针药结合治疗老年原发性高血压伴失眠的疗效观察

目的采用中药汤剂联合针刺治疗原发性高血压合并失眠,观察其临床疗效并评价其实际应用价值。方法选取2020年1月—10月期间于青岛市中医医院(青岛市海慈医院)治未病科就诊的94例老年原发性高血压伴失眠患者,采用随机数字表法将患者分为中药组与联合组,每组各47例。中药组给予中药汤剂治疗,联合组在此基础上加用针刺治疗,4周为1个疗程。1个疗程结束后,采用匹兹堡睡眠质量量表(Pittsburgh sleep quality index,PSQI)评估原发性高血压伴失眠患者睡眠质量,并评价患者睡眠改善情况;检测患者治疗前后血压变化水平,对比两组患者中医证候积分变化情况;检测两组患者治疗前后血清指标25羟维生素D25(OH)D]、脑源性神经营养因子(Brain-derived neurotrophic factor,BDNF)、去肾上腺素(Noradrenaline,NE)表达水平变化情况,并根据患者治疗期间出现的不良反应评估两种治疗方式的安全性。结果治疗后中药组患者睡眠改善总有效率为75.00%(33/44),联合组患者睡眠改善总有效率为93.48%(43/46),联合组患者睡眠改善情况明显优于中药组(P<0.05)。治疗后两组患者PSQI各项评分,各项中医证候积分,收缩压和舒张压水平均较治疗前均明显降低,差异有统计学意义(P<0.05);且联合组患者PSQI各项评分,各项中医证候积分,收缩压和舒张压水平均较中药组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者血清25(OH)D、BDNF水平均较治疗前明显升高,NE水平较治疗前明显降低,差异有统计学意义(P<0.05);且联合组患者血清学指标改善效果明显优于中药组,两组比较,差异有统计学意义(P<0.05)。治疗期间,两组患者均未出现严重不良反应。结论针药结合治疗可以明显改善原发性高血压伴失眠患者睡眠质量并有效控制患者血压水平,缓解患者临床症状,具有较高的安全性。

Observation on the Effect of Acupuncture and Medicine Combined Treatment of Senile Essential Hypertension with Insomnia

Objective To observe the clinical effect of TCM decoction combined with acupuncture in the treatment of essential hypertension complicated with insomnia and evaluate its practical application value.Methods A total of 94 elderly patients with essential hypertension with insomnia who were treated in the Department of Treatment and Preservation of Qingdao Traditional Chinese Medicine Hospital(Qingdao Haici Hospital)from January to October 2020 were included in the study.The patients were randomly numbered and grouped by random number table method,with 47 cases in each group.In the traditional Chinese medicine group,there were 3 cases of abscission(44 cases),and in the combination group,there were 1 case of abscission(46 cases).Patients in the traditional Chinese medicine group were treated with traditional Chinese medicine decoction,while those in the combined group were additionally treated with acupuncture.4 weeks was recorded as a course of treatment.After 1 course of treatment,the Pittsburgh Sleep Quality Scale(PSQI)was used to evaluate the sleep quality of patients with essential hypertension with insomnia,and the improvement of sleep was evaluated.Blood pressure changes were detected before and after treatment,and the changes of TCM syndrome scores were compared between the two groups.The changes in serum levels of 25(OH)D,brain-derived neurotrophic factor(BDNF)and norepinephrine(NE)were detected before and after treatment in 2 groups,and the safety of the two treatment methods was evaluated according to the adverse reactions during treatment.Results After treatment,the total effective rate of sleep improvement in the traditional Chinese medicine group was 75.00%(33/44),and the total effective rate of sleep improvement in the combined group was 93.48%(43/46).The sleep improvement of the combined group was significantly better than that of the traditional Chinese medicine group(P<0.05).After treatment,various PSQI scores,scores of TCM syndromes,systolic blood pressure and diastolic blood pressure in the two groups of patients were significantly lower than those before treatment,and the difference was statistically significant(P<0.05).The scores,scores of various TCM syndromes,systolic blood pressure and diastolic blood pressure were significantly lower than those in the traditional Chinese medicine group,and the difference was statistically significant(P<0.05).After treatment,the levels of serum 25(OH)D and BDNF in the two groups were significantly higher than those before treatment,and the level of NE was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).It was significantly better than the traditional Chinese medicine group,and the difference between the two groups was statistically significant(P<0.05).During the treatment period,there were no serious adverse reactions in the two groups.Conclusions he combination of acupuncture and medicine can significantly improve the sleep quality of patients with essential hypertension and insomnia,effectively control the blood pressure level,relieve the clinical symptoms of patients,and has high safety.