中医内外同治综合疗法治疗女性更年期失眠的临床疗效
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摘要
目的观察中医内服汤剂、外用耳穴、药枕综合疗法治疗女性更年期失眠的临床疗效。方法选择2015年12月至2016年12月保定市第一中医院收治的126例以失眠为主要表现且符合肝郁脾虚证的女性更年期失眠患者为研究对象,依据随机数字法分为观察和对照组,对照组(61例)采用西药艾司唑仑片治疗,观察组(65例)采用内服中药自拟疏肝补脾汤、外用耳穴贴敷、安神药枕的"内外同治"综合疗法。比较两组患者的临床疗效、治疗前后PSQI评分的变化。结果观察组总有效率高于对照组[92. 31%(60/65)比75. 41%(46/61)](P <0. 05)。治疗后,观察组入睡时间、睡眠效率、催眠药物、日间功能障碍和总分低于对照组[0. 5(0. 0,1. 0)分比1. 0(0. 5,1. 0)分、(1. 23±0. 49)分比(1. 52±0. 50)分、(0. 98±0. 88)分比(1. 30±0. 62)分、(0. 92±0. 75)分比(1. 43±0. 80)分、(7. 31±1. 80)分比(9. 07±1. 58)分],睡眠时间高于对照组[1. 0(1. 0,2. 0)分比1. 0(0. 5,2. 0)分](P <0. 05)。观察组复发率低于对照组[4. 76%(3/63)比20. 68%(12/58)](P <0. 05)。结论中医内外同治法综合治疗更年期失眠的临床疗效满意,安全、无不良反应。
Objective To observe the clinical effect of Chinese medicine of internal decoction,external auricular cavity and occipital therapy on female patients with menopausal insomnia. Methods 126 menopausal insomnia women patients with insomnia as the main manifestation and liver depression and spleen deficiency admitted to Baoding No. 1 TCM Hospital from Dec. 2015 to Dec. 2016 were included. According to the random number method,they were divided into an observation group (65 cases) and a control group (61 cases). The control group was treated with the western drug isazolam tablets.The observation group adopted the comprehensive therapy of internal Chinese medicine and external treatment comprehensive therapy of self-prepared Shugan Bupi soup,external auricular patch,and tranquilizing pillow. The clinical efficacy and PSQI score of the two groups were compared. Results The total effective rate of the observation group was higher than that of the control group[92. 31% (60/65) vs 75. 41% (46/61) ] (P < 0. 05). After treatment,time to fall asleep,sleep efficiency,hypnotics,diurnal dysfunction and total score in the observation group were lower than those of the control group[0. 5 (0. 0,1. 0) score vs 1. 0 (0. 5,1. 0) score, (1. 23 ±0. 49) score vs (1. 52 ± 0. 50) score, (0. 98 ± 0. 88) score vs (1. 30 ±0. 62) score, (0. 92 ± 0. 75) score vs (1. 43 ± 0. 80) score, (7. 31 ± 1. 80) score vs (9. 07 ± 1. 58) score],sleep time was longer than that in the control group [1. 0 (1. 0-2. 0) score vs 1. 0 (0. 5-2. 0) score] (P < 0. 05). The recurrence rate of the observation group was lower than that of the control group[4. 76% (3/63) vs 20. 68% (12/58) ] (P < 0. 05). Conclusion The TCM comprehensive therapy has definite clinical effect on menopausal insomnia,which is safe,satisfactory and has no adverse effects.
Objective To observe the clinical effect of Chinese medicine of internal decoction,external auricular cavity and occipital therapy on female patients with menopausal insomnia. Methods 126 menopausal insomnia women patients with insomnia as the main manifestation and liver depression and spleen deficiency admitted to Baoding No. 1 TCM Hospital from Dec. 2015 to Dec. 2016 were included. According to the random number method,they were divided into an observation group (65 cases) and a control group (61 cases). The control group was treated with the western drug isazolam tablets.The observation group adopted the comprehensive therapy of internal Chinese medicine and external treatment comprehensive therapy of self-prepared Shugan Bupi soup,external auricular patch,and tranquilizing pillow. The clinical efficacy and PSQI score of the two groups were compared. Results The total effective rate of the observation group was higher than that of the control group[92. 31% (60/65) vs 75. 41% (46/61) ] (P < 0. 05). After treatment,time to fall asleep,sleep efficiency,hypnotics,diurnal dysfunction and total score in the observation group were lower than those of the control group[0. 5 (0. 0,1. 0) score vs 1. 0 (0. 5,1. 0) score, (1. 23 ±0. 49) score vs (1. 52 ± 0. 50) score, (0. 98 ± 0. 88) score vs (1. 30 ±0. 62) score, (0. 92 ± 0. 75) score vs (1. 43 ± 0. 80) score, (7. 31 ± 1. 80) score vs (9. 07 ± 1. 58) score],sleep time was longer than that in the control group [1. 0 (1. 0-2. 0) score vs 1. 0 (0. 5-2. 0) score] (P < 0. 05). The recurrence rate of the observation group was lower than that of the control group[4. 76% (3/63) vs 20. 68% (12/58) ] (P < 0. 05). Conclusion The TCM comprehensive therapy has definite clinical effect on menopausal insomnia,which is safe,satisfactory and has no adverse effects.
引文
[1]吴勉华,王新月.中医内科学[M].9版.北京:中国中医药出版社,2012:149.
[2]中国医师协会全科医师分会双心学组.心血管病合并失眠诊疗中国专家共识[J].中华内科杂志,2017,56(4):310-315.
[3]中华医学会神经病学分会睡眠障碍学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[4]朱文峰.中医诊断学[M].2版.北京:中国中医药出版社,2007:202.
[5]汪向东,王希林,马弘.心理卫生评定量表手册[J].中国心理卫生杂志社,1999,12(增刊):375-378.
[6]黄彦霞,宋磊,张曦.莉芙敏联合帕罗西丁治疗围绝经期抑郁症的临床观察[J].中华医学杂志,2013,93(8):600-602.
[7]尹贞云,赵忠新.镇静催眠药物对失眠患者睡眠结构的影响[J].中华神经内科杂志,2010,43(1):69-70.
[8]杨代竹,李玉山.老年失眠治疗的研究进展[J].医学综述,2015,21(4):706-707.
[9]贺娟.内经讲义[M].2版.北京:人民卫生出版社,2012:106.
[10]张其慧.从调肝理脾论治失眠[J].四川中医,2005,12(23):9-11.
[11]戈宏焱,陈博,许丹,等.柴胡皂苷A对抑郁模型大鼠脑中单胺类神经递质及其代谢产物含量的影响[J].高等学校化学学报,2008,29(8):1535-1538.
[12]崔广智.芍药苷抗抑郁作用的实验研究[J].现代药物与临床,2009,24(4):231-233.
[13]翟旭峰,肖小春,娄勇军,等.生酸枣仁及其炮制品镇静催眠作用及对失眠大鼠脑电图的影响[J].中药药理与临床,2015,31(6):94-96.
[14]饶琴珠.耳穴贴压疗法治疗围绝经期失眠的护理观察[J].内蒙古中医药,2017,2(4):164-165.
[15]韩晓玲,蔡辉.指压联合耳穴埋籽缓解普外科术前焦虑的临床研究[J].中医药信息,2012,29(6):84-85.
[16]杨松柏,梅志刚,蔡三金,等.不同穴位组合对女性更年期失眠症的疗效比较与对照研究[J].中国针灸,2014,34(1):3-8.
[17]李芳,蔡志军,路政.电耳针配合拔罐治疗失眠50例[J].中国针灸,2004,24(8):584.
[18]许晓跃,王水,葛童娜.针灸治疗原发性失眠患者的神经机制研究[J].中华神经医学杂志,2016,12(15):1251-1254.
[19]汪宏锦,吴俊杰,薛强.冰片对血脑屏障通透性的双向调节作用影响因素及机制探讨[J].中国中药杂志,2017,42(1):2200-2207.
[20]庞英华.中医外治法治疗原发性高血压的研究进展[J].世界中医药,2014,9(6):817-823.
[21]王澍欣,王照浩.耳穴应用中一些问题的探讨[J].中国针灸,2009,29(8):637-638.
[2]中国医师协会全科医师分会双心学组.心血管病合并失眠诊疗中国专家共识[J].中华内科杂志,2017,56(4):310-315.
[3]中华医学会神经病学分会睡眠障碍学组.中国成人失眠诊断与治疗指南[J].中华神经科杂志,2012,45(7):534-540.
[4]朱文峰.中医诊断学[M].2版.北京:中国中医药出版社,2007:202.
[5]汪向东,王希林,马弘.心理卫生评定量表手册[J].中国心理卫生杂志社,1999,12(增刊):375-378.
[6]黄彦霞,宋磊,张曦.莉芙敏联合帕罗西丁治疗围绝经期抑郁症的临床观察[J].中华医学杂志,2013,93(8):600-602.
[7]尹贞云,赵忠新.镇静催眠药物对失眠患者睡眠结构的影响[J].中华神经内科杂志,2010,43(1):69-70.
[8]杨代竹,李玉山.老年失眠治疗的研究进展[J].医学综述,2015,21(4):706-707.
[9]贺娟.内经讲义[M].2版.北京:人民卫生出版社,2012:106.
[10]张其慧.从调肝理脾论治失眠[J].四川中医,2005,12(23):9-11.
[11]戈宏焱,陈博,许丹,等.柴胡皂苷A对抑郁模型大鼠脑中单胺类神经递质及其代谢产物含量的影响[J].高等学校化学学报,2008,29(8):1535-1538.
[12]崔广智.芍药苷抗抑郁作用的实验研究[J].现代药物与临床,2009,24(4):231-233.
[13]翟旭峰,肖小春,娄勇军,等.生酸枣仁及其炮制品镇静催眠作用及对失眠大鼠脑电图的影响[J].中药药理与临床,2015,31(6):94-96.
[14]饶琴珠.耳穴贴压疗法治疗围绝经期失眠的护理观察[J].内蒙古中医药,2017,2(4):164-165.
[15]韩晓玲,蔡辉.指压联合耳穴埋籽缓解普外科术前焦虑的临床研究[J].中医药信息,2012,29(6):84-85.
[16]杨松柏,梅志刚,蔡三金,等.不同穴位组合对女性更年期失眠症的疗效比较与对照研究[J].中国针灸,2014,34(1):3-8.
[17]李芳,蔡志军,路政.电耳针配合拔罐治疗失眠50例[J].中国针灸,2004,24(8):584.
[18]许晓跃,王水,葛童娜.针灸治疗原发性失眠患者的神经机制研究[J].中华神经医学杂志,2016,12(15):1251-1254.
[19]汪宏锦,吴俊杰,薛强.冰片对血脑屏障通透性的双向调节作用影响因素及机制探讨[J].中国中药杂志,2017,42(1):2200-2207.
[20]庞英华.中医外治法治疗原发性高血压的研究进展[J].世界中医药,2014,9(6):817-823.
[21]王澍欣,王照浩.耳穴应用中一些问题的探讨[J].中国针灸,2009,29(8):637-638.