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研究生:吳宜柔
研究生(外文):Yi-Jou Wu
論文名稱:探討針刺足三里穴對疼痛引起之睡眠失調的影響
論文名稱(外文):Effects of acupuncture at ST-36 (Zusanli) on pain-induced sleep disturbance
指導教授:張芳嘉
口試委員:林昭庚徐崇堯陳易宏尹珮璐
口試日期:2016-05-28
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:獸醫學研究所
學門:獸醫學門
學類:獸醫學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:46
中文關鍵詞:足三里穴孤獨徑核內生性鴉片類物質疼痛睡眠失調
外文關鍵詞:ST-36manual acupunctureNTSendogenous opioid systempainsleep disturbance
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針灸足三里穴於臨床上經常被利用來治療失眠,但其缺少科學證據;本實驗證實連續30分鐘針刺足三里穴兩天後,可以增加非快速動眼期與快速動眼期睡眠。而先前實驗室研究已證實電針刺激安眠穴時,藉由刺激交感神經促使孤獨徑核釋放內生性鴉片,使非快速動眼期睡眠增加,因此,我們同樣於孤獨徑核顯微注射鴉片類受器拮抗劑後,發現針刺足三里穴之安眠效果被抑制,進而得知針刺足三里穴可藉由刺激孤獨徑核中鴉片類物質釋放而達到安眠效果。
疼痛與睡眠之間互相影響,患有長期疼痛的病人經常同時存在著睡眠失調之情形;足三里穴除了安眠之外,亦是一止痛效果顯著之穴位,因此,我們進一步探討針刺足三里穴是否能夠改善因疼痛引起之睡眠失調,結果顯示原本因疼痛而造成之非快速動眼期與快速動眼期睡眠下降的情形,在接受針刺治療以後獲得改善。


Sleep disorders and chronic pain are often comorbid conditions and patients with primary insomnia also report chronic pain at the rate over 50%. Clinical studies show that pain-induced sleep disturbance may be improved by relief of pain. In clinic, ST-36 (Zusanli) is one of commonly used acupoints for the treatment of insomnia, but there is no scientific evidence. Therefore, the goal of this study was to investigate whether manual acupuncture at ST-36 can improve sleep and the underlying mechanisms. Therefore, this study also investigated the effects of acupuncture at ST-36 on pain-induced sleep disturbance. Our results indicated that acupuncture at ST-36 per se increased spontaneous NREMS and REMS via endogenous opioid system in NT. Moreover, acupuncture of ST-36 exhibits analgesic effects and improves pain-induced sleep disturbance.

目錄
論文口試委員審定書………………………………………………………………….i
致謝…...………………………………………………………………………….…....ii
中文摘要……………………………………………………………………..……….iii
Abstract……………………………………………………………...………….…....iv
壹、 研究目的與背景 1
一、 睡眠與失眠 1
1. 簡介 1
2. 失眠定義與原因 1
3. 失眠治療 2
4. 疼痛與睡眠 2
5. 疼痛引起睡眠失調之動物模式 3
二、 針灸與疼痛之間的關係 4
1. 簡介 4
2. 針灸止痛 4
3. 孤獨徑核 (nucleus tractus solitarius, NTS) 與針灸止痛之關聯 5
三、 針灸與睡眠之間的關係 6
1. 簡介 6
2. 針灸安眠機制 6
3. 內源性鴉片物質與睡眠之關係 7
四、 研究目的 7
貳、 材料與方法 8
一、 實驗動物 8
二、 實驗方法 ─ 針刺足三里穴組 8
1. 手術 8
2. 實驗流程 10
三、 實驗方法 ─ 探討鴉片類受器在針刺足三里穴中扮演之角色 12
1. 手術 12
2. 實驗用藥 13
3. 實驗流程 13
四、 實驗方法 — 疼痛組 15
1. 手術 15
2. 實驗用藥 15
3. 實驗流程 15
4. 50 %縮腳閾值之測量與計算 15
五、 實驗方法 — 針刺足三里對於疼痛引之睡眠失調的影響 17
1. 手術 17
2. 實驗用藥 17
3. 實驗流程 17
六、 EEG紀錄與分析 18
1. 紀錄 18
2. 分析 18
七、 數據統計 19
參、 結果 20
一、 針刺足三里之安眠效果 20
1. 非快速動眼期 (NREM) 睡眠 20
2. 快速動眼期 (REM) 睡眠 23
二、 於孤獨徑核顯微注射鴉片類受器拮抗劑對於針刺足三里穴產生之安眠效果的影響 25
1. 非快速動眼期與快速動眼期睡眠 25
三、 於右後掌皮下注射CFA引發之疼痛對於50% 縮腳閾值以及睡眠的影響 ………………………………………………………………………27
1. 50% 縮腳閾值 27
2. 疼痛對於睡眠之影響 27
四、 針刺足三里對於疼痛引起睡眠失調之影響 31
1. 50% 縮腳閾值 31
2. 於睡眠失調之影響 31
肆、 討論 34
伍、 結論 40
參考資料……………………………………………………………………………..42

圖目錄
Fig. 1. 植入EEG紀錄電極位置圖 9
Fig. 2. Sham組所選用之不具穴位之位置 11
Fig. 3. 測試針刺足三里對於睡眠影響之實驗流程 11
Fig. 4. EEG電極以及single guide cannula植入位置圖 12
Fig. 5. 探討鴉片類受器在針刺足三里穴中所扮演角色之流程圖 14
Fig. 6. 針刺第一天24小時內非快速動眼期 (NREM) 之睡眠變化 21
Fig. 7. 針刺第二天24小時內非快速動眼期 (NREM) 之睡眠變化 21
Fig. 8. 針刺二天後隔天24小時內非快速動眼期 (NREM) 之睡眠變化 22
Fig. 9. 針刺第一天24小時內快速動眼期 (REM) 之睡眠變化 23
Fig. 10. 針刺第二天24小時內快速動眼期 (REM) 之睡眠變化 24
Fig. 12. 針刺二天以及分別顯微注射PFS (白點) 、naloxone (黑點)以後,24小時內非快速動眼期 (NREM) 之睡眠變化 25
Fig. 13. 針刺二天以及分別顯微注射PFS (白點) 、naloxone (黑點)以後,24小時內快速動眼期 (REM) 之睡眠變化 26
Fig. 14. 疼痛第一天 (黑色) 、疼痛第二天 (深灰色) 、疼痛第三天 (淺灰) 與baseline (白色) 之間50%縮腳閾值之變化 28
Fig. 15. 疼痛第一天24小時內非快速動眼期 (NREM) 之睡眠變化 28
Fig. 17. 疼痛第一天24小時內快速動眼期 (REM) 之睡眠變化 29
Fig. 18. 疼痛第二天24小時內快速動眼期 (REM) 之睡眠變化 30
Fig. 19. 疼痛組 (淺灰色) 、針刺治療組 (深灰色) 與baseline (黑色) 之50%縮腳閾值之變化 31
Fig. 20. 針刺足三里穴後,疼痛第二天24小時內非快速動眼期 (NREM) 之睡眠變化 32




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