1、    【關(guān)鍵詞】  失眠癥；,焦慮；,抑郁；,血液流變學(xué)；,安神飲；,益聰漿摘要：目的觀察安神飲和益聰漿對失眠癥患者睡眠質(zhì)量、焦慮抑郁狀態(tài)的療效。方法將符合失眠癥診斷的病例隨機(jī)分為中藥組和西藥組，中藥組服安神飲合益聰漿，西藥組服舒樂安定、谷維素、維生素B1，采用PSQI，SAS，SDS量表治療前及治療后2，4周評定1次，治療前后行血流變學(xué)檢查，兩組均4周統(tǒng)計(jì)療效，停藥后3個(gè)月統(tǒng)計(jì)復(fù)發(fā)率。結(jié)果組內(nèi)治療前后比較，兩組PSQI，SAS，SDS均有顯著性差異（P<0.001）；治療4周后與對照組比較：PSQI，SAS，SDS均有顯著性差異（P&

2、lt;0.001）；血流變學(xué)檢查：組內(nèi)治療前后比較均有顯著性差異（P<0.05），治療4周后與對照組比較，紅細(xì)胞壓積、全血低切還原黏度、全血高切還原黏度、血漿黏度值、全血黏度值均有顯著性差異（P<0.05）；中藥組總有效率91.1%，西藥組總有效率83.9%（P<0.05）；中藥組復(fù)發(fā)率為20.7%，西藥組復(fù)發(fā)率為43.6%(P<0.005)。結(jié)論安神飲合益聰漿治療失眠癥，對睡眠質(zhì)量、焦慮抑郁狀態(tài)優(yōu)于西藥組。關(guān)鍵詞：失眠癥；  焦慮；  抑郁；  血液流變學(xué)；  安神飲；  益聰漿The Influence of AnS

3、hen Yin combined with YiCongJiang on Sleep Quality, Anxiety/Depression Conditions of Insomnia PatientsAbstract:ObjectiveTo assess the clinical effect of AnShen Yin combined with YiCongJiang on sleep quality, anxiety/depression conditions of insomnia patients.MethodsInsomnia patients were randomly di

4、vided into two groups-Chinese Traditional Medicine Group (CTMG) and Western Medicine Group (WMG). Patients in CTMG were given AnShen Yin combined with YiCongJiang; and patients in the other group were given Estazolam, Oryzanol and Vitamine B1. All patients were evaluated using questionnaires includi

5、ng the Pittsburgh Sleep Quality Questionnaire (PSQI), self-rating anxiety and depression scale (SAS and SDS) before treatment, in the second and fourth week of the treatments. Blood hydrodynamics was also determined before and during the treatments. The efficacy of the medicine in both groups was ev

6、aluated after four-week treatments. Relapse rate was also inspected three months after stopping the treatment.ResultsComparing the results between  before and after the treatment in the same group, PSQI, SAS and SDS had significant difference in each group (P0.001).Comparing the results of 4-we

7、ek treatments between two groups, PSQI, SAS and  SDS had significant difference between the groups (P0.001). Based on blood hydrodynamics tests, remarkable difference was found before and after the treatments in the same group (P0.05). There were significant differences in red blood cell volume

8、, low-shear whole blood viscosity (P0.05) between the two groups after treatment. The average efficacy was 91.1% in CTMG and 83.9% in WMG (P0.05). The relapse rate was 20.7% in CTMG, which was much lower than the rate in WMG (43.6%,P0.05).ConclusionAnShen Yin combined with YiCongJiang is more effici

9、ent to treat insomnia than the western medicines. It helps patients improve sleep quality and alleviate the symptoms of anxiety and depression.Key words:Insomnia;  Anxiety;  Depression;  Blood hydrodynamics;  AnShen Yin;  YiCongJiang    失眠癥是失眠障礙中最常見者。失眠者常伴有焦慮、

10、抑郁癥狀，且發(fā)現(xiàn)失眠者常存在血流變學(xué)異常。筆者從20022006年間以中成藥安神飲合益聰漿治療失眠癥198例，與西藥組150例對照，觀察失眠患者睡眠質(zhì)量、焦慮抑郁狀態(tài)及血流變學(xué)的改善情況，效果滿意。現(xiàn)報(bào)告如下。1  臨床資料1.1  一般情況將患者隨機(jī)分為中藥組和西藥組。中藥組198例，其中門診102例，住院96例；男90例，女108例；年齡1930歲29例，3140歲32例，4150歲45例，5160歲48例，60歲44例。西藥組150例，男59例，女91例；年齡1930歲9例，3140歲34例，4150歲38例，5160歲49例，60歲20例；病情最短1個(gè)月，最長23年

11、。1.2  診斷標(biāo)準(zhǔn)根據(jù)中華人民共和國衛(wèi)生部1993年制定發(fā)布 中藥新藥臨床指導(dǎo)原則 所定中醫(yī)診斷與辨證標(biāo)準(zhǔn)： 有失眠典型癥狀：入睡困難，睡后易醒，睡而不穩(wěn)或醒后不能入睡，晨醒過早，夜不能入睡，白天昏沉欲睡，睡眠不足5 h。 有反復(fù)發(fā)作史。凡符合上述標(biāo)準(zhǔn)者均可納入觀察病例。2  治療方法2.1  中藥組安神飲（何首烏、黃精、百合、炒棗仁、遠(yuǎn)志、郁金、香附、生龍牡、蓮子芯等，文火水煎2次，濃縮成11藥液， 20 ml，3次/d）；益聰漿（黃酒、阿膠、核桃仁、黑芝麻、冰糖等，黃酒文火烊化阿膠，核桃仁、黑芝麻打粉與冰糖納入加溫，待冰糖溶化攪拌均勻，冷卻后成糊狀，20 m

12、l/次，2次/d，早晚服）。2.2  西藥組服舒樂安定2 mg，1次/d，晚服；谷維素10 mg，3次/d；維生素B1 10 mg，3次/d。1周為1個(gè)療程。兩組均4周后統(tǒng)計(jì)療效。2.3  觀察項(xiàng)目兩組患者采用匹茨堡睡眠質(zhì)量指數(shù)量表（PSQI）對其睡眠質(zhì)量進(jìn)行評定PSQI由19個(gè)自評問題和5個(gè)他評問題組成，僅對19個(gè)自評問題的7個(gè)因子計(jì)分，滿分為21分，得分越高表示睡眠質(zhì)量越差。采用焦慮自評量表（SAS）、抑郁自評量表（SDS）評定兩組患者抑郁焦慮狀態(tài)，計(jì)分方法為（總粗分×1.25），整數(shù)部分即為標(biāo)準(zhǔn)分。治療前、治療后2，4周各評定1次。治療前后行血流變學(xué)檢查（北

13、京中勤世帝LG-R-80B血流變分析儀）。停藥后隨訪3個(gè)月統(tǒng)計(jì)復(fù)發(fā)例數(shù)。所有病例治療前后行血常規(guī)、尿10項(xiàng)、肝功能、肌酐、尿素氮檢查。3  療效觀察3.1  療效評定標(biāo)準(zhǔn)睡眠時(shí)間恢復(fù)正常或夜間睡眠時(shí)間在6 h以上，睡眠深沉，醒后精力充沛，為臨床治愈；睡眠明顯好轉(zhuǎn)，睡眠時(shí)間較治療前增加3 h，睡眠深度增加，為顯效；癥狀減輕，睡眠時(shí)間較治療前增加不足3 h，為有效；治療后失眠無明顯改善或反加重者，為無效。3.2  統(tǒng)計(jì)學(xué)分析采用SPSS11.5統(tǒng)計(jì)軟件對資料進(jìn)行分析，計(jì)量資料用±s表示，樣本均數(shù)的比較用t檢驗(yàn)，樣本率的比較用2檢驗(yàn)。-     防止處方調(diào)配差錯(cuò)是一項(xiàng)任重而道遠(yuǎn)的工作,是藥劑人員必須時(shí)時(shí)提高警惕的重要日常工作。它的發(fā)生不是單一的某方面,而是醫(yī)院各個(gè)環(huán)節(jié)的綜合表現(xiàn),對于涉及兒童健康生命大事的職業(yè),每一位藥學(xué)專業(yè)技術(shù)人員都應(yīng)具有高尚的思想品質(zhì)、嚴(yán)謹(jǐn)?shù)墓ぷ髯黠L(fēng)和高度的責(zé)任心,杜絕一切差錯(cuò)發(fā)生,真心實(shí)意為病人提供優(yōu)質(zhì)的藥學(xué)服務(wù)。    【參