加味菖蒲郁金汤联合针刺对心肾不交型失眠症的临床疗效

Clinical effect of supplemented Changpu Yujin Decoction combined with acupuncture in the treatment of insomnia patients with type of imbalance between heart-yang and kidney-yin

目的探讨加味菖蒲郁金汤联合针刺治疗心肾不交型失眠症的临床效果。方法将141例心肾不交型失眠症患者随机分为3组,每组47例。汤药组给予常规西药联合加味菖蒲郁金汤治疗,针刺组给予常规西药联合针刺治疗,联合组给予常规西药联合加味菖蒲郁金汤和针刺治疗。3个疗程结束后,比较3组患者的临床疗效、中医症候积分、睡眠质量、神经递质水平、治疗安全性。结果联合组治疗总有效率为91.49%(43/47),高于汤药组的74.47%(35/47)和针刺组的70.21%(33/47),差异有统计学意义(P<0.05)。治疗后,3组患者的中医症候积分均较治疗前下降,且联合组彻夜不寐、寐而易醒、五心烦热、腰膝酸软等项目积分均低于汤药组、针刺组,差异有统计学意义(P<0.05)。治疗后,3组患者睡眠质量指标水平均改善,且联合组睡眠潜伏期、快速动眼睡眠时间、匹兹堡睡眠质量指数评分(PSQI)低于汤药组、针刺组,睡眠总时间长于汤药组、针刺组,差异有统计学意义(P<0.05)。治疗后,3组患者神经递质指标水平均改善,且联合组5羟色胺(5-HT)、多巴胺(DA)水平低于汤药组、针刺组,γ氨基丁酸(GABA)水平高于汤药组、针刺组,差异有统计学意义(P<0.05)。联合组、汤药组、针刺组患者不良反应发生率依次为14.89%、10.64%、12.77%,差异无统计学意义(P>0.05)。结论加味菖蒲郁金汤联合针刺对心肾不交型失眠症有良好的治疗效果,可改善患者中医症候程度,提高患者睡眠质量,改善与睡眠相关的神经递质水平,且治疗安全性良好。

Objective To explore the clinical effect of supplemented Changpu Yujin Decoction combined with acupuncture in the treatment of insomnia patients with type of imbalance between heart-yang and kidney-yin.Methods A total of 141 insomnia patients with type of imbalance between heart-yang and kidney-yin were randomly divided into three groups,with 47 cases in each group.Decoction group was treated with routine western medicine and supplemented Changpu Yujin Decoction,acupuncture group was treated with routine western medicine and acupuncture,and combined group was treated with routine western medicine,supplemented Changpu Yujin Decoction and acupuncture.After 3 courses of treatment,clinical efficacy,traditional Chinese medicine syndrome score,quality of sleep,neurotransmitter levels and therapeutic safety were compared among the three groups.Results The total effective rate of the combined group was 91.49%(43/47),which was higher than 74.47%(35/47)of the decoction group and 70.21%(33/47)of the acupuncture group(P<0.05).After treatment,the traditional Chinese medicine syndrome score decreased significantly when compared to that before treatment in the three groups,and scores of items such as sleeplessness all night,easy to wake up,dysphoria in chest,palms and soles,and waist and knee soreness in the combined group were significantly lower than those in the decoction group and the acupuncture group(P<0.05).After treatment,the indicators of quality of sleep improved in the three groups,and the sleep latency,sleep time of rapid eye movement and the Pittsburgh Sleep Quality Index(PSQI)score in the combined group were significantly lower than those in the decoction group and the acupuncture group,while the total sleep time was significantly longer than that in the decoction group and the acupuncture group(P<0.05).After treatment,the levels of neurotransmitter indicators in the three groups improved,and the levels of 5-hydroxytryptamine(5-HT)and dopamine(DA)in the combined group were significantly lower than those in the decoction group and the acupuncture group,while theγaminobutyric acid(GABA)was significantly higher than that of the decoction group and the acupuncture group(P<0.05).The incidence rates of adverse reactions in the combined group,the decoction group and the acupuncture group were 14.89%,10.64%and 12.77%respectively,which showed no significant difference among the three groups(P>0.05).Conclusion Supplemented Changpu Yujin Decoction combined with acupuncture has a good therapeutic effect in the treatment of insomnia patients with type of imbalance between heart-yang and kidney-yin,which can improve the degree of traditional Chinese medicine syndrome,enhance the quality of sleep,improve the levels of sleep-related neurotransmitters,and have good therapeutic safety.