基于多导睡眠监测技术观察疏肝健脾安神方对失眠症肝郁脾虚型的影响

Clinical observation of Shugan Jianpi Anshen Decoction on polysomnography in treating insomnia of liver depression and spleen deficiency type

目的观察疏肝健脾安神方对失眠症肝郁脾虚型患者的临床疗效。方法将80例失眠症肝郁脾虚型患者按照随机数字表法分为2组,对照组40例(后退出2例)予佐匹克隆胶囊治疗,治疗组40例(后退出1例)在对照组基础上加用疏肝健脾安神方。2组均治疗4周。比较2组治疗前后及随访时失眠严重指数量表(ISI)评分、匹兹堡睡眠质量指数(PSQI)评分以及治疗后多导睡眠监测(PSG)参数的变化情况。结果治疗组总有效率92.3%(36/39),对照组总有效率73.7%(28/38),治疗组临床疗效优于对照组(P<0.05)。2组治疗后及随访时ISI评分均较本组治疗前降低(P<0.05),随访时对照组较本组治疗后升高(P<0.05),治疗组治疗后及随访时均低于对照组同期(P<0.05)。2组治疗后及随访时PSQI评分均较本组治疗前降低(P<0.05),随访时2组均较本组治疗后升高(P<0.05),治疗组治疗后及随访时均低于对照组同期(P<0.05)。2组治疗后睡眠潜伏期、觉醒时间均较本组治疗前减少(P<0.05),睡眠总时间、睡眠效率均增加(P<0.05),且治疗组各项睡眠结构参数均较对照组改善明显(P<0.05)。在睡眠分期方面,2组治疗后N1期睡眠时间和比例均较治疗前减少(P<0.05);N3期、REM期睡眠时间和比例均较治疗前增加(P<0.05),且治疗组在改善N1期、N3期及REM期睡眠时间和比例方面优于对照组(P<0.05)。结论疏肝健脾安神方对于失眠症肝郁脾虚型患者更加有效,且停药后症状反弹小,值得临床推广运用。

Objective To explore the clinical effect of Shugan Jianpi Anshen Formula on insomnia patients with liver depression and spleen deficiency type.Methods Totally 80 cases of insomnia with liver depression and spleen deficiency were randomly in 1∶1 ratio assigned to two groups.The treatment group(1 case later withdrew)was treated with Zopiclone+Shugan Jianpi Anshen Formula,while the control group(2 cases later withdrew)with the former alone.The treatment was performed for 4 weeks,aiming to compare insomnia severity index(ISI),Pittsburgh sleep quality index(PSQI),and the parameters of polysomnography(PSG)between groups before and after treatment.Results After treatment,the total effective rate in the treatment group was significantly higher than that in the control group(92.3%[36/39]vs 73.7%[28/38],P<0.05).The scores ISI and PSQI in the two groups after treatment and at follow-up were lower than those before treatment(both P<0.05),and which in the treatment group was lower than the concurrentcontrol group(both P<0.05).The PSG parameter results showed that the treatment group can significantly shorten the sleep latency and awakening time compared to the control group(P<0.05),increased the total sleep time,N3 phase time,and REM phase time,and significantly improve the sleep efficiency(P<0.05).Follow up 2 weeks after the end of treatment showed that the treatment group was still superior to the control group in the above indicators(P<0.05).Conclusion Shugan Jianpi Anshen Formula is more effective for patients with insomnia of liver depression and spleen deficiency type,and has little rebound of symptom after drug withdrawal,which is worthy of clinical promotion and application.