發(fā)布時間：2018-05-09 09:19

  本文選題：失眠 + 陽虛肝郁型�。� 參考：《東南大學(xué)》2016年碩士論文

【摘要】：背景 睡眠約占據(jù)了人生三分之一的時間,良好的睡眠是保證健康的重要條件。以往研究顯示,10%-15%的成年人患有慢性失眠,另外25%-35%偶爾失眠或有短暫性失眠。近年來關(guān)于失眠的流行病學(xué)調(diào)查表明,失眠的患病率在增加,正成為困擾人們生活、學(xué)習(xí)、工作、健康的一個棘手的問題�，F(xiàn)代醫(yī)學(xué)針對失眠的治療主要為藥物治療和認(rèn)知行為治療,但效果并不令人滿意,且西藥自身的副作用也成為其治療失眠的一大障礙。而中醫(yī)藥對失眠的治療有著悠久的歷史,不但取得了一定的療效且副作用較少,越來越受到失眠患者的重視。但是,中醫(yī)藥治療失眠,因缺乏嚴(yán)格的臨床試驗(yàn)設(shè)計(jì),限制了其推廣使用。雖然目前中醫(yī)對失眠的辨證分型較多,但缺少陽虛肝郁型失眠的報道,而臨床中確實(shí)存在不少陽虛肝郁型失眠的患者。由于對此證型普遍認(rèn)識不足,導(dǎo)致此部分患者不能及時得到中醫(yī)藥的有效治療。因此,我們在臨床上開展了溫陽疏肝湯治療陽虛肝郁型失眠的研究。目的研究溫陽疏肝湯治療陽虛肝郁型失眠的臨床療效,評價溫陽疏肝湯的有效性。方法采用隨機(jī)、雙盲、安慰劑平行對照的試驗(yàn)設(shè)計(jì),將32例陽虛肝郁型失眠患者隨機(jī)分成兩組,經(jīng)1周洗脫期后,試驗(yàn)組給予溫陽疏肝湯治療2周,對照組給予溫陽疏肝湯安慰劑治療2周。分別在治療前和治療2周后各進(jìn)行一次PSQI、GAD-7、PHQ-9及中醫(yī)癥候量表評定。以PSQI減分率的結(jié)果作為主要療效指標(biāo),中醫(yī)癥候量表減分率的結(jié)果及GAD-7、PHQ-9的減分作為次要療效指標(biāo)。結(jié)果①共有29例患者完成試驗(yàn),試驗(yàn)組15例,對照組14例。②以PSQI減分率為主要療效指標(biāo),溫陽疏肝湯組的總有效率為80%；與治療前相比,PSQI的減分為5.40±2.72,P0.001,95%CI為3.89-6.90,其對日間功能障礙、睡眠效率和睡眠質(zhì)量的治療作用最為明顯。安慰劑組總有效率為28.57%;PSQI的減分為3.00±1.96,P0.001,95%CI為1.87-4.13,其對日間功能障礙、睡眠效率的影響最大。兩組之間PSQI的療效比較,P=0.0080.05。③以中醫(yī)癥候減分率為次要療效指標(biāo),溫陽疏肝湯組的總有效率為86.67%,安慰劑組為35.71%。兩組之間中醫(yī)癥候療效比較,P=0.0040.05。④同時還發(fā)現(xiàn),溫陽疏肝湯能降低GAD-7、PHQ-9的總積分,與治療前相比,有統(tǒng)計(jì)學(xué)差異(P0.05);雖然安慰劑也能降低GAD-7、PHQ-9的總積分,但與治療前相比,沒有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論①無論P(yáng)SQI療效評定還是中醫(yī)癥候評價,溫陽疏肝湯均能有效治療陽虛肝郁型失眠,其治療作用并非是安慰劑效應(yīng)。②對失眠伴有的焦慮、抑郁癥狀,以GAD-7、PHQ-9量表評定,溫陽疏肝湯治療后,對失眠伴有的焦慮、抑郁有一定的緩解作用。
[Abstract]:Background Sleep accounts for about 1/3 of life time, good sleep is an important condition to ensure health. Previous studies have shown that 10 to 15 percent of adults suffer from chronic insomnia, and 25-35 percent have occasional or transient insomnia. The epidemiological survey on insomnia in recent years shows that the prevalence of insomnia is increasing, which is becoming a thorny problem that puzzles people's life, study, work and health. The treatment of insomnia in modern medicine is mainly drug treatment and cognitive behavior treatment, but the effect is not satisfactory, and the side effects of western medicine itself become a major obstacle to insomnia treatment. Traditional Chinese medicine (TCM) has a long history in the treatment of insomnia, which has not only achieved certain curative effect and less side effects, but also has been paid more and more attention to by patients with insomnia. However, traditional Chinese medicine treatment of insomnia, due to the lack of strict clinical trial design, limited its use. Although there are many types of insomnia in TCM at present, there is a lack of reports of insomnia with Yang deficiency and liver depression, and there are many patients with insomnia due to yang deficiency and liver depression in clinic. Due to the lack of general understanding of this syndrome, this part of patients can not get the effective treatment of traditional Chinese medicine in time. Therefore, we carried out a clinical study of warming Yang Shugan decoction for insomnia with yang deficiency and liver depression. Objective to study the clinical efficacy of Wenyang Shugan decoction (WYSD) in treating insomnia with yang deficiency and liver depression. Methods A randomized, double-blind, placebo-controlled trial was conducted. 32 patients with insomnia with Yang deficiency and liver depression were randomly divided into two groups. After one week of elution, the experimental group was treated with Wenyang Shugan decoction for 2 weeks. The control group was treated with placebo for 2 weeks. PSQI GAD-7 PHQ-9 and TCM symptom scale were evaluated before and 2 weeks after treatment respectively. The results of PSQI score reduction, TCM symptom scale and GAD-7 PHQ-9 were taken as the main therapeutic index. Results 1A total of 29 patients completed the test, 15 patients in the trial group and 14 patients in the control group took PSQI reduction rate as the main therapeutic index, the total effective rate of Wenyang Shugan decoction group was 80, and the decrease of PSQI was 5.40 鹵2.72g P0.001P0.001C5.95 CI was 3.89-6.90, and the total effective rate of Wenyang Shugan decoction group was 80, compared with that before treatment, the CI was 3.89-6.90. The therapeutic effects of sleep efficiency and sleep quality were most obvious. In the placebo group, the total effective rate was 28.57 and the decrease of PSQI was 3.00 鹵1.96, P 0.001 and 95 CI was 1.87-4.13, which had the greatest effect on daytime dysfunction and sleep efficiency. Comparison of the efficacy of PSQI between the two groups: the reduction rate of TCM symptoms was taken as the secondary curative effect index, the total effective rate of WYSDG group was 86.67 and that of placebo group was 35.71. Comparison of traditional Chinese Medicine Syndrome Therapeutic effects between the two groups (P0. 0040.05.4) at the same time, it was also found that Wenyang Shugan decoction could reduce the total score of GAD-7 and PHQ-9, which was significantly different from that before treatment, although placebo could also reduce the total score of GAD-7 and PHQ-9, but compared with that before treatment, There was no statistical difference (P 0.05). Conclusion (1) Wanyang Shugan decoction can effectively treat insomnia with deficiency of Yang and liver depression, regardless of the evaluation of PSQI efficacy or TCM symptoms. The therapeutic effect is not placebo effect .2 on anxiety and depression associated with insomnia. GAD-7PH-PHQ-9 scale is used to evaluate the effect of Wenyang Shugan decoction on insomnia. Wenyang Shugan decoction can relieve insomnia with anxiety and depression.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R256.23

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 黃金鳳;皮立宏;;從“人臥血?dú)w于肝”理論探討睡眠對慢性肝病治療的意義[J];中國中醫(yī)藥現(xiàn)代遠(yuǎn)程教育;2016年02期

2 應(yīng)娜;李瑩;李姍姍;馬世平;;抑肝散發(fā)揮抗抑郁作用的機(jī)制研究[J];中國衛(wèi)生檢驗(yàn)雜志;2016年01期

3 趙歡歡;黃俊山;沈銀河;黃真花;;基于形神一體觀理論的失眠與情志的關(guān)系探討[J];時珍國醫(yī)國藥;2015年07期

4 梁英;汪衛(wèi)東;張鴻燕;王興臣;谷萬里;趙世珂;魏銘;;舒眠膠囊與解郁安神膠囊治療失眠癥(肝郁傷神證)多中心隨機(jī)雙盲對照研究[J];中國新藥雜志;2015年10期

5 王海軍;;肝不藏魂是不寐發(fā)生的關(guān)鍵核心機(jī)制[J];時珍國醫(yī)國藥;2015年05期

6 武勝萍;徐立鵬;郭宇;崔亞姍;趙錫燕;李勇;仝小林;連鳳梅;;中國近30年臨床研究中安慰劑的應(yīng)用現(xiàn)狀[J];中國中藥雜志;2015年07期

7 賈玉;賈躍進(jìn);鄭曉琳;;中醫(yī)對失眠認(rèn)識的探討及展望[J];中華中醫(yī)藥雜志;2015年01期

8 王艷芬;于曉紅;;桂枝甘草龍骨牡蠣湯加減治療不寐48例[J];河南中醫(yī);2015年01期

9 王政研;劉旭光;豐芬;;從肝論治失眠癥的研究進(jìn)展[J];時珍國醫(yī)國藥;2014年12期

10 趙高峰;苗治國;;抑肝散治療廣泛焦慮癥臨床研究[J];光明中醫(yī);2014年11期

相關(guān)博士學(xué)位論文 前2條

1 卞立群;腸安Ⅰ號方治療IBS-D的臨床療效評價暨臨床療效評價指標(biāo)的比較研究[D];中國中醫(yī)科學(xué)院;2011年

2 孟迎春;機(jī)體狀況與情志致病研究[D];山東中醫(yī)藥大學(xué);2008年

相關(guān)碩士學(xué)位論文 前6條

1 林臘梅;酸棗仁湯對肝血虛失眠模型大鼠神經(jīng)遞質(zhì)的影響[D];湖北中醫(yī)藥大學(xué);2014年

2 李璇;慢性肝病失眠癥中醫(yī)證型分布特點(diǎn)與肝功能的相關(guān)性研究[D];湖北中醫(yī)藥大學(xué);2012年

3 景興文;心神寧治療失眠癥心脾兩虛兼虛熱內(nèi)擾證48例臨床觀察[D];成都中醫(yī)藥大學(xué);2011年

4 劉瑾瑋;臟腑氣機(jī)失調(diào)與失眠證治的理論研究[D];北京中醫(yī)藥大學(xué);2008年

5 曾天德;柴胡桂枝湯加味治療氣機(jī)失調(diào)型失眠癥的理論研究與臨床觀察[D];北京中醫(yī)藥大學(xué);2006年

6 劉春梓;慢性肝病患者睡眠狀況調(diào)查及不同護(hù)理方法改善睡眠障礙的比較研究[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2006年

，

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