改善效果。方法 回顾性分析2019年6月至2020年6月本院83例心脾两虚型失眠症患者临床资料，其中行艾灸治疗39例（对照组）、行腹针联合艾灸治疗44例（联合组）。两组均治疗4周，记录两组临床疗效，比较两组治疗前及治疗4周后主观睡眠质量[匹兹堡睡眠质量指数量表（pittsburgh sleep quality index， PSQI）、主观睡眠效率]、客观睡眠质量[多导睡眠图（polysomnography， PSG）]、中医症状积分、脑血流[基底动脉（basilar artery， BA）、椎动脉（vertebral artery， VA）的收缩期血流速度峰值（peak systolic blood flow velocity， Vp）、舒张期血流速度（diastolic blood flow velocity， Vd）]差异。结果 治疗后，联合组临床疗效明显优于对照组（P<0.05）。治疗后，两组中医症状积分及PSQI评分、入睡潜伏期、觉醒次数均较治疗前降低（P<0.05），且联合组低于对照组（P<0.05）;两组主观睡眠效率、总睡眠时间及BA-Vp、BA-Vd、VA-Vp、VA-Vd则较治疗前升高（P<0.05），且联合组高于对照组（P<0.05）。两组治疗前后组间及组内非快速动眼睡眠期持续时间比较，差异无统计学意义（P>0.05）。结论 腹针联合艾灸治疗心脾两虚型失眠症患者疗效显著，能调节脑血流、纠正脑供血不足状态、改善睡眠质量、缓解中医症状，适于临床推广。

〔关键词〕 失眠症;心脾两虚;腹针;艾灸;睡眠质量;脑血流

〔中图分类号〕R256.2;R245       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.04.011

〔Abstract〕 Objective To observe the improvement effects of abdominal acupuncture therapy combined with moxa-moxibustion on sleep quality of patients with insomnia with deficiency of heart and spleen. Methods A retrospective analysis was performed on the clinical data of 83 patients with insomnia with deficiency of heart and spleen in the hospital between June 2019 and June 2020. Among them， 39 patients were treated with moxa-moxibustion （control group）， and 44 patients were treated with abdominal acupuncture combined with moxa-moxibustion （combined group）， and both groups were treated with 4 week. The clinical efficacy was recorded in the two groups， and the subjective sleep quality [pittsburgh sleep quality index （PSQI）， subjective sleep efficiency]， objective sleep quality [polysomnography （PSG）]， scores of traditional Chinese medicine （TCM） symptoms and cerebral blood flow [basilar artery （BA）， vertebral artery （VA） peak systolic blood flow velocity （Vp） and diastolic blood flow velocity （Vd）] were compared between the two groups before treatment and after 4 weeks of treatment. Results The clinical efficacy in combined group was significantly better than control group （P<0.05）. After treatment， the TCM symptoms scores and PSQI score， latency to persistent sleep， and number of awakenings in the two groups were lower than those before treatment （P<0.05）， and the indexes in combined group were lower than those in control group （P<0.05）. The subjective sleep efficiency， total sleep time and BA-Vp， BA-Vd， VA-Vp and VA-Vd were higher than those before treatment （P<0.05）， and the indexes in combined group were higher than those in control group （P<0.05）. There was no significant difference in the duration of non-rapid eye movement sleep between the two groups before and after treatment and within the groups （P>0.05）. Conclusion Abdominal acupuncture therapy combined with moxa-moxibustionhas a significant efficacy in the treatment of insomnia with deficiency of heart and spleen. It can regulate cerebral blood flow， correct the insufficient cerebral blood supply， improve the sleep quality， and relieve the TCM symptoms， and is suitable for clinical promotion.

〔Keywords〕 insomnia; deficiency of heart and spleen; abdominal acupuncture; moxa-moxibustion; sleep quality; cerebral blood flow

失眠症的全球发病率为10%～50%，是目前患病率最高的睡眠障碍性疾病，西医常使用苯二氮卓类药物或具有镇静作用的抗抑郁药物来治疗，但长期服用不良反应较多，且可能产生耐受性及依赖性[1]。失眠症在中医学领域属“不寐”范畴，病位在心。思虑忧愁、操劳过度，则损伤心脾，气血虚弱，心神失养;或房劳伤肾，肾阴亏耗，阴虚火旺，心肾不交;或脾胃不和，湿重生痰，痰瘀生热，痰热上扰心神;或抑郁易怒，肝火上扰，致心神不宁，均导致不寐。根据证候表现的不同，失眠症可分为肝郁化火、痰热内扰的实证及心脾两虚、心胆气虚、阴虚火旺的虚证，其中心脾两虚型最为常见，患者可伴神疲、纳差、心悸、健忘等表现[2]。……