镇静安神汤联合米氮平片治疗焦虑抑郁状态伴顽固性失眠的临床研究

Clinical observation of Zhenjing-anshen decoction combined with mirtazapine on anxiety and depression complicated with refractory insomnia

目的观察镇静安神汤联合米氮平片治疗焦虑抑郁状态伴顽固性失眠的临床疗效,并探讨其作用机制。方法将100例焦虑抑郁状态伴顽固性失眠的患者随机分为2组,治疗组50例予镇静安神汤联合米氮平片治疗,对照组50例仅予米氮平片治疗。2组分别于治疗前及治疗2、4、8周后进行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及匹兹堡睡眠质量指数量表(PSQI)评分,比较2组治疗2、4、8周后副反应量表(TESS)评分,并统计疗效。结果 2组治疗2、4、8周后HAMD、HAMA及PSQI评分较治疗前均降低(P<0.05),且治疗组评分均低于对照组(P<0.05);治疗组治疗2、4、8周后TESS评分均低于对照组(P<0.05);治疗组总有效率92%,对照组68%,2组总有效率比较差异有统计学意义(P<0.05)。结论镇静安神汤联合米氮平片可明显改善焦虑抑郁状态伴顽固性失眠患者的情绪障碍及睡眠质量,且副反应少,具有很好的临床疗效。

Objective To observe the clinical effect of Zhenjing-anshen decoction combined with mirtazapine on the treatment of anxiety and depression complicated with refractory insomnia,and its action mechanism.Methods 100 anxiety and depression patients with refractory insomnia were randomly divided into two groups.50 patients in treatment group were treated by Zhenjing-anshen decoction combined with mirtazapine.50 patients in control group were treated by simple mirtazapine.The Hamilton ＇s depression scale（ HAMD）,Hamilton ＇s anxiety scale（ HAMA） and Pittsburgh sleep quality index（ PSQI） before and 2,4,8 weeks after treatment were evaluated in two groups,the score of the treatment emergent symptom scale（ TESS） 2,4,8 weeks after treatment were compared between two groups,and the curative effect was evaluated.Results The scores of HAMD,HAMA and PSQI2,4,8 weeks after treatment were decreased as compared with those in before treatment in two groups（ P〈0.05）,and the decrease in treatment group was lower than that in control group（ P〈0.05）.The score of TESS 2,4,8weeks after treatment in treatment group was lower than that in before treatment（ P〈0.05）.The total effective rate in treatment and control group was 92% and 68% respectively,and there was significant difference between two groups（ P〈0.05）.Conclusion Zhenjing-anshen decoction combined with mirtazapine can obviously improve the emotional disorder and sleep quality in anxiety and depression patients with refractory insomnia,and fewer sideeffects,has satisfactory clinical effects.