苯二氮氮類鎮(zhèn)靜劑成癮戒斷治療的研究

李國祥,胡亞梅,劉　慧,石鶴峰,劉　寶,李書劍,王　麗

(1.河南省省直第一醫(yī)院，河南 鄭州 450003；2.河南省人民醫(yī)院，河南 鄭州 450003;3.河南省省立醫(yī)院，河南 鄭州 450000)

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李國祥1,胡亞梅2,劉慧1,石鶴峰1,劉寶1,李書劍2,王麗3

(1.河南省省直第一醫(yī)院，河南 鄭州 450003；2.河南省人民醫(yī)院，河南 鄭州 450003;3.河南省省立醫(yī)院，河南 鄭州 450000)

1　臨床資料

1.2治療方法2組均給予藥磁滲透輔以經(jīng)絡(luò)導(dǎo)平和認知行為干預(yù)等綜合治療，逐漸減少鎮(zhèn)靜劑用量，先用半量1周，第2周再應(yīng)用1/4量，第3周內(nèi)逐漸停用。對于少數(shù)有自主神經(jīng)活動增強如肌肉震顫、心血管興奮等患者，可加服心得安，然后在癥狀減輕或療程結(jié)束時停用。

1.2.1藥磁滲透治療取五味子20 g、菟絲子15 g、桑葚子20 g、女貞子15 g、蛇床子15 g、首烏15 g、茯苓20 g、夜交藤15 g等制成中藥湯劑，將8層的棉墊在湯劑中浸透，覆于百會、四神聰、印堂、安眠、風(fēng)池等穴位上，然后再應(yīng)用HX-C2型rTMS經(jīng)顱磁療儀的磁片對準(zhǔn)該穴位做藥磁穴位滲透，每次30 min，每日1次,每10次為1個療程，共治療2個療程。

1.2.2經(jīng)絡(luò)導(dǎo)平治療對于單用藥磁滲透達不到理想效果者輔以經(jīng)絡(luò)導(dǎo)平技術(shù)(ZDZ-5型經(jīng)絡(luò)導(dǎo)平治療儀)導(dǎo)平鳳池、神庭、本神等穴位，頻率2.5 Hz，每日1次，每次30 min，每10次為1個療程，共治療2個療程。

1.2.3認知行為治療所有患者均給予認知行為治療,幫助患者重建理性的認知和行為模式，培養(yǎng)患者建立適合于自己的睡眠習(xí)慣，消除患者的負性情緒。

1.3觀察指標(biāo)觀察2組治療后隨訪3個月以內(nèi)的睡眠情況和其伴隨癥狀及鎮(zhèn)靜劑的停用情況。

1.4療效判定標(biāo)準(zhǔn)痊愈：停用鎮(zhèn)靜劑，不用任何助眠藥物，3個月隨訪睡眠正常，無其他癥狀，工作學(xué)習(xí)正常。顯效：服用鎮(zhèn)靜催眠藥物次數(shù)或量減少，睡眠改善，隨訪每日睡眠時間在6 h以上，或較以前睡眠時間延長2 h以上。有效：患者睡眠較以前延長但不足2 h或睡眠不足6 h但伴隨癥狀明顯減輕。無效：服用鎮(zhèn)靜催眠藥物同以前，癥狀無明顯改善或?qū)θ粘Ｉ罟ぷ魅杂忻黠@影響。

1.5統(tǒng)計學(xué)方法數(shù)據(jù)采用SPSS10.0統(tǒng)計軟件進行統(tǒng)計分析。計數(shù)資料用百分比(%)表示，組間比較采用2檢驗，P<0.05為差異有統(tǒng)計學(xué)意義。

2　結(jié)　　果

表1　2組療效比較　例 (%)

表2　2組治療前后戒斷癥狀情況比較　　　例(%)

3　討　　論

中醫(yī)認為失眠癥是中醫(yī)神志病中常見的一種病癥，其主要病機為七情內(nèi)傷導(dǎo)致機體臟腑陰陽失調(diào)、氣血失和，或陰虛不能納陽，或陽盛不得入陰，由這些病因引起心、肝、膽、脾、胃、腎的氣血失和，陰陽失調(diào)，出現(xiàn)陽盛陰衰的情況。中醫(yī)治療從調(diào)節(jié)陰陽平衡的整體治療入手，通過多層次、多靶點、多環(huán)節(jié)調(diào)節(jié)人體的神經(jīng)-內(nèi)分泌軸，調(diào)整大腦整體興奮和抑制過程，維護患者失調(diào)的神經(jīng)內(nèi)分泌功能的平衡，逐步恢復(fù)患者對睡眠與覺醒的調(diào)控，使患者逐漸恢復(fù)自然睡眠，與目前醫(yī)學(xué)理論提出的模式是一致的，臨床上也有中醫(yī)藥戒斷鎮(zhèn)靜劑治療的報道[2]。

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Study on treatment of addiction withdrawal with benzodiazepine sedatives and non-benzodiazepine sedatives

LI Guoxiang1, HU Yamei2, LIU Hui1, SHI Hefeng1, LIU Bao1, LI Shujian2, Wang Li3

(1.The First Hospital of Henan Province, Zhengzhou 450003, Henan, China; 2.The People’s Hospital of Henan Province, Zhengzhou 450003, Henan, China; 3.Henan Provincial Hospital, Zhengzhou 450000, Henan, China)

Objective It is to investigate the addiction of benzodiazepine sedatives and non-benzodiazepine sedatives and their effect of withdrawal treatment.Methods 193 collected cases of chronic insomnia patients with long-term use of sedative drugs, there are 98 cases used benzodiazepine, and 95 cases used non-benzodiazepine.All the patients had histories of using sedatives more than half year, and were treated with drug withdrawal by the same integrated traditional Chinese and Western medicine treatment.The addictive situations and the effects of drug withdrawal therapy of the two groups were observed.Results The total effective rate and the cure rate of the non-benzodiazepine group were significantly higher than those of the benzodiazepine group (all P<0.01); Most of the two groups of withdrawal symptoms were disappear; and the rate of rebound insomnia in the group with non-benzodiazepine was significantly lower than that in the group with benzodiazepine (P<0.05).Conclusion Both benzodiazepine and non-benzodiazepine can lead to patients with addiction, combined treatment of TCM and Western medicine can help to get rid of the sedative addiction of patients with insomnia, and non-benzodiazepine is easier than benzodiazepine to drop their addiction.

benzodiazepine; non-benzodiazepine; addiction; withdrawal therapy

李國祥，男，副主任醫(yī)師，主要從事神經(jīng)內(nèi)科神經(jīng)癥睡眠醫(yī)學(xué)的研究。

2012年度河南省科技攻關(guān)計劃項目(122102310057)

10.3969/j.issn.1008-8849.2016.24.004

R256.23

A

1008-8849(2016)24-2632-04

2016-02-25