【作者】 赵莉婕；

【导师】 古继红；

【作者基本信息】 广州中医药大学 ， 中医学， 2008， 硕士

【摘要】 研究目的近年来失眠症发病率呈上升趋势,其中相关因素引起特定中医证型的失眠逐渐引起研究者的关注。研究发现,高失眠率与不同人群特定的相关因素有密切的关系,同时,不同患者失眠的发生主要集中在特定的中医证型上,导致了一部分人群失眠的高发和频发。本研究旨在通过青年高校生人群和广州中、老年人群的睡眠情况和相关因素进行分析和评价,探讨导致不同人群睡眠质量下降的相关因素;并进一步深入调查研究了临床失眠患者的相关情况,结合失眠的中医辨证分型,试图找出失眠患者相关因素及其与中医证型之间的关系,为进一步研究应用中医辨证论治理论防治失眠提供依据。研究方法在系统总结《内经》和其他中医文献有关失眠论述的基础上,结合现代医学中失眠的生理病理、诊断治疗的论述以及失眠患者生存质量的调查研究进行分析和演绎,从理论上总结回顾失眠的相关理论研究和临床进展。采用横断面研究的调查方法,调查华南师范大学和广州中医药大学在校学生共276名的睡眠情况,探讨青年高校生人群睡眠质量下降的相关因素;调查广州老年大学学员共180名的睡眠情况,探讨中、老年人群睡眠质量下降的相关因素;调查广州中医药大学第一附属医院内科门诊失眠患者共306例,探讨导致患者失眠的相关因素及其与中医证型的相关性。现场调查收集包括一般情况、PSQI、生理、躯体、SCL-90、中医体质分型、临床辨证资料、睡眠、用药、诊断治疗等情况,并用SPSS11.5软件建立数据库,进行统计学分析处理与统计图表制作。计数资料用t检验,计量资料用x~2检验,等级资料用秩和检验,相关性用回归分析。研究结果1.性别和体重是影响高校生睡眠质量的一般因素;影响高校生睡眠质量最显著的躯体因素包括遗传史、手术外伤输血史、特别嗜好或习惯;影响高校生睡眠质量最显著的生理因素包括乘车、船、飞机等,宿舍环境以及近期工作学习压力;心理问题会影响高校生睡眠质量,其中躯体化因子、强迫症状因子、抑郁因子、精神症状因子以及饮食等心理因子与PSQI总分呈正相关,恐怖因子与PSOI总分呈负相关。强迫症状是高校学生最为突出的心理问题。2.性别、饮食规律、目前健康状况是中、老年人睡眠质量的影响因素;广州中、老年人中医体质类型以阳虚质为最多,其次为气虚质;阳虚质、气郁质和平和质对广州中、老年人睡眠质量有影响,其中,阳虚质和气郁质与PSQI总分呈正相关,平和质和PSOI总分呈负相关。3.失眠患者的中医证型分布,最多为心脾两虚型,其次为肝郁化火型,最少为心火炽盛型;性别、年龄、特别嗜好或生活习惯影响失眠患者中医证型的构成;入睡困难、睡后易醒、醒后再难入睡以及白天无法保持清醒四个方面在失眠患者中医证型间分布存在差异。研究结论1.青年高校生人群失眠相关因素以外因为主,常表现为应激事件带来的生理影响以及负性生活事件刺激的心理因素所引发的睡眠质量下降。2.中、老年人群失眠的相关因素除了外因的作用,更主要是内在因素的作用。生理机能衰退,脏腑组织功能低下,导致其体质发生改变,是引起睡眠质量下降甚至导致失眠的重要原因。3.临床失眠患者中医证型以心脾两虚型和肝郁化火型为主,特别嗜好或生活习惯成为影响患者失眠中医证型的主要外在因素。而失眠的发生无论是在正常人群或是患者当中,性别都是显著的影响因素,呈现出女性高发的特点。更多还原

【Abstract】 Objectives:The insomnia morbidity is on the rise in recent years, among them the related factors that cause insomnia of the particular Chinese medicine syndromes to arouse the attention from researchers gradually. Research is discovered , the high insomnia rate has close relations with different crowd’ s particular related factors, meanwhile, the emergence of different patient’s insomnia mainly concentrates on particular Chinese medicine syndromes, which cause some group’s insomnia be taken place highly and frequently. Research this aim at, through the analysis and appraisal of the sleep situation and related factors about the crowds of young university students and middle-aged and elder people, discuss related factors causing different crowd’s sleep quality to drop;And making further investigations thoroughly about related situations of the clinical insomnia patients, combine the dialectical syndromes of Traditional Chinese medicine of insomnia, attempt to find out insomnia related factors and the relationship with TCM syndromes, offer basis for further studying and employing the dialectical theory of Chinese medicine of preventing and curing insomnia.Methods:On the basis of summarizing in system the argumentation about suffering from insomnia in "Neijing" and other Chinese medicine literature, to analyzes and deduces combining physiological and pathological while diagnosing and treatment argumentation of insomnia in modern medical science and investigations in quality that the insomnia patient survives, summarize and review the relevant theoretical research and clinical progress of insomnia theoretically. Adopt the investigation method that cross section studies, investigate the sleep situation of the students in South China Normal University and Guangzhou university of Chinese medicine amount to 276, discuss the related factors that caused the young university students’ sleep quality drops; Investigate the sleep situation of the students in the university for the aged of Guangzhou amount to 180, discuss the related factors that caused the sleep situation of in middle-aged and elderly people; Investigate the physical medicine clinic insomnia patient of the first affiliated hospital of Guangzhou university of Chinese medicine amounts to 306, discuss the related factors that results insomnia and the relationship with TCM syndromes. Investigate live collects includes the general condition, PSQI scores, physiology, body condition, SCL-90, Chinese medicine physique dividing types, clinical dialectical materials, sleeping situation, using medicine situation, diagnosing and treating, etc., and set up the database with SPSS11. 5 software, carrying out statistics handles and making the statistical charts. Counting materials uses t test, measuring materials uses chi square test, grade materials uses rank sum test, the correlation uses regression.Results:1. Sex and weight are that universities grow the influence factors of sleep quality; Influence the universities to grow the sleep quality most prominent body factors including hereditary history, operation traumatic blood transfusion history, special hobby or habit; Influence the universities to grow the sleep quality most prominent physiological factor including by bus, ship, plane, etc., the environment of the dormitory , the pressure of recent studying and working; The psychological problem will influence the universities’ sleep quality, among them body factor, forcing psychological factor, depressed factor, spiritual symptom factor and diet, etc. presenting positive correlation with PSQI total scores, terrific factor presenting negative correlation with PSQI total scores. Force symptom is university student’s most outstanding psychological problem.2. Sex , dietary , present healthy situation are Guangzhou middle-aged and elderly people sleep mass influencing factors; Guangzhou middle-aged and elderly people’s TCM physique constitution type investigation shows, qualitiy of deficiency of yang are the most, secondly it is the quality of deficiency of qi; The TCM body constitution types that influence the middle-aged and elderly people’s sleep quality are quality of deficiency of yang, angry strongly blocking quality and fair plain quality, among them, the kind quality of deficiency of yang and angry strongly blocking quality presenting positive correlation with PSQI total scores, while the fair plain quality presenting negative correlation with PSQI total scores.3. The TCM syndromes of the insomnia patient is distributed, first for the weakness of both spleen and heart syndrome, second for the fire melted by strongly blocking of live syndrome, the fire flaming by heart syndrome is the least one; Sex, age, special hobby and habits influence the composition of the insomnia patient’s TCM syndromes; Falling asleep difficult, easy be wakeing up, difficulty fall asleep after awake and unable keeping sober in daytime are four respects that distributing differences among the TCM syndromes in insomnia patients.Conclusions:1. The young university students suffer from insomnia mainly because of outside related factor reasons, mass often comes down for behaviour responding to sleep quality drop down initiated by the physiology effect that the exciting event brings about and upset psychological factor of negativity life event.2. Besides the effect of the external cause of related factors of middle-aged and elderly people insomnia, it is the function of the internal factors to be predominant. The physiology is decaying, the internal organs function is decling, lead to the type of TCM physique constitution changed, which is the important reason caused sleep quality dropping even insomnia.3. Clinical insomnia patients’ TCM syndromes are predominant by the weakness of both spleen and heart syndrome and he fire melted by strongly blocking of live syndrome, special hobby and habits turn out to be the most important external factor influencing TCM syndromes. And the emergence of insomnia no matter among the normal crowds or patients, sex is all prominent influence factors, demonstrate the incidence frequency is high in female.更多还原