针刺治疗苯二氮类药物依赖性失眠的前瞻性病例系列研究

Prospective studies on case series of acupuncture in the treatment of benzodiazepine-dependent insomnia

目的探讨针刺治疗对苯二氮类药物依赖性失眠的临床疗效和药物戒减作用。方法采用前瞻性病例系列研究,对15例服用苯二氮类药物超过3个月,日剂量折算地西泮≤10 mg,且减药困难的原发性失眠患者进行针刺治疗同时按规则指导减药。取穴百会、神庭、四神聪、神门(双)、三阴交(双),每周5次,治疗4周,分别于基线期、治疗第4周末、治疗结束后第4周末进行匹兹堡睡眠指数量表(Pittsburgh sleep quality index,PSQI)减药率评估,比较治疗前后的差异;同时,在治疗中第1周末、第2周末、第3周末、第4周末、治疗结束后第4周末,采用苯二氮类药物戒断症状量表(Benzodiazepine withdrawal symptom questionnaire,BWSQ)对减药过程中的戒断反应进行评估,并以此来调整减药速度。结果依据PSQI评分,总有效率85.71%。口服药物减量或停药,总有效率为92.86%。随访4周,总有效率均无变化。治疗后患者PSQI总分及各维度评分均较治疗前明显下降(P<0.01,P<0.05)。治疗期间,出现乏力等不良反应,以第1周为著,均与减药相关。调整减药速度,症状减轻或消失。结论针刺对苯二氮类药物依赖性失眠症睡眠质量改善、药物戒减有较好疗效和安全性。

Objective To investigate the clinical efficacy and drug withdrawal effects of acupuncture on benzodi- azepine-dependent insomnia. Methods A prospective case series study was applied. For 15 patients with primary in- somnia who had been taking benzodiazepines for more than 3 months, with the daily dose equivalent to 10 mg of di- azepam, and had difficulty in reducing dosage, acupuncture treatment was given and reduction of dosage was prescribed according to the rules. Acupuncture was given to acupoints such as Baihui, Shenting, Sishencong, Shenmen （bilateral） and Sanyinjiao （bilateral）, 5 times a week for a total of 4 weeks. Pittsburgh sleep quality index（PSQI） and dosage reduc- tion rate were assessed at the baseline period, at the end of the fourth week of treatment and at the end of the fourth week after the end of treatment, and the difference was compared before and after the treatment; at the same time, Benzodiazepine Withdrawal Symptom Questionnaire （BWSQ） was used to assess the withdrawal response during drug dosage reduction at the end of the first week, second week, third week, fourth week and at the end of the fourth week after the treatment, so as to adjust the dosage reduction rate. Results According to the PSQI score, the total effective rate was 85.71%. After dosage reduction or withdrawal of the oral drug, the total effective rate was 92.86%. After 4 weeks of follow-up, there was no change in total effective rate. After treatment, the total PSQI scores and scores of all dimensions were decreased significantly compared with those before treatment（P〈0.01, P〈0.05）. During the treatment period, fatigue and other adverse reactions were detected, which were significant in the first week, and were associated with the dosage reduction. When the rate of dosage reduction was adjusted, the symptoms were alleviated or disap- peared. Conclusion Acupuncture has a better efficacy and safety for the improvement of sleep quality and dosage re- duction or drug withdrawal in benzodiazepine-dependent insomnia.