失眠的证候学特征及与心率变异分析相关性的临床研究

目的：寻找诊断和评估失眠的有效方法，研究失眠程度与中医临床症状之间的关系，明确心率变异分析在评估失眠中的作用。方法：①中医证候症状学调查；②依据匹兹堡睡眠质量量表（PSQI）对失眠程度进行评估、分析。③用心率变异分析仪测量有关数据，并对测量值与PSQI分数作相关性研究。结果：共观察102例，病程1月至50年。经PSQI评分，轻度睡眠障碍14例，占13．7％；中度46例，占45．1％；重度42例，占41．2％。心率变异分析结果，PSQI分值与低频功率与高频功率的比值（LF／HF）值之间不存在直线关系。结论：失眠见于多种疾病，女性和老年人发生率高。证候分类以心脾两虚型最多，临床上多虚实夹杂，以偏于虚证者最多见。根据PSQI评分结果，本次观察以中、重度失眠病例占主导。心率变异分析结果，PSQI分值增高并不能直接引发LF／HF值升高。心率的变化是交感神经（SNS）和副交感神经（PNS）拮抗作用的结果。

Clinical Study on Syndromic Characteristic of Insomnia and Its Relationship with Heart Rate Variability

Objective: To search the modus operandi of diagnosing and evaluating insomnia and study the relationship between insomnia degree and clinical symptoms of TCM,so as to identify the effect of heart rate variability(HRV) inspection in the evaluation of insomnia.Methods: This study were divided into four parts: 1 Traditional Chinese medicine semeiologic and syndromic Survey;2 Evaluation and analysis according to Pittsburgh sleep quality index(PSQI);3 Using heart rate variability analysator to determine the related data,then the relationship between the heart rate variability(HRV) inspection and the score of PSQI were studied.Results: There were total 102 cases insomnia patients,and the courses of disease were from one month to fifty year.According PSQI grading,there were 14 cases of lower grade somnipathy patients,accounting for 13.7%;46 cases of midrange patients,accounting for 45.1%;42 cases of heavy degree patients,accounting for 41.2%.HRV analytic result showed that PSQI does not have a linear relationship with LF/HF(P>0.05).Conclusion: Insomnia is seen in many kinds of diseases,female and aged people have high incidence rate.The type of deficiency of both the heart and spleen was the most in the syndrome grouping,and in the clinic,they were mostly mixed up with both excess and deficiency,and the patients leaning deficient syndrome were at most.According to the PSQI graded result, the midrange and heavy degree insomnia patients were dominant.HRV analytic result shows that PSQI does not have a linear relationship with LF/HF.HRV is the result of antagonistic effect of SNS and PNS.