Clinical Study On The Treatment Of Insomnia By Ultrasound-guided Stellate Ganglion Block Combined With Acupuncture

Objective:By comparing the clinical efficacy of acupuncture treatment,ultrasound-guided stellate ganglion block and the combination of the two methods in the treatment of insomnia,to explore the advantages and characteristics of the three treatment methods,and to provide a treatment scheme with higher safety and better efficacy for patients with insomnia.Methods:A total of 120 patients with insomnia eligible for the study were randomly divided into three groups,40 cases in each group.The first group was acupuncture therapy group(group A).The main acupoints were shenmen,neiguan,zhaohai and shenmai.According to the syndrome differentiation of insomnia,different acupoints were selected.Phlegm heat interference with the inner court,fenglong;Xinpi deficiency plus xinshu and pishu;Heart-kidney non-overlapping heart-shu,kidney-shu;Xindanqixu plus xinshu,danshu,acupuncture once a day;The second group was the ultrasound-guided stellate ganglion block group(SGB group):the ultrasound-guided stellate ganglion block was performed at 7~thh cervical vertebral level with3mL 1%lidocaine one side per day.The third group was the combined group(AS group):ultrasound-guided stellate ganglion block with acupuncture once a day(SGB group).All patients received treatment for10 days.Before treatment(T0)and after treatment(T1),a month later(T2),TCM clinical symptoms observation scale,the Pittsburgh sleep quality index(PSQI)scale score,the ministry of health of the Chinese medicine new medicine clinical research guiding principles,rate of PSQI score points for outcome and record the related complications were recorded separately.Results:Among the 120 cases of patients with insomnia met the inclusion criteria,2 cases fell out of the 3 groups due to various reasons,and a total of 114 cases(38 cases in each group)were finally rolled in the statistical analysis.1.The differences of gender,age,insomnia syndrome differentiation,PSQI score before treatment,and clinical symptom observation scale score of insomnia in Chinese medicine among three groups,were not statistically significant(P>0.05).2.Clinical symptom observation scale score and PSQI score of the three groups:T1 and T2 had lower scores than T0(P<0.05)and T1 had lower scores than T2(P<0.05)within groups.All scores at T0 was no statistical difference between groups(P>0.05).The time points of T1 and T2 in AS group were lower than those in A group and SGB group(P<0.05).There was no significant difference between group A and SGB T1 and T2(P>0.05).4.PSQI score deduction rate:T2 time point was lower than T1time point within groups(P<0.05);point deduction rate at T1 and T2 of AS group was lower than that of group A and SGB group(P<0.05),while point deduction rate at T1 and T2 point of A and SGB group was not statistically different(P>0.05).5.Efficacy evaluation:The total effective rate was 63.2%in group A,57.9%in SGB,86.8%in AS at T1.The total effective rate was 55.3%in group A,50.0%in SGB and 86.8%in AS at T2.The total effective rate at T1 and T2 in the AS group were higher than the A group and SGB group(P<0.05),while there was no statistical significance between the A group and SGB group(P>0.05).6.A total of784 SGB tests were performed in the study,and Horner sign(ineffective block)was not found in 15 procedures,with a success rate of 98.09%.7.In this clinical study,SGB patients underwent ultrasound for a total of 8times and experienced transient hoarseness,which was relieved less than2 hours later.No dysphagia,pharyngeal foreign body sensation,numbness and weakness of upper limbs,pneumothorax,severe hematoma and other complications occurred.Conclusion:1.Stellate ganglion block combined with acupuncture for insomnia could be more effective than acupuncture alone and stellate ganglion block for insomnia.2.Acupuncture and stellate ganglion block had similar effects on insomnia.