【作者】 李绍旦；

【导师】 杨明会；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2008， 博士

【摘要】 【目的】①研究亚健康失眠状态的中医证候学特征。②探讨和胃安神法对亚健康失眠的治疗作用。【方法】①对262例亚健康失眠者应用亚健康中医证候测量量表和匹兹堡睡眠质量指数量表进行量表测量,并对其中168例亚健康失眠者应用微动敏感床垫睡眠监测系统、脑电超慢涨落图分析仪等进行检测分析。②采用随机对照试验设计,将156例亚健康失眠者随机分配入对照组和试验组各78例,对照组采用安神补心胶囊治疗,试验组采用和胃安神法为主治疗,疗程为4周,治疗前后均进行亚健康中医证候测量量表、匹兹堡睡眠质量指数量表、微动敏感床垫睡眠监测系统、脑电超慢涨落图分析仪等的测量与检测。【结果】①亚健康失眠者以男性较多(约58.8%),以已婚者为主(约77.8%),年龄大多在30岁～50岁(约76.3%);主要影响因素包括有娱乐聚会(93.1%)很少、体育锻炼(92.4%)和休闲活动(92.3%)缺乏、经常加班加点(80.6%)、饮食没有规律(71.4%)等;主要临床表现有睡眠满意度低、入睡困难、早醒、多梦、易醒等;常见症状可由睡眠因子、疲劳因子、心理性格因子、脾胃肠道因子、心肺因子等10个因子来概括;常见证候主要有肝郁脾虚证、脾胃不和证、心脾两虚证、心肾不交证、肝胃不和证、脾胃气虚证、肝胃气滞证、脾虚湿困证、胃肠气滞证、胃火炽盛证等10类;睡眠结构异常,主要表现在入睡潜伏期延长、深睡期和REM期不足、浅睡期和醒觉总时间过多等;HRV检测指标SDNN、rMSSD和LF、HF、LF/HF均偏高;EFG异常则以GABA和Glu中枢神经递质功率明显下降、兴奋抑制指数和熵值显著升高等为主要表现。262例亚健康失眠者PSQI总分均＞7分,其中以8～17分的轻、中度失眠为主(约98.5%)。②试验组和胃安神法改善临床症状的总有效率达92.0%,而对照组的总有效率为71.2%(P＜0.01);试验组和胃安神法对睡眠质量和睡眠结构完全改善率分别为81.3%和48.0%,而对照组分别为64.4%(P＜0.05)和28.8%(P＜0.05);试验组和胃安神法对HRV检测结果SDNN、rMSSD和LF、HF与对照组比较均有显著性差异(P＜0.05或P＜0.01);试验组和胃安神法对EFG的完全改善率为36.0%,而对照组为20.5%(P＜0.05)。【结论】①亚健康失眠状态好发人群的社会角色较为稳定;主要影响因素涉及社会生活环境、心理性格情绪、饮食生活方式等方面;主要临床表现在睡眠、躯体、精力以及心理与社会功能等四个方面内容;常见症状可由睡眠因子、疲劳因子等10个因子来概括;常见证候有肝郁脾虚证、脾胃不和证等10类;睡眠结构特征主要表现在入睡困难、睡眠表浅、睡眠不实等;HRV特征主要表现在交感神经、副交感神经、迷走神经的兴奋性均增高,交感神经与副交感神经活动平衡失调、自主神经功能异常;EFG的显著特征是脑内中枢神经递质活动异常、大脑中枢兴奋性升高以及脑功能状态紊乱;失眠程度则以轻、中度失眠为主要特点。②和胃安神法对亚健康失眠状态的总体疗效良好,在改善亚健康失眠的临床症状、睡眠质量、睡眠结构以及调整自主神经功能、改善中枢神经递质异常活动和脑功能状态等方面的作用效果均较明显。更多还原

【Abstract】 【Objective】①To investigate the syndrome features of Traditional Chinese Medicine for sub-healthy state with insomnia.②To explore the therapeutical effects of Traditional Chinese Medicine with the Method of "Hewei Anshen" for sub-healthy state with insomnia.【Method】①Measuring TCM syndrome features and Pittsburg sleep quality index (PSQI)value of 262 insomniacs by Measuring Scale of TCM Syndrome for Sub-healthy State and PSQI Scale respectively,and detecting sleep architecture, heart rate variability(HRV)and Encephalofluctuograph(EFG)characteristics of 168 insomniacs by Micro-movement Sensitive Mattress Sleep Monitoring System (MSMSMS)and EFG technique respectively.②According the design proposal of randomized control trials(RCT),156 insomniacs were randomly divided into the control group and the trial group,78 in each.The control group was treated with Anshen Buxin Capsule and the trial group was treated Chinese Medicine of "Hewei Anshen".Both groups took 4 weeks for a period of treatment.All the 156 insomniacs were measured and detected by Measuring Scale of TCM Syndrome for Sub-healthy State,PSQI, MSMSMS and EFG before and after treatment.【Result】①Most of sub-healthy people with insomnia were male(about 58.8%),and most of them were married(about 77.8%)and 30-50 years old(about 76.3%).The main influencing factors of sub-healthy state with insomnia included seldom entertainment(93.1%),lack of physical exercise(92.4%),short amusement-time (92.3%),often overtime-work(80.6%),un-regular dietary(71.4%)and so on. The main clinical manifestations consisted of lower satisfaction in sleep quality, difficulty falling asleep,early wake-up,more dreams and festless sleep,etc.The common symptoms were mainly summarized by 10 factors including sleep factor, Fatigue factor,character-mental factor,spleen-stomach-intestine factor,heart-lung factor and so on.The main TCM syndromes were liver QI stagnation with spleen deficiency,spleen-stomach incoordination,heart-spleen deficiency,heart-kidney disharmony,liver-stomach incoordination,spleen-stomach QI deficiency,liverstomach QI stagnation,splenasthenic fluid-retention,stomach-intestine QI stagnation,stomach-fire excessiveness.Sleep architectures of sub-healthy people with insomnia were abnormal including prolonging sleep latency,insufficient deep sleep and REM sleep,excessive light sleep and total wake time.The results of HRV were abnormal obviously,and the changes mainly existed in notable elevation of SDNN、rMSSD and LF、HF、LF/HF.The results of EFG were also abnomal,and the changes mainly existed in decrease of main central neurotransmitters’ power,increase of excite-inhibition index and Entropy value. The PSQI value of each insomniacs exceeded 7,and the value of most objects was between 8 and 17(about 98.5%).②The total effective rate on ameliorating the clinical symptoms of the trial group was 92.0%,which of the control group was 71.2%(P＜0.01).The improving rate of the sleep architecture and the sleep quality of the trial group was 81.3% and 48.0%respectively,which of the control group was 64.4%(P＜0.05)and 28.8%(P＜0.05).Comparison of the detecting values of HRV after treatment between the two groups showed significantly different(P＜0.05 or P＜0.01).The improving rate of EFG of the trial group was 36.0%,which of the control group was 20.5%(P＜0.05). 【Conclusion】①The social roles of the crowd of sub-healthy state with insomnia are obviously outstanding,which is relative to the influencing factors including social life condition,mentality and personality,unhealthy habits and un-regular dietary. The main clinical manifestations include four contents of sleep,body,vigour, mentality and social fuction.The common symptoms are represented by 10 factors and there are ten varieties of main TCM syndromes.Characteristics of sleep architectures are difficulty falling asleep,superficial sleep and festless sleep. Characteristics of HRV are increased excitability of sympathetic nerve, parasympathetic nerve,vagus nerve,dysequilibrium of them and disorder of autonomic nerve function.Characteristics of EFG are abnormal activity of central neurotransmitters,increased excitability of brain central nerve and disordered state of brain function.Degree of insomnia is from low to middle range mainly.②As compared with the control group,the general therapeutic effect of TCM of "Hewei Anshen" in the trial group is satisfactory obviously.The treatment strategy of "Hewei Anshen" in the trial group has been shown better than that of "Buxin Anshen" in the control group on ameliorating clinical symptoms, enhancing sleep quality,improving sleep architecture,regulating autonomic nerve function,accelerating rehabilitation of central neurotransmitters activity and brain function state.更多还原