通讯作者: 李亚平, liyapin0186@vip.sina.com

DOI：10.12201/bmr.202408.00031

Clinical Observation on the Treatment of Perimenopausal Insomnia of the Heart-kidney Disharmony Type by Regulating the Spirit and Nourishing the Heart Tang

• 摘要：目的 观察运用调神养心汤治疗心肾不交型围绝经期患者失眠及围绝经期症状改善情况,以期探索临床治疗围绝经期失眠的新思路。 方法 选取于李亚平教授门诊和浙江省立同德医院精神科门诊就诊的患者中符合心肾不交型围绝经期睡眠障碍诊断标准的患者,共60例,以随机表法将纳入试验的60例患者分入试验组和对照组,每组共30例。试验组采用调神养心汤增减治疗,对照组采用中成药乌灵胶囊治疗。所有患者分别在治疗前和治疗后第4周、第8周填写并记录PSQI评分、Kuperman评分、HAMA量表和中医症状评分。 结果? 两组治疗前后的PSQI评分均有明显改善(P＜0.01),其中试验组疗效优于对照组(P＜0.05)。PSQI具体各项评分比较中,治疗后试验组在睡眠质量、入睡时间、睡眠时间等方面疗效优于对照组(P＜0.05),日间功能障碍评分两组无明显差异(P＞0.05)。围绝经期症状改善情况:两组治疗前后的Kupperman评分均有明显改善(P＜0.01),其中试验组疗效明显优于试验组(P＜0.01)。治疗后试验组在潮热及出汗、失眠、心悸等方面优于对照组(P＜0.05),在眩晕、疲乏、皮肤蚁走感、泌尿系感染方面两组无明显差异(P＞0.05)。两组治疗前后的HAMA评分均有明显改善(P＜0.01),且试验组疗效优于对照组(P＜0.05)。两组治疗前后在中医证候方面均有改善(P＜0.05),且试验组疗效优于对照组(P＜0.05),试验组治疗有效率及显效率均优于对照组(P＜0.05)。在中医各项积分方面,两组均较治疗前有改善,且试验组在“失眠、乏力耳鸣、胸闷心悸、潮热盗汗”积分方面与对照组有差异(P＜0.05),在“心烦、腰膝酸软、头晕”积分方面与对照组差异不明显(P＞0.05)。 结论 对于心肾不交型围绝经期失眠患者,调神养心汤可以通过提高睡眠质量、缩短入睡时间、延长睡眠时间来改善睡眠障碍,还可以减轻围绝经期症状,尤其是潮热及出汗、心悸等。调神养心汤可以缓解围绝经期的焦虑症状。

  关键词： 失眠，围绝经期，心肾不交型，调神养心汤

   

  Abstract: Objective To observe the improvement of insomnia and perimenopausal symptoms in perimenopausal patients with cardiorenal and renal dysfunction by using Zhi Shen Nang Xin Tang, with a view to exploring new ideas for clinical treatment of perimenopausal insomnia. Methods A total of 60 patients who met the diagnostic criteria for perimenopausal sleep disorders of the cardiorenal and renal dysfunction type were selected from the outpatient clinic of Professor Li Yaping and the psychiatric clinic of Zhejiang Tongde Hospital, and the 60 patients included in the trial were divided into the experimental group and the control group by the method of randomisation, with a total of 30 patients in each group. The test group was treated with increasing and decreasing the number of tonifying the spirit and nourishing the heart soup, and the control group was treated with the proprietary Chinese medicine wuling capsule. All patients filled in and recorded the PSQI score, Kuperman score, HAMA scale and TCM symptom score before treatment and at the 4th and 8th week after treatment, respectively.Methods A total of 60 patients who met the diagnostic criteria of perimenopausal sleep disorders of cardiorenal dysfunction type were selected from the outpatient clinic of Professor Li Yaping and the psychiatric clinic of Zhejiang Provincial Tongde Hospital, and the 60 patients included in the trial were classified into the test group and the control group by the method of randomisation table, with a total of 30 cases in each group. The test group was treated with increasing and decreasing the number of tonifying the spirit and nourishing the heart soup, and the control group was treated with the proprietary Chinese medicine wuling capsule. All patients filled in and recorded the PSQI score, Kuperman score, HAMA scale and TCM symptom score before treatment and at the 4th and 8th week after treatment, respectively.Results The PSQI scores of both groups before and after treatment showed significant improvement (P＜0.01), in which the efficacy of the experimental group was better than that of the control group (P＜0.05).In the comparison of the specific scores of the PSQI, the experimental group had a better efficacy than the control group in terms of the quality of sleep, time of falling asleep, and time of sleep after treatment (P＜0.05), and there was no significant difference in the scores of the daytime dysfunction between the two groups (P＞0.05). Improvement of perimenopausal symptoms: Kupperman scores before and after treatment were significantly improved in both groups (P < 0.01), with the efficacy of the test group being significantly better than that of the control group (P < 0.01). After treatment, the experimental group was better than the control group in terms of hot flashes and sweating, insomnia and palpitations (P < 0.05), and there was no significant difference between the two groups in terms of vertigo, fatigue, ants in the skin, and urinary tract infection (P > 0.05). The HAMA scores of both groups before and after treatment were significantly improved (P < 0.01), and the efficacy of the experimental group was better than that of the control group (P < 0.05). Both groups showed improvement in Chinese medicine symptoms before and after treatment (P < 0.05), and the therapeutic effect of the experimental group was better than that of the control group (P < 0.05), and the therapeutic efficiency and apparent efficiency of the experimental group were better than that of the control group (P < 0.05). In terms of the points of Chinese medicine, both groups improved compared with the pre-treatment period, and the experimental group differed from the control group in terms of the points of insomnia, tinnitus, chest tightness, palpitation, hot flashes and night sweating (P<0.05), and the points of heartburn, lumbar and knee soreness, dizziness (P<0.05), and did not differ significantly from the control group (P<0.05). There was no significant difference with the control group (P>0.05) in the points of heartburn, lumbar and knee pain and dizziness.Conclusion For patients with perimenopausal insomnia of the heart-kidney disharmony type, Tonify the Spirit and Nourish the Heart Soup can improve sleep disorders by improving sleep quality, shortening the time to sleep, and lengthening the duration of sleep, and it can also alleviate perimenopausal symptoms, especially hot flushes and sweating, palpitations, and so on. Tonify the Spirit and Nourish the Heart Soup can alleviate perimenopausal anxiety symptoms.

  Key words: Insomnia, Perimenopausal, Heart-kidney Disharmony Type, Regulating the Spirit and Nourishing the Heart Tang.

  提交时间：2024-08-15

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  1	2024-07-02	bmr.202408.00031V1	下载

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