临床状态医学理念指导下中西医结合治疗失眠障碍的临床研究

Clinical Study of Integrated Chinese and Western Medicine in the Treatment of Insomnia Disorder Under the Guidance of Clinical State Medicine Philosophy

【目的】观察临床状态医学理念指导下中西医结合诊疗方案治疗失眠障碍患者的临床疗效,为临床治疗失眠障碍提供新的思路与方法。【方法】将62例失眠障碍患者随机分为试验组和对照组,每组各31例。对照组给予常规中西医结合治疗,试验组给予临床状态医学理念指导下中西医结合诊疗方案治疗,疗程为1个月。观察2组患者治疗前后匹兹堡睡眠质量指数(PSQI)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、中医健康状况量表(TCM-HSS)评分的变化情况。【结果】(1)治疗过程中,试验组和对照组各脱落1例,最终每组各30例完成试验。(2)PSQI评分方面:治疗后,2组患者PSQI的睡眠质量、入睡时间、睡眠时间、睡眠效率、失眠障碍、催眠药物、日间障碍等各维度评分及其总分均较治疗前改善(P<0.05),且试验组患者对日间功能障碍和PSQI总分的改善作用均明显优于对照组(P<0.05)。(3)SAS和SDS评分方面:治疗后,试验组患者的SAS和SDS评分均较治疗前明显改善(P<0.05),而对照组患者均较治疗前略有改善,但差异均无统计学意义(P>0.05);组间比较,试验组对SAS和SDS评分的改善作用均明显优于对照组(P<0.05)。(4)TCM-HSS评分方面:治疗后,试验组患者TCM-HSS的精力、疼痛、饮食、大便、小便、睡眠、情绪和健康自我评分均较治疗前改善(P<0.05),对照组患者仅大便、小便、睡眠和健康自我评分较治疗前改善(P<0.05);组间比较,试验组患者对TCM-HSS的精力、疼痛、饮食、大便和情绪评分的改善作用明显优于对照组(P<0.05)。【结论】采用临床状态医学理念指导下的中西医结合治疗与常规中西医结合治疗失眠障碍均有明显效果,但临床状态医学理念指导下中西医结合诊疗方案在改善患者失眠状态、焦虑抑郁状态、中医状态方面有独特优势,能够提高患者的生活质量。

Objective To observe the clinical efficacy of integrated Chinese and western medicine in the treatment of insomnia patients under the guidance of clinical state medicine philosophy, so as to provide new ideas and methods for the clinical treatment of insomnia. Methods Sixty-two patients with insomnia were randomly divided into the trial group and the control group, 31 cases in each group. The control group was treated with the conventional integrated Chinese and western medicine treatment, while the trial group was treated with the integrated Chinese and western medicine treatment regimen under the guidance of clinical state medicine philosophy,the course of treatment lasting one month. The scores of Pittsburgh sleep quality index(PSQI),selfrating depression scale(SDS),self-rating anxiety scale(SAS)and traditional Chinese medicine health state scale(TCM-HSS)in the two groups before and after treatment were observed. Results(1)During the treatment,there was one case fell off in each group,and 30 cases in each group eventually completed the trial.(2)After treatment,the scores of PSQI items of sleep quality, time for falling asleep, sleep time, sleep efficiency, insomnia disorder,use of hypnotic medicine,and daytime dysfunction as well as the overall PSQI scores in the two groups were significantly improved compared with those before treatment(P < 0.05). And the trial group had stronger effect on improving the daytime dysfunction scores and overall PSQI scores than the control group(P<0.05).(3)After treatment,SAS scores and SDS scores in the trial group were significantly improved compared with those before treatment(P < 0.05),while those in the control group were slightly improved compared with those before treatment and the differences were not statistically significant(P > 0.05). The intergroup comparison showed that the effect on improving SAS and SDS scores in the trial group was significantly superior to that in the control group(P < 0.05).(4)After treatment,the scores of TCM-HSS items of energy,pain,diet,stool,urine,sleep,mood and self-rating health in the trial group were improved compared with those before treatment(P < 0.05),while only the scores of stool,urine,sleep and self-rating health in the control group were improved compared with those before treatment(P < 0.05). The intergroup comparison showed that the effect on improving the scores of energy,pain,diet,stool and mood of TCM-HSS in the trial group was significantly superior to that in the control group(P < 0.05). Conclusion Both of the integrated Chinese and western medicine treatment regimen under the guidance of clinical state medicine philosophy and conventional integrated Chinese and western medicine treatment have significant effect in the treatment of insomnia disorder, whereas the former has unique advantages in improving the insomnia state,anxiety and depression state,and traditional Chinese medicine state,which can improve the quality of life of the insomnia patients.