基于“胆主决断”理论胆量训练治疗失眠症患者的临床疗效研究

目的] 验证中医胆量训练治疗心胆气虚型失眠障碍的临床疗效，为临床治疗失眠障碍提供可靠的心理治疗方法。方法] 招募符合入组标准的2017年9月—2019年1月中国中医科学院广安门医院心理科心胆气虚型失眠障碍患者80例，随机分为心理组和西药组，每组40例，心理组采用中医胆量训练进行干预，西药组采用佐匹克隆进行干预。比较两组患者治疗后有效率的差异和治疗前后主客观睡眠数据变化，主观失眠症状评估采用匹兹堡睡眠质量指数（PSQI），客观睡眠评估采用多导睡眠监测（PSG），观察时间为8周。结果] 1）心理组有效率为88%，西药组有效率为43%，心理组有效率高于西药组（P<0.05）。2）PSQI组内比较：心理组可增加患者PSQI的睡眠时间，减少入睡时间，改善睡眠质量、提高睡眠效率，治疗睡眠障碍、改善日间功能，从整体上改善睡眠（P<0.05）。PSQI组间比较：心理组在睡眠质量、睡眠效率和日间功能方面的改善效果优于西药组（P<0.05）。3）PSG组内比较：心理组可以增加失眠障碍患者总睡眠时间、提高睡眠效率、减少觉醒次数，优化睡眠结构（P<0.05）。PSG组间比较：心理组较西药组觉醒次数更少，浅睡眠比例更少，REM睡眠比例更接近正常人（P<0.05）。结论] 中医胆量训练治疗心胆气虚型失眠，较佐匹克隆具有更显著的临床疗效，可以改善患者的主客观失眠数据，值得进一步研究与推广应用。

Clinical efficacy study of traditional Chinese medicine courage training to treat insomnia patients based on gallbladder governs decision

Objective] To verify the clinical efficacy of traditional Chinese medicine courage training in treating insomnia disorder of heart and gallbladder qi deficiency type,and to provide reliable psychological treatment methods for the clinical treatment of insomnia disorder.Methods] The 80 patients with insomnia due to deficiency of heart and gallbladder qi were randomly divided into psychological group and western medicine group,with 40 cases in each group. The psychological group was intervened by courage training of traditional Chinese medicine,while the Western medicine group was intervened by zopiclone. Comparing the difference of effective rate between the two groups after treatment and the changes of subjective and objective sleep data before and after treatment,Pittsburgh Sleep Quality Index (PSQI) was used for subjective insomnia symptom assessment,and polysomnography (PSG) was used for objective sleep assessment, and the observation time was 8 weeks.Results] 1) The effective rate of courage training group was 88%,and that of zopiclone group was 43%,which was higher than that of zopiclone group (P<0.05). 2) Comparison within PSQI group:courage training group can increase sleep time,reduce sleep time,improve sleep quality,improve sleep efficiency,treat sleep disorder,improve daytime function and improve sleep as a whole (P<0.05);Comparison between PSQI groups:the improvement effect of sleep quality,sleep efficiency and daytime function in courage training group was better than that in zopiclone group(P<0.05).3) Comparison within PSG group:courage training group can increase the total sleep time,improve sleep efficiency,reduce awakening times and optimize sleep structure (P<0.05). Comparison between PSG groups:compared with zopiclone group,the courage training group had fewer awakening times,less shallow sleep ratio,and the REM sleep ratio was closer to that of normal people (P<0.05).Conclusion] Courage training of traditional Chinese medicine is more effective than zopiclone in treating insomnia of heart and gallbladder qi deficiency type,and can improve subjective and objective insomnia data of patients,which is worthy of further research and popularization.