丹栀逍遥散联合舍曲林片治疗老年失眠症疗效观察及对血清5-羟色胺、多巴胺水平的影响

Observation of Clinical Effect of Danzhi Xiaoyao Powder Combined with Sertraline Tablets for Senile Insomnia and Its Effect on Levels of 5-Hydroxytryptamine and Dopamine in Serum

目的:观察丹栀逍遥散联合舍曲林片治疗老年肝郁化火型失眠症的临床疗效及对血清5-羟色胺(5-HT)、多巴胺(DA)水平的影响。方法:按随机数字表法将98例肝郁化火型老年失眠症患者分为联合组与对照组,各49例。对照组给予基础治疗联合盐酸舍曲林片治疗,联合组在对照组基础上加用丹栀逍遥散治疗。比较2组治疗前后中医证候评分、匹兹堡睡眠质量指数(PSQI)、汉密尔顿焦虑量表(HAMA)评分及5-HT、DA水平,分析其临床疗效、复发率及安全性。结果:联合组总有效率为91.84%,对照组为75.51%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组不寐多梦、烦躁易怒、头痛面红、目赤口苦、胸闷胁痛、便秘溲赤等中医证候评分均较治疗前降低(P<0.05),且联合组各项中医证候评分均低于对照组(P<0.05)。治疗后,2组PSQI、HAMA评分均较治疗前降低(P<0.05),且联合组上述2项评分均低于对照组(P<0.05)。治疗后,2组血清DA水平较治疗前降低(P<0.05),且联合组DA水平低于对照组(P<0.05);2组血清5-HT水平较治疗前升高(P<0.05),且联合组5-HT水平高于对照组(P<0.05)。联合组无复发病例,对照组复发率为50.00%,2组比较,差异有统计学意义(P<0.05)。2组治疗期间未见明显不良反应。结论:丹栀逍遥散联合舍曲林片治疗老年肝郁化火型失眠症疗效优于单纯西药治疗,能有效调控患者神经递质分泌,改善睡眠质量,减轻焦虑程度,复发率低且安全性良好。

Objective:To observe the clinical effect of Danzhi Xiaoyao Powder combined with Sertraline Tablets on senile insomnia of liver constraint transforming into fire type and its effect on levels of 5-hydroxytryptamine(5-HT)and dopamine(DA)in serum.Methods:A total of 98 senile patients with insomnia of liver constraint transforming into fire type were divided into the combination group and the control group according to the random number table method,with 49 cases in each group.The control group was treated with basic treatment combined with Sertraline Hydrochloride Tablets,and the combination group was additionally treated with Danzhi Xiaoyao Powder based on the treatment of the control group.The traditional Chinese medicine(TCM)syndrome scores,Pittsburgh Sleep Quality Index(PSQI),Hamilton Anxiety Scale(HAMA),and the levels of 5-HT and DA were compared before and after treatment between the two groups.The clinical effects,recurrence rates,and safety were analyzed.Results:The total effective rate was 91.84%in the combination group,and 75.51%in the control group,the difference being significant(P<0.05).After treatment,the scores of TCM syndromes such as insomnia and excessive dreaming,restlessness and irritability,headache and red face,red eyes and bitter mouth,chest tightness and hypochondriac pain,constipation and redness in the two groups were decreased when compared with those before treatment(P<0.05),and the TCM syndrome scores in the combination group were lower than those in the control group(P<0.05).After treatment,the PSQI and HAMA scores in the two groups were decreased when compared with those before treatment(P<0.05),and the score in the combination group was lower than that in the control group(P<0.05).After treatment,the serum DA levels in the two groups were decreased when compared with those before treatment(P<0.05),and the DA level in the combination group was lower than that in the control group(P<0.05).The 5-HT levels in serum in the two groups were increased when compared with those before treatment(P<0.05),and 5-HT level in the combination group was higher than that in the control group(P<0.05).The combination group had no recurrence cases,and the control group had a recurrence rate of 50.00%,the difference being significant(P<0.05).During the treatment period,there were no significant adverse reactions observed in the two groups.Conclusion:Danzhi Xiaoyao Powder combined with Sertraline Tablets has a better curative effect on insomnia in senile patients of liver constraint transforming into fire type than simple western medicine treatment.It can effectively regulate the secretion of neurotransmitters,improve sleep quality,alleviate anxiety levels,and have a low recurrence rate and good safety.