我国围绝经期睡眠障碍的影响因素及针灸治疗概况

我国已步入老年型社会,以中老年女性居多。因此,我国的老年人口的问题很大程度上都是老年女性的问题。而女性一生大约有1/3的时间在围绝经期及绝经后度过,故解决围绝经期问题成为医学界研究热点。经过大量的流行病学调查,发现围绝经期的主要症状是睡眠障碍,其受围绝经期不适症状、精神、社会等多因素影响。现代治疗围绝经期睡眠障碍以激素疗法为主,但不良反应多。中医治疗多以中药治疗、针灸治疗为主。针灸治疗因其临床的有效性及方便性广受国内外患者的欢迎。     

围绝经期睡眠障碍中西医发病机制

围绝经期是指妇女绝经前后的一段时期,从接近绝经时出现与绝经有关的内分泌学、生物学与临床特征起至绝经后1年内的时期[1].由于卵巢功能开始衰退,女性可出现一系列精神、心理、神经、内分泌和代谢变化所致各系统症状和体征的综合表现,即围绝经期综合征.而睡眠障碍是围绝经期综合征的一种主要症状. 1 围绝经期睡眠障碍的发病率 研究发现,女性在绝经期和绝经后期睡眠障碍显著增加.     

近10年针灸治疗围绝经期睡眠障碍临床研究述评

睡眠障碍是我国围绝经期妇女较为常见的一种症状,针灸治疗安全、疗效明确,本文通过整理近10年间针灸治疗此病的文献,总结介绍现阶段围绝经期睡眠障碍的针灸疗法研究现状,并强调针灸治疗结合心理干预治疗围绝经期睡眠障碍的重要性,为临床针灸治疗此病提供参考,以期提高疗效。     

益肾清心汤治疗围绝经期睡眠障碍46例

目的:观察益肾清心汤治疗围绝经期睡眠障碍(心肾不交型)的疗效,并探讨其作用机理。方法:选择围绝经期睡眠障碍(心肾不交型)患者46例,予益肾清心汤治疗2个疗程,通过观察治疗前后匹兹堡睡眠质量指数(PSQI)的变化,评价益肾清心汤对围绝经期睡眠障碍的改善情况;通过观察改良的kupermann评分以及性激素(E2、FSH、LH)水平的变化,评价益肾清心汤对围绝经期其它症状的改善情况和对性激素的影响。结果:治疗后与治疗前相比失眠症状明显改善,总有效率为84.78%,匹兹堡睡眠质量指数与治疗前相比有显著性差异(P<0.01);治疗后围绝经期其它症状也显著改善,改良Kupermann评分与治疗前相比有显著性差异(P<0.01);治疗后患者血清雌二醇(E2)有上升趋势,卵泡刺激素(FSH)和黄体生成素(LH)有下降趋势,但无统计学意义(P<0.05)。结论:益肾清心汤具有滋肾清心,清肝宁神的功效,能显著的改善围绝经期失眠症状,对围绝经期其它症状也有较好的疗效;对围绝经期综合征妇女体内内分泌水平具有一定的调节作用。     

围绝经期睡眠障碍中西医治疗研究进展

<正>围绝经期是指妇女绝经前后的一段时期,从接近绝经时出现与绝经有关的内分泌学、生物学与临床特征起至绝经后1年内的时期[1]。围绝经期的妇女由于卵巢功能减退、雌激素水平下降而引起一系列生理、心理的变化,如潮热出汗、心烦易怒、睡眠障碍等。而睡眠障碍是妇女围绝经期中最常见病证之一,可导致身心疲倦、情绪激动,严重影响人的情绪、行为和认知力,且加重围绝经期其他症状,从而影响人们的生活质量。现将近年来西医及中医对围绝经期睡眠障碍的治疗进行     

补虚泻实治疗围绝经期综合征66例临床分析

目的：通过自身对照，评价补虚泻实法治疗围绝经期综合征的临床疗效。方法：回顾分析临床病例，对符合围绝经期综合征诊断，采用滋肾、泻肝、清心治法的患者潮热出汗、睡眠障碍、情绪异常及其他躯体不适等症状作治疗前后对比。结果：经治1疗程，潮热出汗、情绪异常、睡眠障碍以及躯体症状缓解合消失率分别为56．06％、55％、61．37％、62．17％。结论：补虚泻实能有效缓解或消除围绝经综合征患者临床症状。     

从“心肾相交”角度探讨围绝经期睡眠障碍

围绝经期是女性生命周期中的特殊阶段，睡眠障碍在该时期的发病率明显增高，是困扰围绝经期女性的主要问题之一。本文从“心肾相交”角度探讨围绝经期睡眠障碍的论治，认为围绝经期睡眠障碍以心肾不交，神明不安为主要病机，其中肾虚是发病的基础，其具体病机包括“肾水不足，心火偏亢，热扰神明”“肾阳不足，心阳失温，神失鼓舞”“肾精不足，心血亏虚，神失所养”三个方面。治疗时应紧握病机，以交通心肾、安神助眠为原则，根据患者睡眠障碍类型及伴随症状的不同，辨证应用“补肾滋阴，清心安神”“补肾助阳，暖心安神”“补肾填精，养心安神”之法，以使心肾相交，神明安宁，帮助患者恢复正常睡眠。     

浅析围绝经期睡眠障碍的中医发病机制

目的：探讨围绝经期睡眠障碍的中医发病机制。方法：分析肾、心、肝三脏与围绝经期睡眠障碍的关系。结论：心肾不交、肝阳上亢是围绝经期睡眠障碍的主要病理机制。     

围绝经期睡眠障碍与心肾失济

围绝经期及绝经期后妇女睡眠障碍的发生率显著增加。发生原因与雌激素水平降低、血管舒缩变化、情绪障碍有关。围绝经期睡眠障碍属中医绝经前后诸证中失眠症,心肾病机在围绝经期综合征发病中占有重要地位,心肾失济也是绝经前后诸证之不寐发病的关键。拟益肾宁心之更年冲剂治疗围绝经期综合征,亦可有效控制围绝经期综合征睡眠障碍。     

针刺治疗围绝经期综合征研究进展

该文围绕围绝经期不同的症状,整理相关针刺疗法的临床应用及其可能的作用机制。临床中应用单纯针刺或针刺联合疗法均能有效改善围绝经期月经不规则、血管舒缩症状、睡眠障碍、情绪障碍,其作用机制主要是通过调节激素或神经递质含量以影响下丘脑-垂体-卵巢轴,为针刺治疗围绝经期综合征提供借鉴。     

围绝经期失眠症肝郁患者的常见症状及证素特点研究

目的探讨围绝经期失眠症肝郁患者的常见症状及证素特点,为围绝经期失眠症的临床治疗提供思路。方法选择100例围绝经期失眠症肝郁患者,采用证素积分的方法,通过四诊资料规范化采集,分析围绝经期失眠症肝郁患者的症状分布情况及不同肝郁分级患者的病位、病性证素特点。结果围绝经期失眠肝郁患者症状发生频率较高的依次为易激动、潮热汗出、眩晕、骨关节肌肉痛、感觉异常等;主要病位证素为肾、脾、胞宫和心神;主要实证病性证素为痰、湿、血瘀和热;虚证病性证素为阴虚、气虚、血虚与阳虚。结论围绝经期失眠肝郁患者多兼肾、脾、胞宫和心神等脏腑的病理改变,虚实夹杂为本病的基本病机特点。     

绝经女性颈动脉粥样硬化的临床调研与病机探讨

目的探讨绝经女性颈动脉粥样硬化（CAS）的病机与证候分布规律。方法采集临床绝经女性CAS患者的相关信息,运用统计学方法对患者的症状、病史及相关资料进行分析,筛选绝经女性CAS的危险因素。结果增龄,雌激素缺乏,鼾眠,嗜辛辣、甜食、咸味,被动吸烟,超重,腹型肥胖,高血压、高脂血症病史是绝经女性CAS的主要危险因素;绝经女性组与正常生育期女性组在雌激素水平、打鼾程度、肥胖、高血压、高血脂、CAS程度方面具有显著差异;证候分布在绝经早期以火热证居多,随着绝经年限的延长,雌激素水平降低,肝肾阴虚的程度愈甚。结论绝经女性CAS危险因素多端,其证候分布以火热证、肝肾阴虚证居多;阴虚火盛是绝经女性CAS发病的病理基础,阴虚失养、火盛灼脉是核心病机。     

帕金森病患者的睡眠障碍研究进展

帕金森病睡眠障碍目前尚无国际公认的分类标准,国外的学者倾向于将其分为失眠、快速动眼(REM)睡眠行为障碍、日间睡眠过多、睡眠发作4种类型。而帕金森病本身对睡眠中枢结构及递质的影响,帕金森病的运动症状,帕金森病的治疗和精神症状,以及自主功能失调、基因突变等均可影响睡眠。该文阐述了帕金森病非运动并发症睡眠障碍的类型、病因和发病机制,帕金森病睡眠障碍基本的治疗策略,以提高临床医生对帕金森病睡眠障碍的认识,改善帕金森病患者的生活质量。     

王小云教授运用中医情志疗法治疗更年期综合征的经验

目的：总结王小云教授治疗更年期综合征精神神经症状的临床经验。方法：通过收集王小云教授多年治疗更年期综合征精神神经症状的典型病例,分析、总结其治疗方法。根据更年期女性情志障碍的特点,以情志相胜法为主体,结合语言开导,创立情志相胜四部曲。结果与结论：该中医情志治疗方案能较好地改善更年期妇女精神神经症状,其经验对临床有重要的指导意义。     

绝经综合征论治难点与对策分析

绝经综合征是妇科常见病多发病,绝经相关症状及绝经后相关疾病具有多系统、多样化的特点,严重影响绝经期及绝经后女性的身心健康,故确立绝经相关症状和疾病的治疗对策,对提高和改善妇女的生活质量有重要意义。目前现代医学主要是采用激素疗法(HT)治疗,中医学也发挥重要作用。文章分析了绝经综合征中潮热汗出、情绪障碍及绝经远期病变的防治难点与对策,希冀有益于开拓中医药防治绝经综合征思路和提高防治水平。     

中医治疗围绝经期综合征的分型探讨与名家经验

围绝经期综合征指因雌激素水平波动或下降所致的以植物性神经系统功能紊乱合并神经心理症状为主的综合症,多发生于45～55岁之间。探讨中医对本病临床症状和病因病机的认识,着重从脏腑之间的关系进行辨证分型以及对各位名家用方经验进行了总结,同时指出围绝经期是一个正常生理阶段,患者精神疗法不可忽视。     

Acupuncture treatment of a male patient suffering from long-term schizophrenia and sleep disorders

OBJECTIVE: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders.METHODS: A 42-year-old German male outpatient,suffering from long-term schizophrenia and sleep disorders, entered the study. Acupuncture was used as a non-pharmacological intervention. In addition to his ongoing Western Medicine(pharmacological) treatment, the patient received 12 weekly(non-standardized) acupuncture treatments in the clinic. The Traditional Chinese Medicine(TCM) diagnosis, the psychological assessment and the actiwatch data were compared before and after the acupuncture treatment.RESULTS: The TCM diagnosis revealed a Liver Fire pattern before the acupuncture treatment, which was still present, although to a lesser degree, after the treatment. The psychological assessment revealed no change in the positive symptoms, but a small decrease in the negative symptoms and the general psychopathology of the patient. This was further illustrated by the small decrease in the number of depressive symptoms. The subjective sleep disorders improved markedly after acupuncture treatment, but the daytime sleepiness did not. The actiwatch results showed that after acupuncture treatment, the patient was moving less during sleep, but no significant results were found for the other sleep parameters.CONCLUSION: Acupuncture was found to be an effective non-pharmacological add-on method for treating subjective sleep disorders, and, to a lesser degree, objective sleep disorders and the negative symptoms of chronic schizophrenia. Future larger clinical trials with follow-up measurements are needed in order to replicate the present preliminary beneficial acupuncture findings and in order to determine whether the observed effects can be sustained.     

Fallbericht: Patientin mit Schlafstörung

Background

Since the onset of her menopause about ten years ago, a sixty-year old patient has been suffering from hot flashes and sleep disorders causing her to become increasingly anxious and nervous. As the patient's mother had died of breast cancer, substitution of hormones was not advisable. Relaxation methods such as Yoga and Autogenic Training could only mildly alleviate the symptoms.

Objective

To effectively treat the sleep disorder, improve quality of life, lessen frequency and severity of hot flashes

Methods

Weekly sessions with ear- and body acupuncture for ten weeks

Results

After the third acupuncture session the patient reported a decrease of nightly waking episodes but suffered from acute pain in the neck as well as shoulder region. After nine therapy sessions, the patient reported a 50% decrease of nightly waking episodes. The hot flashes, however, remained unchanged.

Discussion

In this case, acupuncture significantly improved the patient's sleeping disorder. It also reduced the symptoms of anxiety and nervousness. Other menopausal symptoms such as hot flashes and dryness of mucous tissues, could not be influenced.     

Effects of Ziyin Jianghuo Ningxin decoction plus dehydroepiandrosterone and femoston in treatment of patients with menopausal symptoms

OBJECTIVE: To determine the therapeutic effect of Ziyin Jianghuo Ningxin Decoction(ZYJHNXD) plus dehydroepiandrosterone(DHEA) and menopausalhormone therapy(MHT) in patients suffering from menopausal symptoms identified as, in terms of Traditional Chinese Medicine, symptom pattern of Yin deficiency with hyperactive fire.METHODS: Totally 180 postmenopausal women aged 40 to 60 years were assigned into four groups and accepted femoston, femoston with ZYJHNXD,femoston with DHEA, femoston with ZYJHNXD and DHEA therapies, respectively, for three months.Common questionnaire-based measure instruments included modified Kupperman index(MKI),Hamilton Rating Scale for Anxiety(HAMA), and Hamilton Rating Scale for Depression(HAMD). Follicle-stimulating hormone(FSH), luteinizing hormone(LH), estradiol(E2), 5-hydroxyindole-3-acetic acid(5-HIAA), norepinephrine(NE), dopamine(DA),bone mineral density(BMD), and sleep quality were evaluated before and three months after the treatments.RESULTS: In all four groups, the scores of MKI, HAMA, HAMD and the levels of FSH, LH decreased significantly(P 0.05) after the treatment, while the levels of E2, 5-HIAA, NE, and DA showed obvious elevation(P 0.05). The group receiving ZYJHNXD and DHEA combined with femoston had superiority in the preservation of bone mineral density and improvement of total sleep time and nighttime sleep time over the other three groups.CONCLUSION: ZYJHNXD and DHEA combined with MHT therapy have a favorable outcome in managing menopausal symptoms, restoring hormone levels, preventing skeletal rarefaction or osteoporosis,and improving sleep quality for postmenopausal women.     

黑升麻治疗妇女围绝经期综合征的临床研究

目的对黑升麻治疗围绝经期综合征的临床试验进行综述。方法利用国外权威数据库,查找相关的黑升麻临床试验的文献,并对其进行分析。结果研究表明黑升麻能较好地缓解围绝经期的症状。结论黑升麻是治疗围绝经期综合征的具有潜力的药物。