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归脾汤加减内外合治心脾两虚型失眠的临床研究

发布时间:2018-11-29 07:18
【摘要】:研究目的对归脾汤加减内外合治心脾两虚型失眠进行临床观察,以期客观评价其临床疗效,为今后寻找更易推广的中医内外合治法提高失眠疗效提供新的思路;创新性地观察及比较中药足浴与温水足浴辅助治疗失眠的临床疗效,进一步评估中药足浴的疗效并探讨其作用机理,从而为中药足浴法提高失眠疗效提供临床依据。研究方法选取北京中医药大学东直门医院脑病科门诊符合病例筛选标准的心脾两虚型失眠症患者,随机分配至内服汤药组(A组)、内服汤药配合温水足浴组(B组)、内服汤药配合中药足浴组(C组)。A组予归脾汤加减口服,日一剂,早晚分服。B组予归脾汤加减口服的基础上,同时配合温水足浴,每晚一次。C组予归脾汤加减口服的基础上,同时将汤药药渣加水用于足浴,每晚一次。三组疗程均为28天,疗程结束后观察三组中医证候积分及PSQI评分的变化,并判定临床疗效。研究结果1.基线资料方面,本研究共入组病例60例,其中内服汤药组(A组)20例,内服汤药配合温水足浴组(B组)20例,内服汤药配合中药足浴组(C组)20例。三组病人入组当天的性别、年龄、病程、身高、体重、文化程度、职业分布、中医证候积分及PSQI评分等基线资料比较均无统计学意义(P0.05),具有可比性。2.中医证候积分方面,治疗结束后,三组患者各症状积分及总分较治疗前均有所下降,差异有统计学意义(P0.05)。其中在失眠、食少纳呆、神疲乏力、气短懒言、面色fD白、唇爪淡白、畏寒肢冷、舌质舌苔及总分方面,三组有明显差异(P0.05)。食少纳呆、神疲乏力及畏寒肢冷方面,B组优于A组(P0.05),C组明显优于A、B两组(P0.05)。而在失眠、气短懒言、面色fD白、唇爪淡白、舌质舌苔及总分方面,A组与B组并无明显异(P0.05),但C组仍明显优于A、B两组(P0.05)。提示C组能有效缓解患者失眠症状及伴随症状,且均优于A、B两组;而在食少纳呆、神疲乏力及畏寒肢冷方面,B组优于A组。3.PSQI评分方面,治疗结束后,三组患者PSQI各单项评分及总分较治疗前均有所下降,差异有统计学意义(P0.05)。其中睡眠质量、入睡时间及总分方面,三组有明显差异(P0.05)。入睡时间及日间功能障碍方面,B组优于A组(P0.05),C组优于A、B两组(P0.05)。总分方面,C组优于A、B组两组(P0.05),A组与B组并无明显差异(P0.05)。提示C组在降低PSQI评分及入睡时间、日间功能障碍两项单项积分方面明显优于A、B两组;而B组在入睡时间、日间功能障碍方面明显优于A组。4.失眠的中医证候疗效方面,治疗结束后,A组总有效率为80.00%,B组总有效率为85%,C组总有效率为90%。且存在明显差异(P0.05)。其中经统计后A组与B组疗效类似(P0.05);C组疗效明显优于A组、B组(P0.05)。提示C组在中医证候疗效方面明显优于A组、B组,A组与B组中医证候疗效类似。5.失眠的综合临床疗效方面,治疗结束后,A组总有效率为80.00%,B组总有效率为85%,C组总有效率为95%。且存在明显差异(P0.05)。其中经统计后A组与B组疗效类似(P0.05),C组疗效明显优于A组及B组(P0.05)。提示C组在临床疗效方面明显优于A组、B组,A组与B组临床疗效类似。研究结论归脾汤加减内外合治的综合疗法在降低患者PSQI评分及改善中医临床症状方面明显优于单纯内服汤药及配合温水足浴的方案,配合温水足浴在改善食少纳呆、神疲乏力及畏寒肢冷等症状方面及入睡时间、日间功能障碍方面优于单纯内服汤药。总体来说,归脾汤加减内外合治的综合疗法有着较好的临床疗效,值得在基层推广应用。
[Abstract]:The purpose of this study is to make a clinical observation on the deficiency type insomnia of the spleen and the spleen, which is combined with the addition and subtraction of the spleen and the stomach, in order to evaluate the clinical curative effect objectively, and to provide a new thought for the improvement of the curative effect of the internal and external combination of the traditional Chinese medicine for improving the curative effect of the insomnia in the future; The curative effect of the traditional Chinese medicine foot bath and the warm water foot bath in the treatment of insomnia is observed and compared, and the curative effect of the traditional Chinese medicine foot bath is further evaluated and the action mechanism of the traditional Chinese medicine foot bath is further evaluated, so that the clinical basis for improving the curative effect of the insomnia is provided for the traditional Chinese medicine foot bath method. The method of the study was to select the patients with two-deficiency type of heart and spleen in the outpatient department of Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine. The patients were randomly assigned to the oral decoction group (group A), and the oral decoction was combined with the warm water foot bath group (group B), and the oral decoction was used to match the traditional Chinese medicine foot bath group (group C). Group A is prepared by the following steps of: adding and adding the spleen and the decoction for oral administration, and taking the day and evening as an agent, and taking the decoction in the morning and the evening. The B group was given to the spleen and soup for oral administration, and the warm water foot bath was used for every night. Group C was taken as the basis of the addition and subtraction of the decoction of the spleen and the decoction, and the decoction dregs were added to the foot bath for once every night. The three-group treatment course was 28 days. After the course of treatment, three groups of TCM syndrome and the change of PSQI score were observed, and the clinical curative effect was determined. Study Results 1. On the basis of the baseline data, 60 cases were enrolled in the study, of which 20 cases were taken orally and 20 cases of the warm water foot bath group (group B) were matched with the oral decoction, and 20 cases were matched with the traditional Chinese medicine foot bath group (group C). The sex, age, course, height, body weight, degree of culture, occupational distribution, symptom score and PSQI score of the three groups were not statistically significant (P0.05). After the end of the treatment, the symptoms and total score of the three groups decreased and the difference was statistically significant (P0.05). Among them, there were significant differences in the three groups (P0.05). In group B, group B was superior to group A (P0.05), and group C was better than that of group A and B (P0.05). There was no significant difference between group A and group B in group A and group B (P <0.05), but group C was better than that in group A and B (P <0.05). in group B, group B was better than that of group A and group B in group A and B in group B, and in group B, group B was better than group A. The scores of PSQI and the total score of PSQI in three groups were decreased and the difference was statistically significant (P0.05). Among the three groups, the sleep quality, time of sleep and total score were significantly different (P0.05). In group B, group B was superior to group A (P0.05), and group C was superior to group A and group B (P0.05). In terms of total score, group C was superior to group A and group B (P0.05), and there was no significant difference between group A and group B (P0.05). The results showed that group C was better than that of group A and group B in the aspects of reducing PSQI score and falling asleep time and daytime dysfunction, while group B was significantly better than group A in time of sleep and daytime dysfunction. After the treatment, the total effective rate of group A was 80.00%, the total effective rate of group B was 85%, and the total effective rate of C group was 90%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05). The curative effect of group C was better than that of group A and group B (P0.05). The results showed that group A and group B were better than group A and group B, and group A and group B were similar to those in group B. The total effective rate of group A was 80.00%, the total effective rate of group B was 85% and the total effective rate of C group was 95%. and there was a significant difference (P0.05). The effect of group A and group B was similar to that of group B (P0.05), and the curative effect of group C was better than that of group A and group B (P0.05). The clinical effect of group A and group B was similar to that of group A and group B. The result of the study is that the combined therapy of the external and external combination treatment of the spleen decoction is superior to that of the pure oral decoction and the warm water foot bath in the aspect of reducing the PSQI score of the patient and improving the clinical symptoms of the traditional Chinese medicine, The symptoms such as the fatigue force of God and the cold limbs cold and other symptoms and the time of falling asleep and the day dysfunction are superior to the pure oral decoction. In general, the combination therapy for both internal and external treatment of the spleen and the stomach has a good clinical curative effect, and is worthy of being popularized and applied at the grass-roots level.
【学位授予单位】:北京中医药大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R256.23

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