黄连温胆汤治疗痰热内扰型失眠症的临床观察(1)

http://www.100md.com 2018年5月1日 《世界睡眠医学杂志》 20185

     摘要 目的：观察黄连温胆汤对痰热内扰型失眠的临床疗效，并对其部分机制进行探讨。方法：选取2017年1～12月隆化县医院收治的痰热内扰型失眠患者60例纳入研究，随机分为对照组和观察组，每组30例。对照组患者睡前服用艾司唑仑，1 mg/次；观察组在对照组治疗基础上加用黄连温胆汤，1剂/d，200 mL煎服，早晚温服分服。2组均连续治疗14 d，治疗结束后比较2组患者匹兹堡睡眠质量指数(PSQI)、睡眠自评量表(SRSS)评分的变化，同时检测外周血5-羟色胺(5-HT)、β-内啡肽(β-EP)浓度变化。结果：1)治疗后2组PSQI、SRSS评分均较治疗前有所下降(P<0.05)，观察组下降得较对照组明显，差异有统计学意义(P<0.05)；2)治疗后2组5-HT及β-EP浓度均较治疗前下降(P<0.05)，其中观察组优于对照组(P<0.05)。结论：黄连温胆汤对痰热内扰型失眠有理想疗效，其作用机制可能与下调患者5-HT、β-EP有关。

    关键词 失眠；痰热内扰；黄连温胆汤；5-羟色胺；β-内啡肽

    中图分类号：R277.7文献标识码：Adoi：10.3969/j.issn.2095-7130.2018.05.020

    Abstract Objective：To observe the clinical effect of Huanglian Wendan decoction on phlegm and internal disturbance insomnia and to discuss its mechanism.Methods：From January to December 2017，60 patients with internal disturbance of phlegm heat were selected and randomly divided into control group and observation group，each with 30 cases.The patients in the control group were given 1 mg of eszolam before bedtime，and those in the observation group were treated with Huanglian Wendan decoction (200 mL/d)on the basis of the treatment in the control group，and were taken separately in the morning and evening.The Pittsburgh sleep index (PSQI)，sleep self-rating scale (SSRSS)and the levels of 5-HT and β-endorphin (β-EP)in peripheral blood were measured after 14 days of continuous treatment in both groups.Results：1)after treatment，the SRSS scores of the two groups were lower than those before treatment (P<0.05)，and the scores of 5-HT and β-EP in the observation group were significantly lower than those in the control group (P<0.05).After treatment，the concentrations of 5-HT and β-EP in the two groups were lower than those before treatment (P<0.05)，and the observation group was better than the control group (P<0.05).Conclusion：Huanglian Wenqi Decoction has ideal effect on phlegm-heat internal disturbance type insomnia，and its mechanism of action may be related to down-regulation of 5-HT and β-EP in patients.

    Key Words Insomnia；Phlegm heat internal disturbance；Huanglian Wendan decoction；5-HT；β-EP

    由于各種原因导致睡眠-觉醒机制紊乱，引起相关神经生理功能易化作用增强，影响参与调节睡眠-觉醒的神经结构的病理性改变，从而出现失眠症[1]。其属于中医学“不寐”“目不瞑”等范畴[2]。以苯二氮艹卓类为主的助眠西药虽可在一定程度改善睡眠，但其成瘾性、依赖性及停药反跳性等不良反应严重影响用药依从性。中医药以其安全性高、疗效显著等优势被大多数患者接受。《古今医统大全》曰“痰火扰乱，心神不宁，思虑过伤、火炽痰郁而致不眠者，多矣”。在对临床病例观察及查阅大量文献后我们亦发现痰热内扰型失眠的主要证型，因此清热化痰是治疗的根本。基于此，我们利用黄连温胆汤对痰热内扰型失眠患者进行治疗，并对其作用机制进一步研究，现将结果报道如下。

    1 资料与法

    1.1 一般资料 选取2017年1～12月隆化县医院收治的痰热内扰型失眠患者60例纳入研究，随机分为对照组和观察组，每组30例。对照组中男12例，女18例，年龄35～68岁，平均年龄(45±2.12)岁；观察组中男13例，女17例，年龄34～65岁，平均年龄(42±3.35)岁。2组患者在年龄、性别等一般情况方面比较，差异无统计学意义(P>0.05)，具有可比性。2组患者诊断均符合2006年陈彦方著《中国精神障碍分类与诊断标准》中关于失眠的诊断[3]，及1994年国家中医药管理局颁布的《中医病证诊断疗效标准》中痰热内扰型失眠的诊断[4]。(杨连祥)

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