作者：王爱卿，高红，赵伟东，窦荣花，张万辉

单位：

061000河北省沧州市，河北省沧州中西医结合医院脑病科

Units：

Department of Encephalopathy, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou 061000, China

关键词：

脑梗死；睡眠障碍；加味柴胡疏肝散；穴位贴敷疗法；治疗结果；5-羟色胺；5羟吲哚乙酸

Keywords：

Brain infarction; Sleep disorders; Added Chaihu Shugan powder; Acupoint sticking therapy; Treatment outcome; 5-hydroxytryptamine; 5-hydroxy-3-indoleacetic acid

CLC：

R 743.33 R 277.7

DOI：

10.12114/j.issn.1008-5971.2024.00.016

Funds：

河北省中医药管理局科研项目（2022599）

摘要：

目的　探讨加味柴胡疏肝散联合穴位贴敷治疗脑梗死后睡眠障碍（肝郁化火型）的临床疗效及其对血 清5-羟色胺（5-HT）、5羟基吲哚乙酸（5-HIAA）水平的影响。方法　选取2022年2月—2023年2月河北省沧州中西 医结合医院收治的脑梗死后睡眠障碍（肝郁化火型）患者80例为研究对象，采用随机数字表法将其分为对照组和观察 组，每组40例。对照组采用常规药物治疗，观察组在对照组治疗基础上采用加味柴胡疏肝散联合穴位贴敷治疗，两组 均连续治疗4周。比较两组临床疗效，治疗前后中医主症积分、匹兹堡睡眠质量指数（PSQI）评分、睡眠状况自评量 表（SRSS）评分、多导睡眠仪监测结果及血清5-HT、5-HIAA水平，治疗期间不良反应发生率。结果　观察组临床疗 效优于对照组（u=2.087，P=0.037）。治疗后对照组和观察组心烦不能入睡、烦躁易怒、胸闷胁痛、头痛面红积分分 别低于本组治疗前，且观察组低于对照组（P＜0.05）。治疗后对照组和观察组PSQI评分、SRSS评分分别低于本组治 疗前，且观察组低于对照组（P＜0.05）。治疗后，对照组和观察组睡眠潜伏期、觉醒时间分别短于本组治疗前，总睡 眠时间分别长于本组治疗前，睡眠效率、快速眼动睡眠（REM）期比例分别高于本组治疗前（P＜0.05）；治疗后观 察组睡眠潜伏期、觉醒时间短于对照组，总睡眠时间长于对照组，睡眠效率、REM期比例高于对照组（P＜0.05）。 治疗后对照组和观察组血清5-HT、5-HIAA水平分别高于本组治疗前，且观察组高于对照组（P＜ 0.05 ）。观察组治疗 期间不良反应发生率为12.5%（5/40），与对照组的17.5%（7/40）比较，差异无统计学意义（χ 2 = 0.392 ，P=0.531）。 结论　加味柴胡疏肝散联合穴位贴敷治疗脑梗死后睡眠障碍（肝郁化火型）的临床疗效确切，其能有效减轻患者临床 症状和睡眠障碍，改善患者睡眠质量，提高患者血清5-HT、5-HIAA水平，且安全性较好。

Abstract：

Objective To investigate the clinical efficacy of added Chaihu Shugan powder combined with acupoint sticking in the treatment of sleep disorders after cerebral infarction (stagnation of liver Qi and transformation into fire type) and its effect on serum 5-hydroxytryptamine (5-HT) and 5-hydroxy-3-indoleacetic acid (5-HIAA) levels. Methods A total of 80 patients with sleep disorders after cerebral infarction (stagnation of liver Qi and transformation into fire type) admitted to Cangzhou Hospital of Integrated TCM-WM·Hebei from February 2022 to February 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 40 cases in each group. The control group was treated with conventional drugs, and the observation group was treated with added Chaihu Shugan powder combined with acupoint sticking on the basis of the control group. Both groups were treated continuously for 4 weeks. The clinical efficacy, TCM main symptom score, Pittsburgh Sleep Quality Index (PSQI) score, Self-Rating Scale of Sleep (SRSS) score, polysomnography monitoring results and serum 5-HT, 5-HIAA levels before and after treatment, and the incidence of adverse reactions during the treatment were compared between the two groups. Results The clinical efficacy of the observation group was better than that of the control group (u=2.087, P=0.037) . After treatment, the scores of unable to sleep due to restlessness, irritability, chest distress and hypochondriac pain, headache and flushing in the control group and the observation group were lower than those before treatment, respectively, and those in the observation group were lower than those in the control group (P < 0.05) . After treatment, the PSQI score, SRSS score of the control group and the observation group were lower than those before treatment, respectively, and those in the observation group were lower than those in the control group (P < 0.05) . After treatment, the sleep latency and the awakening time were shorter than those before treatment, total sleep time was longer than that before treatment, and the sleep efficiency and rapid eye movement (REM) stage ratio of the control group and the observation group were higher than those before treatment, respectively (P < 0.05) . After treatment, the sleep latency and the awakening time were shorter than those in the control group, total sleep time was longer than that in the control group, and the sleep efficiency and REM stage ratio in the observation group were higher than those in the control group (P < 0.05) . After treatment, the serum levels of 5-HT and 5-HIAA in the control group and the observation group were higher than those before treatment, respectively, and those in the observation group were higher than those in the control group (P < 0.05) . There was no significant difference in the incidence of adverse reactions during the treatment between observation group and control group [12.5 % (5/40) vs 17.5% (7/40) , χ 2 =0.392, P=0.531] . Conclusion The clinical efficacy of added Chaihu Shugan powder combined with acupoint sticking in the treatment of sleep disorders after cerebral infarction (stagnation of liver Qi and transformation into fire type) is definite. It can effectively reduce the clinical symptoms and sleep disorders of patients, improve the sleep quality and the serum levels of 5-HT and 5-HIAA, and with a better safety.

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