失眠症的临床治疗进展

rogress in clinical treatment of insomnia

目的:失眠是一种睡眠障碍性疾病,是多种躯体、精神和行为疾病所具有的常见临床表现,严重影响着人们身心健康,生活质量和工作效率,对其进行研究具有临床现实意义。资料来源:通过计算机检索Medline数据库1996-02/2005-11期间的与人类失眠的临床表现、诊断、治疗相关的资料,检索词:“insomnia,treatment”。限定文章种类为英文。同时手工检索与之内容相关的书籍。资料选择:对资料进行初审,选取流行病学研究、随机对照临床试验,排除重复性研究。资料提炼:共收集到1439篇关于失眠及其治疗的研究、随机对照临床试验,200篇研究符合纳入标准,排除的1239篇研究中,826篇研究因系重复的同一研究,413篇为Meta分析或综述。选择其中的18篇用于综述。资料综合:失眠是患者对睡眠时间和/或质量不满足并影响白天社会功能的一种主观体验。临床表现不完全相同。按病程可分为一过性或急性失眠、短期或亚急性失眠、长期或慢性失眠。失眠的明确分类对确定适当的治疗有用,其治疗方法主要分为:非药物治疗和药物治疗。在非药物治疗中可采用:①睡眠卫生教育(给予睡眠卫生知识)。②光照治疗(适当强度、时间的光照可以改变睡眠-觉醒节律)。③心理和认知行为治疗。在药物治疗中可采用:①苯二氮类药物(非选择性拮抗γ-氨基丁酸A复合受体。短效药的代表三唑仑,常用的中效药舒乐安定,阿普唑仑,羟基安定,氯羟安定;长效药有安定,硝基安定,氟基安定)②非苯二氮类药物:主要药物有佐匹克隆和吡唑坦,系选择性γ-氨基丁酸A复合受体拮抗剂。③抗焦虑、抑郁药:丁螺环酮;帕罗西丁、博乐欣、左洛夫、米氮平;多虑平、阿米替林和去甲丙咪嗪。④草药:颉草属植物的提取物可诱导睡眠,如颉草烯酸。⑤激素替代疗法:褪黑激素。⑥其他:前列腺素D可增加睡眠,白细胞介素1具有促进睡眠作用。结论:失眠的病因复杂多样,在治疗上,由于个体差异的存在,不少患者的疗效不尽理想,故应强调个体化原则。因缺乏大规模对行为及药物疗法的研究,无具体的治疗指南,使得失眠的治疗很富有挑战性,失眠治疗的远期疗效尚需进一步研究。

OBJECTIVE： Insomnia is a kind of sleep disorder, which is the common clinic performance for various physical, mental and the behavior diseases, and seriously affects the people＇s health in mind and body, the quality of life and efficicncies, so it is of significance to conduct the research. DATA SOURCES： A computer-based online search of Medline database was undertaken to identify the articles about the clinic performance, diagnosis and treatment of insomnia published in English between February 1996 and November 2005 with the keywords of ＂insomnia, treatment＂. Meanwhile, related books were searched manually. STUDY SELECTION： After the first cheek, the epidemiological studies and randomized controlled trials were selected, and the duplicated studies were removed. DATA EXTRACTION： Totally 1 439 epidemiologcial studies and randomized controlled trials about insomnia and its treatment were collected, 200 studies met the inclusive criteria; Of the I 239 excluded articles, 826 were repetitive and 413 were reviews or Meta analysis,18 of which were cited. DATA SYNTHESIS： Insomnia is one kind of subjective exPerience, the patient suffered insomnia from which is not satisfied with the sleep time and/or quality, it influences the social function at daytime. The clinical findings are incompletely the same. According to the course of diseases, it includes transient or acute insomnia, short-term or subacute insomnia, long-term or chronic insomnia. The definite classification of insomnia is useful to the suitable treatment, the treatment mainly includes the non-drug treatment and the drug treatment. The followings are included in the former： （1） sleep health education （got sleep hygienic knowledge）. （2） illumination therapy （suitable intensity, time illumination may change sleep-awakening rhythm）. （3） Psychological and cognition behavior treatment. The followings are included in the latter： （1） benzodiazepines （the non-selectivity anti-gamma-amino-butyric acid A compound acceptor）, the short effect medicine representative is triazolam, the middle ones are midazolam, aiprzolam, temazepam, lorazepam; the long ones are diazepam, nitrazepam, flurazepam. （2） non-benzodiazepines： The main medicine has Zoleplon and Zolpidem - the selective anti-gamma-amino-butyric acid A compound receptor. （3） the anti-anxiety, antidepressant medicines： such as Bhspirene, Fluoxetine, etc. （4） herbal medicine： valerian extract can induce sleep, like valerenic acid. （5） substitute therapy of hormone： melatonin. （6） others： progstaglandin D may increase the sleep, interleukin-1 has the function of promoting sleep. CONCLUSION： The causes of insomnia are complex and diverse. Because of the existence of the individual difference, the many patients＇ curative effect is not to the utmost ideal in the treatment, therefore the individual principle should be emphasized. Because of lack of the studies about behavior and drug treatments on the big scale, no concrete treatment guide, so the treatment of insomnia isa challenge to us, forward curative effect of which need further studies.