耳穴定向磁疗治疗职业性颈性失眠：随机安慰剂对照试验

Effect of auricular directional magnetotherapy in the treatment of occupational cervical insomnia： a randomized，placebo-controlled trial

关键词:  职业性颈椎病  失眠  耳穴定向磁疗  随机对照试验  安慰剂效应

Key words:  occupational cervical spondylosis  insomnia  auricular directional magnetotherapy  randomized controlled trial  placebo effect

摘要:

[目的] 观察耳穴定向磁疗对职业性颈性失眠患者睡眠障碍及心身健康的影响。[方法] 将90例职业性颈性失眠患者随机分为耳穴定向磁疗组、耳穴非定向磁疗组、耳穴伪磁疗组，每组30例。3组均接受对症支持治疗，在此基础上，3组分别于耳穴给予定向磁珠穴贴、非定向磁珠穴贴和伪磁珠穴贴，耳穴均取交感、神门、枕、皮质下、肾、肝、脾、心，每日按压3次，每次10～15 min，2～3 d更换1次，双耳交替，治疗30 d，并于3个月后随访。观察3组治疗前后及随访期匹兹堡睡眠质量指数量表（PSQI）及简明健康状况量表（SF-36）评分，评定睡眠质量与心身健康状况，并比较3组临床疗效。[结果] 84例完成试验。治疗后及随访期，3组PSQI总分均较治疗前降低（耳穴定向磁疗组、耳穴非定向磁疗组P<0.01，耳穴伪磁疗组P<0.05），耳穴定向磁疗组、耳穴非定向磁疗组PSQI评分低于耳穴伪磁疗组（P<0.01或P<0.05）；治疗后，耳穴定向磁疗组PSQI评分低于耳穴非定向磁疗组（P<0.01）。与治疗前比较，耳穴定向磁疗组、耳穴非定向磁疗组两组治疗后SF-36各维度评分及耳穴伪磁疗组除生理机能、精神健康、总体健康状况外的5个维度评分均提高（P<0.05）；随访期，耳穴定向磁疗组除社会功能外的7个维度，耳穴非定向磁疗组除生理机能、社会功能、躯体疼痛外的5个维度，以及耳穴伪磁疗组生理职能、情感职能两维度评分均高于治疗前（P<0.05）；治疗后，耳穴定向磁疗组除情感职能外的7个维度得分高于耳穴伪磁疗组（P<0.05或P<0.01），耳穴非定向磁疗组在精神健康维度得分高于耳穴伪磁疗组（P<0.05），耳穴定向磁疗组在生理机能、生理职能、社会功能、活力各维度得分高于耳穴非定向磁疗组（P<0.05）；随访期，耳穴定向磁疗组除社会功能、总体健康状况外的6个维度得分高于耳穴伪磁疗组（P<0.05或P<0.01）；耳穴非定向磁疗组在生理机能、精神健康、情感职能各维度得分高于耳穴伪磁疗组（P<0.05）；耳穴定向磁疗组在生理职能、躯体疼痛、活力各维度得分高于耳穴非定向磁疗组（P<0.05）。耳穴定向磁疗组治疗后及随访期总有效率均高于耳穴伪磁疗组（均P<0.05）。[结论] 耳穴定向磁疗能有效改善职业性颈性失眠患者睡眠和生活质量。

Abstract:

[Objective] To observe the effect of auricular directional magnetotherapy on somnipathy and psychosomatic health in patients with occupational cervical insomnia.[Methods] The 90 patients with insomnia were randomly divided into auricular directional magnetotherapy group,auricular non-directional magnetotherapy group,and auricular sham-magnetotherapy group,30 cases in each group. Symptomatic supportive treatment was applied in three groups. Based on above treatment,auricular directional magnetic bead sticking was added in auricular directional magnetotherapy group,and auricular non-directional magnetic bead sticking in auricular non-directional magnetotherapy group,and auricular sham magnetic bead sticking in auricular sham-magnetotherapy group. Following auricular points were selected for all groups:jiaogan(AH6a) and shenmen (TF4),zhen (AT3) and pizhixia (AT4),shen (CO10) andgan (CO12),pi (CO13) andxin (CO15),press 3 times a day and 10~15 minutes at a time,replacement once in 2~3 days and alternate two ears, treating for 30 days and follow-up 3 months later. The scores of Pittsburgh Sleep Quality Index (PSQI) and Short Form 36-item Health Survey (SF-36) were observed before and after treatment and follow-up period in each group. Sleep quality and psychosomatic health were assessed,and clinical efficacy was compared in each group.[Results] Atotal of 84 cases completed the test. After treatment and follow-up,the scores of PSQI decreased in all groups compared with that before treatment (auricular directional magnetotherapy group and auricular non-directional magnetotherapy group:P<0.01,auricular sham-magnetotherapy group:P<0.05). The scores of PSQI in auricular directional magnetotherapy group and auricular non-directional magnetotherapy group were lower than that in auricular sham-magnetotherapy group (P<0.01 or P<0.05). After treatment,the score of PSQI in auricular directional magnetotherapy group was lower than that in auricular non-directional magnetotherapy group (P<0.01). Compared with before treatment,scores of each dimension inside SF-36 in auricular directional magnetotherapy group and auricular non-directional magnetotherapy group,and scores of 5 dimensions except physical function,mental health and general health in auricular sham-magnetotherapy group were improved after treatment(P<0.05). During follow-up period,scores of 7 dimensions except social function in group auricular directional magnetotherapy group,5 dimensions except physical function,social function and body pain in auricular non-directional magnetotherapy group,and 2 dimensions of role physical and role emotional in auricular sham-magnetotherapy group were higher than those before treatment(P<0.05). After treatment,scores of 7 dimensions in auricular directional magnetotherapy group were higher than those in auricular sham-magnetotherapy group except for role emotional(P<0.01 or P<0.05),and group auricular non-directional magnetotherapy group scored higher in mental health dimension than auricular sham-magnetotherapy group (P<0.05),and auricular directional magnetotherapy group scored higher in dimensions of physical function,role physical,social function and vitality than auricular non-directional magnetotherapy group. During follow-up period,scores of 6 dimensions in auricular directional magnetotherapy group were higher than those in auricular sham-magnetotherapy group except for social function and general health(P<0.05 or P<0.01),and group auricular non-directional magnetotherapy group scored higher in physical function,mental health and role emotional than auricular sham-magnetotherapy group (P<0.05),and scores of physical function,body pain and vitality in group auricular directional magnetotherapy group were higher than those in auricular non-directional magnetotherapy group (P<0.05). The total effective rate of auricular directional magnetotherapy group was higher than that of auricular sham-magnetotherapy group after treatment and during follow-up period.[Conclusion] Auricular directional magnetotherapy can effectively improve quality of sleep and life in patients with occupational cervical insomnia.