發(fā)布時(shí)間：2018-01-06 10:17

  本文關(guān)鍵詞：痰熱失眠病機(jī)變化淺析及清痰養(yǎng)陰法治療痰熱陰虛型失眠的臨床研究　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 失眠 病機(jī)變化 痰熱陰虛型 清痰養(yǎng)陰法 臨床研究

【摘要】：第一部分痰熱失眠病機(jī)變化淺析目的:初步探討痰熱失眠的病機(jī)變化規(guī)律,指導(dǎo)臨床辨證用藥。方法:經(jīng)過閱讀大量文獻(xiàn),及從門診大量失眠患者的臨證經(jīng)驗(yàn)中得出,現(xiàn)代社會(huì)大多數(shù)失眠患者就診時(shí)有痰熱證候,表明痰熱易擾心神且致臟腑氣血失和而纏綿難愈,但臨床中單純的痰熱證并不多見,往往虛實(shí)夾雜,較為復(fù)雜。本研究以在南京市中醫(yī)院腦病科門診就診的失眠患者為研究對(duì)象,篩選出250例以痰熱證為主的失眠患者,進(jìn)行證候主次兼夾的整理分析和歸納,統(tǒng)計(jì)總結(jié)出痰熱失眠的常見證候分布,并初步探討痰熱失眠的病機(jī)變化,從而進(jìn)一步指導(dǎo)臨床辨證用藥。結(jié)果:(1)性別分布:男性78例,女性172例,男女比例為1:2.21;(2)年齡分布:青年組(45歲)60例,占24%;中年組(≥45歲且60歲)131例,占52.4%;老年組(≥60歲)59例,占23.6%。平均年齡51.62±11.02(歲);(3)250例具有痰熱證候的失眠患者的具體證型,結(jié)果示:單純的痰熱證為3例,僅占1.2%;痰熱陰虛型為93例,占37.2%;痰熱內(nèi)蘊(yùn),心膽氣虛型為28例,占11.2%;痰熱內(nèi)蘊(yùn),心脾兩虛型為56例,占22.4%;痰熱內(nèi)蘊(yùn),肝氣郁結(jié)型為12例,占4.8%;痰熱內(nèi)蘊(yùn),心肝火旺型為5例,占2%;風(fēng)痰火上擾型為47例,占18.8%;痰瘀互結(jié)型為6例,占2.4%。結(jié)論:(1)失眠多見于女性患者;(2)失眠多見于中年人;(3)單純的痰熱失眠并不多見,多以痰熱為主線,隨著失眠的起病及病情變化會(huì)出現(xiàn)各種兼夾或滋生證候,其中痰熱陰虛型失眠在臨床上最為常見。第二部分清痰養(yǎng)陰法治療痰熱陰虛型失眠的臨床研究目的:觀察清痰養(yǎng)陰法治療痰熱陰虛型失眠的臨床療效。方法:將符合中醫(yī)及西醫(yī)診斷標(biāo)準(zhǔn)的90例痰熱陰虛型失眠患者納入本次研究,采取隨機(jī)對(duì)照試驗(yàn),分為治療組(黃連溫膽湯合天王補(bǔ)心湯加減+艾司唑侖)60例和對(duì)照組(百樂眠膠囊+艾司唑侖)30例。治療組根據(jù)患者證候的變化,在清痰養(yǎng)陰方的基礎(chǔ)上酌情調(diào)整用藥,兩組患者療程均為1月。1月后分別評(píng)價(jià)兩組治療前、治療后的匹茲堡睡眠質(zhì)量指數(shù)(PSQI)及中醫(yī)臨床證候評(píng)分等指標(biāo)的變化,并進(jìn)行治療后的組間對(duì)照。結(jié)果:(1)匹茲堡睡眠質(zhì)量指數(shù)方面:治療組與對(duì)照組都能改善患者的睡眠質(zhì)量指數(shù),尤其在提高睡眠質(zhì)量、減少入睡時(shí)間、改善睡眠障礙及日間功能障礙方面,差異有統(tǒng)計(jì)學(xué)意義(p0.05),治療組優(yōu)于對(duì)照組。(2)中醫(yī)證候方面:治療組能夠顯著地改善失眠患者所伴發(fā)的睡眠不安、心煩易怒、胸悶、多夢(mèng)易醒、舌紅、苔黃膩等兼夾癥狀(p0.05)。(3)睡眠質(zhì)量療效方面:治療組痊愈3例(5.1%),顯效10例(16.9%),有效40例(67.8%),無效6例(10.2%),總有效率89.8%;對(duì)照組痊愈0例(0),顯效1例(3.3%),有效22例(73.3%),無效7例(23.3%),總有效率76.7%。兩組綜合療效對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(p0.05),治療組優(yōu)于對(duì)照組。(4)中醫(yī)證候療效方面:治療組痊愈18例(30.5%),顯效34例(57.6%),有效3例(5.1%),無效4例(6.8%),總有效率93.2%;對(duì)照組痊愈0例(0),顯效1例(3.3%),有效18例(60.0%),無效11例(36.7%),總有效率63.3%。兩組綜合療效對(duì)比,差異有統(tǒng)計(jì)學(xué)意義(p0.05),治療組優(yōu)于對(duì)照組。結(jié)論:清痰養(yǎng)陰法可有效改善痰熱陰虛型失眠患者的睡眠狀況,值得臨床借鑒。
[Abstract]:The first part of phlegm heat insomnia pathogenesis analysis objective: To investigate the pathogenesis regularity of phlegm heat insomnia, guide the clinical treatment. Methods: after reading a lot of literature, and a large number of insomnia patients from the outpatient clinic experience in the modern society, the majority of patients with insomnia treatment with phlegm heat syndrome, phlegm heat show easily disturbed mind and caused the estrangement and lingering between Qi and blood, but in clinical pure phlegm heat syndrome is rare, often mixed with the actual situation, is more complicated. In this study, in Nanjing City Hospital Outpatient Department of encephalopathy insomnia patients as the research object, select 250 cases of insomnia patients with phlegm heat syndrome were mainly. The primary and secondary syndromes and clip analyzed and summarized, summed up the common statistical distribution of syndrome of phlegm heat insomnia, and to investigate the pathogenesis of insomnia of phlegm heat, so as to guide the clinical treatment. Results: (1): 7 male gender distribution 8渚，

本文編號(hào)：1387431