針刀治療頸源性失眠的臨床效果

馬輝　李康　董燦

[摘要] 目的 探討針刀治療頸源性失眠的臨床效果。 方法 選取2014年10月～2016年5月于南京中醫藥大學附屬南京中醫院針灸科、江蘇省第二中醫院針灸科及南京市雨花區岱山社區衛生服務中心針灸科門診治療的頸源性失眠患者90例，按照隨機數字表法將其隨機分為針刀組、藥物組及針藥組，每組30例。比較三組患者的治療效果、匹茲堡睡眠質量指數（PSQI）評分、視覺模擬評分（VAS）及患者滿意度。 結果 治療2個療程后，三組總有效率比較差異無統計學意義（P > 0.05）。三組治療后PSQI日間功能障礙、催眠藥物、睡眠障礙、睡眠效率、睡眠時間、入睡時間、睡眠質量評分及總分均較治療前明顯降低，差異有統計學意義（P < 0.05），但三組治療后組間比較差異無統計學意義（P > 0.05）。三組治療后VAS評分均較治療前明顯降低（P < 0.05），且針藥組治療后VAS評分明顯低于藥物組（P < 0.05）。治療后，針刀組和針藥組滿意度明顯高于藥物組，差異有統計學意義（P < 0.05）。 結論 針刀療法能改善患者的失眠癥狀，提高患者睡眠質量，值得臨床進一步推廣。

[關鍵詞] 針刀；頸源性失眠；睡眠質量

[中圖分類號] R274.915 [文獻標識碼] A [文章編號] 1673-7210（2018）11（c）-0134-04

Clinical effect of needle-knife in the treatment of cervical insomnia

MA Hui1 LI Kang2 DONG Can2 ZHANG Cairong2

1.Department of Acupuncture and Moxibustion， Jiangsu Provincial Second Hospital of Traditional Chinese Medicine， Jiangsu Province， Nanjing 210000， China； 2.Department of Acupuncture and Moxibustion， Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine， Jiangsu Province， Nanjing 210000， China

[Abstract] Objective To investigate the clinical effect of needle-knife in the treatment of cervical insomnia. Methods Ninety cases of patients with cervical insomnia treated in Department of Acupuncture and Moxibustion， Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine， Department of Acupuncture and Moxibustion， Jiangsu Provincial Second Hospital of Traditional Chinese Medicine and Outpatient Department of Acupuncture and Moxibustion of Daishan Community Health Service Center of Yuhua District in Nanjing City from October 2014 to May 2016 were selected and divided into needle-knife group， drug group， needle-knife + drug group by random number table method， with 30 cases in each group. The therapeutic effects， Pittsburgh sleep quality index （PSQI） scores， visual analogue scale （VAS） and the satisfaction of patients in the three groups were compared. Results After treatment for two courses， there was no significant difference in the total effective rates among the three groups （P > 0.05）. After treatment， the scores of daytime dysfunction， hypnotic， sleep disorder， sleep efficiency， sleeping time， fall-sleep time， sleep quality and total scores in the three groups were all lower than those before treatment， the differences were statistically significant （P < 0.05）， while there was no signficant difference among the three groups after treatment （P > 0.05）. After treatment， the scores of VAS in the three groups were significantly lower than those before treatment （P < 0.05）， and the VAS score in the needle-knife + drug group was significantly lower than that of drug group after treatment （P < 0.05）. After treatment， the degree of satisfaction in needle-knife group and needle-knife + drug group was higher than that of drug group， the difference was statistically significant （P < 0.05）. Conclusion The needle-knife therapy can improve the insomnia symptoms and the sleep quality of patients， which is worthy of clinical further promotion.

[Key words] Needle-knife； Cervical spondylosis； Sleep quality

頸源性失眠是指由頸椎相關疾病引起的失眠，臨床上多見于頸椎失穩、小關節錯位、頸肌無菌性炎癥或痙攣等引發疼痛，以及交感神經興奮或椎動脈攣縮，使大腦的興奮性增強，導致難以入睡、睡后易醒或睡眠不足[1-2]。目前臨床多選用短效鎮靜安眠藥物，雖然可以改善病情，但患者易對藥物形成依賴性，且伴有副作用[3]。針灸治療失眠具有療效可靠、操作簡便、副作用小等特點，多種針灸方法可用于失眠的治療[4]。針刀醫學是在現代發展起來的新興醫學，對頸肩腰腿痛等慢性軟組織傷痛類疾病具有獨特的療效，針刀治療具有傳統針刺的作用，又具有手術刀的部分功能，可以松解、切割慢性攣縮、粘連狀態的病變軟組織，重構人體局部力學平衡，目前有報道針刀對頸源性頭痛、頸源性眩暈等頸源性疾病有著較好的療效[5-6]。頸……