| Objective1.On the basis of the acupuncture method of Tongdu Tiaoshen,through the evaluation of the indicators such as sleep quality,daily activity ability and the degree of clinical neurological deficit of the patients with insomnia after ischemic stroke before and after acupuncture intervention,discusses the effect of TongduTiaoshen acupuncture on sleep quality and quality of life in patients with insomnia after ischemic stroke provides clinical ideas for acupuncture to treat insomnia after ischemic stroke.2.According to the geographical situation of the researcher,this study was carried out in Taiwan to explore the applicability and clinical effect of Tongdutiaoshen acupuncture on insomnia after ischemic stroke in Taiwan.Research method1.Literature researchIn the literature review,this study focused on the analysis of the research progress of traditional Chinese and western medicine for insomnia after ischemic stroke.The pathogenesis,treatment and rehabilitation methods of this disease are summarized from two aspects of modern medicine and traditional medicine,so as to lay a theoretical foundation for clinical research.2.Clinical researchThis study refer to neurology branch of Chinese medical association in 2018,China issued by the acute ischemic stroke guidelines to establish criteria for the diagnosis of cerebral apoplexy,with reference to the latest 2017 standard,the diagnosis of disease and curative effect of traditional Chinese medicine will be included in the standard of 129 cases from north port of China pharmaceutical university hospital in Taiwan,mackay memorial hospital,chi ay i linkou chang gung memorial hospital,chang gung memorial hospital,kaohsiung chang gung memorial hospital after the acute phase of ischemic stroke patients with insomnia,this experiment adopts random grouping random single blind method,western medicine group and intervention group and tong tai intervention group 43 cases with god.All three groups received routine basic treatment and home-based rehabilitation training.In the basic intervention group,acupuncture and moxibustion therapeutics,the 10th edition of the textbook of China press of traditional Chinese medicine for national colleges and universities,was used to prescribe acupoints for stroke and acupoints for insomnia:Shuigou,Neiguan,Jiquan,Chize,Zhongzhong,Sanyinjiao,Zhaohai,Shenmai,and Anmian.Acupoints:Liver Yang Hyperactivity Syndrome with Taichong and Taixi;Wind-phlegm Obstruction Syndrome with Fenglong and Hegu;Tan Phlegm Syndrome with Quchi,Inner Court,Fenglong,Tianshu;Qi Deficiency and Blood Stasis Syndrome with Blood Sea Zusanli,Qihai;Yin deficiency and wind movement with Shenshu and Taichong;Tongdu Tiaoshen Intervention Group adopted Tongdu Tiaoshen acupuncture to take acupuncture points.Main points:Baihui,Dazhui,Yintang,Shenting,Fengfu,Shenzhu,Shenmen.Acupoints:Liver Yang Hyperactivity Syndrome with Ganshu and Qimen;Wind-phlegm Obstruction Syndrome with Spleen Yu,Ganshu and Zhangmen;Tan Phlegm Syndrome with Quchi,Inner Chamber,Fenglong,Tianshu;Qi Deficiency and Blood Stasis Syndrome With Guan Yuan,Qi Hai,Tong Yu;Yin deficiency and wind movement with Ganshu,Shenshu,Sanyinjiao,Jingmen;In the western medicine group,1 mg/day/time of estazolam tablet was taken orally before going to bed.In the clinical acupuncture intervention,the patients in the acupuncture group were treated with acupuncture once every two days for 30 minutes each and lasted for 8 weeks.The twelve regular meridian points were bilateral acupoints,and the Dumai and Renmai points were single points.Before acupuncture intervention,the sleep state of the patients was assessed by Pittsburgh sleep quality index scale and arthens Insomnia Scale.The life ability and nerve function of the patients were assessed by Barthel index of activity of daily living scale and clinical neurological deficit scale of stroke.In the process of acupuncture intervention,the sleep state,life ability and nerve function were evaluated every 4 weeks,Follow-up was conducted 4 months after the end of the course of treatment,that is,6 months after the initiation of the enrolling intervention.Clinical research results1.Basic informationThere were no significant differences in age and gender among the three groups.In terms of dialectical classification,qi deficiency and blood stasis accounted for the most in both groups,followed by wind-phlegm blocking collaterals and Yin deficiency and wind-motion.2.Sleep quality scores before and after acupuncture interventionThe difference of PSQI score between the basic intervention group,the Tongdu Tiaoshen group and the estazolam group was statistically significant(P<0.01)at 4 weeks and 8 weeks after intervention,and the PSQI score after intervention was significantly lower than that before intervention.At 4 weeks of intervention,the PSQI score of the basic group was higher than that of the western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the PSQI score of the Tongdu Tiaoshen group and that of the western medicine group(P≥ 0.05).At 8 weeks of intervention,PSQI score of Tongdu Tiaoshen group was lower than that of Western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between PSQI score of basic intervention group and Western medicine group(P≥ 0.05).Patients in the basic intervention group,the Tongdu Tiaoshen group,and the estazolam group had statistically significant differences in the AIS scores at 4 weeks and 8 weeks of intervention(p<0.01).The AIS score was significantly reduced before the intervention.At 4 weeks of intervention,the AIS score of basic group was higher than that of Western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the AIS score of Tongdu Tiaoshen group and Western medicine group(P≥0.05).At 8 weeks of intervention,the AIS score of Tongdu Tiaoshen group was lower than that of Western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the AIS score of basic intervention group and Western medicine group(P≥ 0.05).3.Life ability score results before and after acupuncture interventionPatients in the basic intervention group,the Tongdu Tiaoshen group,and the estazolam group had statistically significant differences in daily living ability scores at 4 weeks and 8 weeks(p<0.01).The daily living ability score was significantly higher after intervention than before intervention.At 4 weeks of intervention,the scores of the ability of daily living in Tongdu Tiaoshen group were higher than those in the western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the basic group and the western medicine group(P≥0.05).At 8 weeks of intervention,the daily life ability score of Tongdu Tiaoshen group was higher than that of Western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the basic intervention group and Western medicine group(P≥ 0.05).4.Evaluation results of clinical neurological deficit of stroke before and after acupuncture interventionThe difference of NDS scores between the basic intervention group,the Tongdu Tiaoshen group and the estazolam group was statistically significant(P<0.01)at 4 weeks and 8 weeks after intervention,and the NDS scores after intervention were significantly lower than those before intervention.At the same time point,there was no significant difference in the NDS score between the basic intervention group and the Tongdu Tiaoshen group compared with the estazolam group(p≥0.05).5.Results of sleep quality score of follow-up patients before and after acupuncture interventionAfter 4 weeks,8 weeks and 6 months follow-up,the difference of PSQI score between the basic intervention group,Tongdu Tiaoshen group and eszolam group was statistically significant(P<0.01),and the PSQI score after intervention was significantly lower than that before intervention.At 4 weeks of intervention,the PSQI score of the basic group was higher than the PSQI score of the western medicine group,and the difference was statistically significant(p<0.05 or p<0.01).There was no statistical difference in the PSQI score of the Tongdu Tiaoshen group and the PSQI score of the western medicine group.Significance(p≥0.05).At 8 weeks of intervention,there was no significant difference in PSQI scores between the Tongdu Tiaoshen group and the basic intervention group compared with the PSQI scores of the western medicine group(p≥0.05).After 6 months follow-up,the PSQI score of the basic group was lower than that of the western medicine group,and the difference was statistically significant(P<0.01).There was no significant difference between the PSQI score of the Tongdu Tiaoshen group and that of the western medicine group(P≥0.05).After 4 weeks,8 weeks and 6 months follow-up,the patients in the basic intervention group,the Tongdu Tiaoshen group and the estazolam group showed statistically significant difference in AIS score(P<0.01),and the AIS score after intervention was significantly lower than that before intervention.After 4 weeks of intervention,the AIS score of the basic intervention group and tongdu tiaoshen group was higher than that of the western medicine group,and the difference was statistically significant(p<0.01).At 8 weeks of intervention,the AIS score of tongdu tiaoshen group was lower than that of western medicine group,with a statistically significant difference(p<0.01).There was no statistically significant difference between the AIS score of basic intervention group and western medicine group(p≥0.05).After 6 months follow-up,the AIS score of Tongdu Tiaoshen group was lower than that of Western medicine group,and the difference was statistically significant(P<0.05).There was no significant difference between the AIS score of basic intervention group and western medicine group(P≥0.05).6.Life ability score of follow-up patients before and after acupuncture interventionPatients in the basic intervention group,the Tongdu tiaoshen group and the estazolam group were followed up at 4 weeks,8 weeks and 6 months after the intervention compared with those before the intervention,and the difference in the life ability score was statistically significant(p<0.01).The life ability score was significantly higher after the intervention than before the intervention.At 4 weeks of intervention,the life ability score of the Tongdu Tiaoshen group was higher than that of the western medicine group,and the difference was statistically significant(p<0.01).There was no difference in the life ability score of the basic intervention group and the life ability score of the western medicine group(p≥0.05).At 8 weeks of intervention,there was no significant difference in the living ability scores of the basic intervention group and the Tongdu Tiaoshen group with the living ability scores of the western medicine group(p≥0.05).After 6 months follow-up,the life ability scores of the basic intervention group and the Tongdu Tiaoshen group were higher than those of the western medicine group,and the difference was statistically significant(P<0.01).7.Evaluation results of clinical neurological deficit of stroke follow-up patients before and after acupuncture interventionAfter 4 weeks,8 weeks and 6 months follow-up,the difference of NDS score between the basic intervention group,the Tongdu Tiaoshen group and the estazolam group was statistically significant(P<0.01),and the NDS score after intervention was significantly lower than that before intervention.After 4 weeks and 8 weeks of intervention,there was no significant difference in NDS between the basic intervention group and the basic intervention group(P>0.05).After 6 months follow-up,the NDS score of Tongdu Tiaoshen group was lower than that of Western medicine group,and the difference was statistically significant(P<0.05).8.Adverse reactions in each group during clinical studyThere were 32 adverse reactions in 129 patients included in this study,including 7 cases in basic intervention group(5.43%),3 cases in Tongdu Tiaoshen group(2.32%),and 22 cases in estazolam group(17.05%).The difference was statistically significant(P<0.01).Conclusion1.The main syndrome of ischemic stroke in Taiwan is Qi deficiency and blood stasis.2.Tongdu Tiaoshen acupuncture and basic acupuncture can improve the sleep quality of insomnia patients after ischemic stroke.3.The effect of Tongdu Tiaoshen acupuncture is better than that of basic acupuncture and Western medicine in improving PSQI score and AIS score of insomnia patients after ischemic stroke.4.The effect of Tongdu Tiaoshen acupuncture is better than that of basic acupuncture and Western medicine in improving the scores of daily life ability and NDS of insomnia patients after ischemic stroke.5.Tongdu Tiaoshen acupuncture is an effective and safe intervention method in the clinical treatment of insomnia after ischemic stroke,which is worthy of clinical promotion. |
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