| 引用本文: |
汪毅明, 帕茹克·鲁提夫拉, 刘娟, 朱杰, 马忠.针刺联合艾司唑仑改善缺血性卒中后失眠的临床效应研究[J].湖南中医药大学学报,2026,46(4):725-731[点击复制] |
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| 针刺联合艾司唑仑改善缺血性卒中后失眠的临床效应研究 |
| 汪毅明,帕茹克·鲁提夫拉,刘娟,朱杰,马忠 |
| (新疆医科大学附属中医医院针灸一科, 乌鲁木齐 830000) |
| 摘要: |
| 目的 探讨针刺联合艾司唑仑对缺血性卒中后失眠（PSI）患者睡眠质量及脑睡眠功能网络异常的临床干预效果。方法选取2023年6月至2025年5月于新疆医科大学附属中医医院就诊的PSI患者60例，随机分为联合干预组（30例）和药物干预组（30例）。药物干预组在基础治疗上加用艾司唑仑片（1 mg/次，1次/d），联合干预组在药物干预组基础上联合针刺疗法（30 min/次，1次/d）。5 d为1个疗程，疗程间隔2 d，均干预4个疗程。治疗后，评价两组临床疗效；治疗前后，采用匹兹堡睡眠质量指数（PSQI）、失眠严重程度指数（ISI）评估睡眠质量，多导睡眠监测（PSG）测定宏观睡眠结构及脑电微结构参数，汉密尔顿焦虑量表（HAMA）及健康调查简表（SF-36）评估焦虑状态与生活质量，ELISA检测血浆γ氨基丁酸（GABA）及血清脑源性神经营养因子（BDNF）水平。结果治疗后，两组PSQI、ISI、HAMA评分及睡眠潜伏期（SL）、快速眼动睡眠潜伏期（RL）、觉醒次数（AC）均较治疗前降低（P<0.05），总睡眠时间（TST）、快速眼动睡眠时间（REM）、睡眠效率（SE）、N2期纺锤波密度、N3期δ波功率、SF-36评分及GABA、BDNF水平均较治疗前升高（P<0.05）；治疗后，联合干预组临床总有效率高于药物干预组（P<0.05）,PSQI、ISI、HAMA评分及SL、RL、AC均低于药物干预组（P<0.05）,TST、REM、SE、N2期纺锤波密度、N3期δ波功率、SF-36评分及GABA、BDNF水平均高于药物干预组（P<0.05）。Pearson相关性分析显示，联合干预组治疗后GABA、BDNF水平与N2期纺锤波密度、N3期δ波功率均呈显著正相关（P<0.01）。两组不良反应均较轻微，发生率比较差异无统计学意义（P>0.05）。结论 针刺联合艾司唑仑治疗PSI患者临床疗效确切，可显著改善睡眠质量、缓解焦虑情绪、提高生存质量，并逆转卒中后脑睡眠网络异常。 |
| 关键词: 缺血性卒中后失眠|针刺|艾司唑仑|多导睡眠监测|睡眠质量|焦虑状态|γ氨基丁酸|脑源性神经营养因子 |
| DOI：10.3969/j.issn.1674-070X.2026.04.009 |
| 投稿时间：2025-12-25 |
| 基金项目:新疆维吾尔自治区自然科学基金青年科学基金项目(2023D01C245) |
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| Clinical efficacy of acupuncture combined with estazolam in improving ischemic post-stroke insomnia |
| WANG Yiming, PARUKE Lutifula, LIU Juan, ZHU Jie, MA Zhong |
| (Acupuncture and Moxibustion Department I, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi, Xinjiang 830000, China) |
| Abstract: |
| Objective To investigate the clinical intervention effects of acupuncture combined with estazolam on sleep quality and abnormal brain sleep function networks in patients with ischemic post-stroke insomnia(PSI). Methods A total of sixty PSI patients treated at Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, from June 2023 to May2025 were enrolled and randomly divided into combined intervention group(n=30) and drug intervention group(n=30). The drug intervention group received estazolam tablets(1 mg/time, once daily) based on standard treatment. The combined intervention group underwent acupuncture therapy(30 min/time, once daily) in addition to the drug group's treatment. Five days constituted one treatment course, with a two-day interval between courses, and both groups underwent four courses. After treatment, clinical efficacy was evaluated between the two groups. Before and after treatment, sleep quality was assessed using the Pittsburgh sleep quality index(PSQI) and insomnia severity index(ISI), macro-sleep architecture and EEG microstructure parameters were monitored via polysomnography(PSG), anxiety status and quality of life were evaluated using the Hamilton anxiety scale(HAMA) and 36-item short form health survey(SF-36), and plasma gamma-aminobutyric acid(GABA) and serum brain-derived neurotrophic factor(BDNF)levels were measured via ELISA. Results Compared with before treatment, both groups showed decreases in PSQI, ISI, and HAMA scores, sleep latency(SL), rapid eye movement sleep latency(RL), and arousal count(AC) after treatment(P<0.05), with increases in total sleep time(TST), rapid eye movement(REM) sleep time, sleep efficiency(SE), N2 stage spindle density, N3 stage delta wave power, SF-36 score, and GABA and BDNF levels(P<0.05). After treatment, the combined intervention group had a higher overall clinical effective rate(P<0.05), lower PSQI, ISI, and HAMA scores, lower SL, RL, and AC compared with the drug intervention group(P<0.05), as well as higher TST, REM, SE, N2 stage spindle density, N3 stage delta wave power, SF-36 score, as well as GABA and BDNF levels(P<0.05). Pearson correlation analysis revealed that post-treatment GABA and BDNF levels in the combined intervention group were significantly and positively correlated with N2 stage spindle density and N3 stage delta wave power(P<0.01). Adverse reactions in both groups were mild, with no statistically significant difference in the incidence rates(P>0.05). Conclusion Acupuncture combined with estazolam has demonstrated definite clinical efficacy in patients with PSI, significantly improving their sleep quality,alleviating anxiety, enhancing overall quality of life, and reversing abnormalities in the post-stroke brain sleep network. |
| Key words: ischemic post-stroke insomnia|acupuncture|estazolam|polysomnography|sleep quality|anxiety status|gamma-aminobutyric acid|brain-derived neurotrophic factor |
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