原发性失眠的机制研究进展及临床用药

Research Progress on Mechanism of Primary Insomnia and Clinical Medication

原发性失眠(primary insomnia,PI)的发生机制与特定脑区结构、功能和代谢异常、神经递质、细胞因子、TRL7等密切相关。治疗方面,西药以苯二氮卓类、巴比妥类、新的非苯二氮卓类为代表,作用机制较为明确,临床使用广泛;中药以补虚泻实、调整阴阳为治则,实证当疏肝泻火、清化痰热、消导和中,虚证当补益心脾、滋阴降火、益气镇静安神,总结了近几年的文献,论述了PI的发病机制及中西医结合的临床用药普遍规律,对药物作用机制做了较为详细的论述,以期为临床用药提供参考,为精准治疗失眠及辅助诊断提供依据,为中西医结合治疗PI提供新思路。

The mechanism of primary insomnia(PI)is closely related to the abnormal structure,function and metabolism of specific brain areas,neurotransmitters,cytokines and TRL7.In terms of treatment,Western medicines are represented by benzodiazepines,barbiturates and new non-benzodiazepines.The mechanism of action is relatively clear and the clinical use is wide.Traditional Chinese medicine treats Yin and Yang by replenishing the deficiency and reducing the sufficiency and adjusting Yin and Yang.When soothing the liver and purging fire,clearing phlegm and heat,dispelling and reconciling the middle,the deficiency syndrome is to nourish the heart and spleen,nourish Yin and reduce fire,nourish Qi and calm the nerves.This article summarized the literature in recent years and discussed the pathogenesis of PI and its mechanism.The general law of clinical medication of integrated western medicine has made a more detailed discussion on the mechanism of drug action in order to provide the reference for clinical medication,providing the basis for precise treatment of insomnia and auxiliary diagnosis and new ideas for the treatment of PI with integrated traditional Chinese and western medicine.