失眠症的中医证候分析与中药治疗概况

失眠症是指持续相当长时间的对睡眠的质和量不满意的状况,可引起精神无法集中、思考能力减退、警觉力与判断力下降、免疫功能低下、内分泌紊乱等,还与感冒、抑郁症、糖尿病、肥胖、中风、心脏病和癌症的发生有关。现代社会,随着生活水平的提高,体力劳动减少,脑力劳动增加,工作及精神压力日益加重,很多失眠患者情志不畅的表现尤为突出。经过临床观察,我们发现五脏气机失调在失眠症的辨证论治中占有主导作用,因此对失眠及失眠症的研究与治疗就成为重要课题。     

浅谈赵敏教授治疗失眠的经验

随着当今经济社会的快速发展,失眠的发病率正在不断升高,已严重威胁人类生活质量及身体健康。目前临床西医治疗失眠症虽然疗效明显,但副作用及不良反应亦非常突出。中医药治疗失眠较西医显著的优点是不会成瘾,也不会产生依赖性,故失眠患者多选用中医中药进行辨证治疗[1]。赵敏教授总结多年的临床经验,认为失眠脏腑病位以心和肝出现频次最多,且与脾肾有关。失眠证候病机虚和实出现频次对半,因此对失眠进行辨证,尤其要注意心肝并重、虚实并重,具体辨证多责之于痰火扰神、心脾气血虚、肝郁气滞、阴虚火旺、肝火炽盛和心肾不交,则临床上多以补虚泻实,调整脏腑阴阳为治疗原则,同时配合外治法,效果显著。     

酒石酸唑吡坦对非器质性失眠症患者Actigraphy检测指标的影响

目的:应用Actigraphy仪检测酒石酸唑吡坦对非器质性失眠患者睡眠质量的影响。方法:选择非器质性失眠症患者36例,实验第二晚给予10 mg酒石酸唑吡坦,实验第一晚和第四晚采用Actigraph仪监测,观察用药后Actigraph指标的变化。同时设置正常对照组24名,进行基础Actigraph监测。结果:失眠组患者服用酒石酸唑吡坦后,夜间Actigraphy检测显示实际觉醒时间(AWT)、睡眠潜入期(SL)、平均每次觉醒时间(MWB T)与服药前相比,显著缩短(P0.01);睡眠效率(SE)、平均静息状态时长(MLI)与服药前相比,显著提高(P0.01),同时反映身体活动的参数平均活动分数(MAS)和睡眠总体破碎程度的割裂指数(FI)与对照组相比,显著降低(P0.05)。结论:酒石酸唑吡坦能明显改善非器质性失眠患者睡眠,在非器质性失眠症的诊断治疗中Actigraphy仪是一种有效、便捷的方法。     

睡前饮酒会加重失眠

一项研究表明,为了追求睡个好觉,失眠症患者们花在酒精饮品上的钱数远远超过他们在安眠药花费上的总和。然而专家们却说,如果你真的睡不着,喝到酒瓶见底应该是最后不得已的选择。酒精不能帮助入睡,恰恰相反,它实际上会加重失眠症状。     

补肾填精法对脑卒中失眠症模型大鼠血清褪黑素含量表达的影响

目的:探讨补肾填精法对脑卒中失眠症模型大鼠血清褪黑素(Melatonin,MT)含量表达的影响。方法:24只建模成功的脑卒中失眠症大鼠随机平分为3组-模型组、低剂量组、高剂量组。于造模第7 d起,三组分别给予生理盐水及补肾填精汤(低剂量组最终含生药浓度低剂量为0.7 g/mL、中剂量为1.4 g/mL)以1 mL/(100 g·d)灌胃,连续14 d,记录血清MT表达变化情况。结果:三组治疗第1 d、第7 d与第14 d的逃避潜伏期在组内与组间对比差异无统计学意义(P>0.05)。低剂量组、高剂量组治疗第7 d与第14 d的进入中央区次数多于模型组(P<0.05),也多于治疗第1 d(P<0.05),高剂量组也多于低剂量组(P<0.05)。低剂量组、高剂量组治疗第14 d的血清MT含量、去甲肾上腺素转运蛋白与褪黑素受体蛋白相对表达水平高于模型组(P<0.05),高剂量组高于低剂量组(P<0.05)。结论:补肾填精法在脑卒中失眠症模型大鼠中的应用能促进血清MT的释放,提高去甲肾上腺素转运蛋白与褪黑素受体蛋白的表达,从而促进缓解失眠症状。     

放松疗法对高龄老年失眠患者的有效性研究

目的:评价放松疗法对75岁以上老年人失眠状况的有效性。方法:收集90名75岁以上失眠症老年患者病例,随机分配到干预组(n=45)和对照组(n=45),采取随机对照的单盲临床试验。评测工具为匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)、焦虑自评量表(Self-rating Anxiety Scale,SAS)、老年抑郁量表(Geriatric Depression Scale,GDS)和幸福度量表(Memorial University of Newfoundland scale of happiness,MUNSH)。采用重复测量的方差分析评定干预疗效。结果:与对照组相比,干预组在PSQI总分(P0.001)、SAS(P=0.022)、和GDS(P=0.001)上有统计学意义的显著优势。结论:我们的研究表明,放松疗法对缓解75岁以上老年人的失眠情况有显著疗效。     

失眠症患者脑电超慢涨落图特征研究

目的:探讨失眠症患者的脑电超慢涨落图特征.方法:选择30例失眠症(Insomnia)患者,30例健康体检者作为对照组,在治疗前及常规治疗2月后,运用脑电超慢涨落图(Encephalofluctuograph,EFG)分析技术检测脑内6种神经递质的值.结果:治疗前,脑内神经递质Ach、5-HT、DA、GABA值均低于对照组,两组间比较差异有统计学意义(P＜0.01),而NE、Glu值高于对照组,两组间比较差异均统计学意义(P＜0.01).治疗2月后,失眠症组患者脑内神经递质Ach、5-HT、DA、GABA值较治疗前增加(P＜0.01),而神经递质NE、Glu值较治疗前降低(P＜0.01).结论:脑内神经递质改变极不平衡是失眠症的重要病因,脑电超慢涨落图检测可作为失眠症诊断和疗效判断的依据之一,并对治疗有指导意义.     

酸枣仁汤辅助治疗有助于改善失眠患者的睡眠质量

为了探究酸枣仁汤对治疗失眠的药理作用,本研究将96例失眠症患者根据随机数字表分为两组,其中对照组予以艾司唑仑片治疗,观察组予以艾司唑仑片+酸枣仁汤(suanzaoren decoction,SD)治疗。对比两组治疗前后的疗效及患者匹兹堡睡眠质量指数量表(pittsburgh sleep quality index,PSQI)得分、IL-1α、IL-1ra、IL-1β水平变化,发现观察组有效率高于对照组。两组治疗后的睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能得分较治疗前降低,观察组较对照组降低明显(p0.05)。两组治疗前的IL-1α、IL-1ra、IL-1β水平差异无统计学意义(p0.05);治疗后的IL-1ra、IL-1β水平较治疗前提高,IL-1ra水平较治疗前降低,且观察组比对照组变化明显(p0.05)。研究表明酸枣仁汤可改善患者睡眠质量,是治疗失眠症的有效药物。     

复方安神精油吸入给药的镇静催眠作用及化学成分的GC-MS分析

为研究复方安神精油吸入给药的镇静催眠作用,本实验采用动物自主活动测试和戊巴比妥钠诱导的睡眠潜伏期与睡眠时间实验:GC-MS分析复方安神精油的挥发性化学成分与入脑的主要化学成分;基于网络药理学预测和筛选出治疗失眠症相关靶蛋白与活性成分,旨在为复方安神精油治疗与改善失眠症提供理论依据。研究发现,复方安神精油具有镇静催眠作用,可显著减少动物自主活动,缩短睡眠潜伏期,延长睡眠时间;复方安神精油主要化学成分与入脑主要化学成分中含有多种具有神经中枢镇静催眠作用以及抗焦虑、抗抑郁作用的化学成分;基于网络药理学预测和筛选出25个治疗失眠症相关活性成分作用于39个治疗失眠症相关作用靶点,体现复方安神精油多成分、多靶点发挥镇静催眠作用的特点。     

脑电治疗在帕金森病伴失眠症患者中的应用疗效观察

目的观察脑电治疗帕金森病伴失眠症患者的疗效。方法将我院神经内科收治的68例帕金森病伴失眠症的患者随机分为对照组和干预组各34例,对照组仅给予药物治疗,干预组在药物治疗基础上加用脑电治疗,观察两组患者治疗4周后的匹兹堡睡眠质量指数(PSQI)评分的变化情况,并采用帕金森病综合评分表(UPDRS)为量化指标评估两组患者治疗前后的临床效果。结果干预组的匹兹堡睡眠质量指数(PSQI)显著低于对照组,两组比较差异有统计学意义(P0.05)。治疗4周后,两组患者的UPDRS评分均较治疗前下降(P0.05),而干预组的评分下降较为显著,与对照比较差异有统计学意义(P0.05)。结论脑电治疗能有效改善帕金森病患者的失眠症状,而且能显著缓解帕金森病肌强直症状,安全性高,值得临床推广应用。     

生物统计学专业课教育融合劳动教育的初步设计北大核心CSCD

当前大学教育中,劳动教育的实际施行与劳动教育的重要性仍不匹配,主要表现为劳动教育观念未与时俱进、劳动教育形式单一和劳动教育资源缺乏,与当前社会的专业性、创造性劳动需求仍有较大差距。将劳动教育与专业教育相融合将是解决上述问题的有效途径之一。两者的融合不仅可以丰富劳动教育和专业教育的教学形式,使专业教育和劳动教育互相促进,而且可以使劳动教育结合专业知识和专业技能,兼具传统劳动教育的要素和创造性劳动的时代需求。文中重点介绍了生物统计学课程教育中融合劳动教育的设计和实践方法,并分析了两者互相促进的途径及效果。     

Nonmarket Labor Processes in an Advanced Capitalist Economy

In advanced capitalist economies, the treatment of labor as a commodity suggests that labor's cost and availability depend on market mechanisms. Although neoclassical economic thought recognizes the influence of collective bargaining and labor legislation on the cost and availability of labor, economists generally pay scant attention to the ways informal and formal relations of power, along with myths of sexuality, ethnicity, and nationality, combine within labor processes in advanced capitalist economies to influence the cost and availability of labor. This article presents data on the labor processes in the North Carolina seafood processing industry and compares them to the labor processes accompanying the annual, seasonal importation of legal alien farm labor by U.S. agricultural producers. The labor processes of the former rest on kinship and informal social relations while those of the latter rest on formal political authority. The analysis suggests that, even in advanced capitalist economies, employers faced with labor supply problems do not rely on market mechanisms but instead tap formal and informal systems of authority to assure supplies of labor, and support their behaviors with myths of sexuality, ethnicity, and nationality. The article concludes with a discussion of these behaviors in the context of post-World War II international divisions of labor.     

Changes in urinary 6-keto-prostaglandin F1 alpha excretion during pregnancy and labor

Urinary excretion of 6-keto-PGF1 alpha was measured by high pressure liquid chromatography and radioimmunoassay at various stages of pregnancy and labor. In the first trimester of pregnancy, urinary 6-keto-PGF1 alpha concentrations were not different from those measured before pregnancy, but they showed a significant increase in the second trimester of pregnancy (p less than 0.001). The levels rose further in the third trimester, although this increase was not statistically significant when compared to levels obtained in the second trimester. There was no evidence for a significant change in 6-keto-PGF1 alpha excretion with the onset of labor. During well-established, progressive labor mean values of 6-keto-PGF1 alpha excretion were about twice as high as before the onset of labor, but the range of values during labor was so wide that there was no statistical difference with values obtained in the second half of pregnancy. It is concluded that the increase in the urinary excretion of 6-keto-PGF1 alpha occurs later in pregnancy than the increase in TXB2 excretion and that labor at term is not associated with marked changes in 6-keto-PGF1 alpha excretion.     

Physiology and electrical activity of uterine contractions

Presently, there is no effective treatment for preterm labor. The most obvious reason for this anomaly is that there is no objective manner to evaluate the progression of pregnancy through steps leading to labor, either at term or preterm. Several techniques have been adopted to monitor labor, and/or to diagnose labor, but they are either subjective or indirect, and they do not provide an accurate prediction of when labor will occur. With no method to determine preterm labor, treatment might never improve. Uterine electromyography (EMG) methods may provide such needed diagnostics.     

PATCHY CONTRAST OF HABITAT AFFECTS INTRACLONAL DIVISION OF LABOR OF POTENTILLA ANSERINA

 相互连接的克隆植物分株分别处于资源互补性的不同斑块时, 将可能发生形态结构的特化, 以更有效地吸收利用所处斑块中丰富的资源, 形成分株的功能分化, 即克隆内分工。生境的斑块对比度, 作为资源或环境异质性的主要素, 在一定程度上决定克隆内分工的发生状况。该文以鹅绒委陵菜(Potentilla anserina)为材料, 在自然条件下将多组分株对置于不同的斑块对比度处理下, 比较了它们克隆内分工的发生状态, 试图发现分工与斑块对比度的关系, 同时考察在克隆分工过程中分株的可塑性变化及其与分工的关系。该实验的理论假设是: 分株发生分工的程度与分株所处斑块的资源对比度成正相关。研究结果表明, 鹅绒委陵菜分株的高度和叶面积对局部光照环境产生强烈的可塑性反应, 反应的结果是增加了对匮乏的光资源的获取。从分株根冠比和我们提出的分工指数来看, 分工的程度在一定的斑块对比度范围内随斑块对比度的增强而增强, 但到达一个最大值后又迅速降低。鹅绒委陵菜分株之间的分工和结构特化往往滞后于分株对所处局部环境的适应性可塑性变化, 而后者往往在分株之间具有独立性和局部特征。克隆内分工主要依赖于生物量分配的调节而实现, 其发生状态都是分株系统在分工收益、分工代价与分工风险之间权衡的结果, 而这种结果在很大程度上取决于分株所处的斑块对比度。     

Role of ERK1/2 in uterine contractility and preterm labor in rats

The present study tested the hypothesis that ERK activation is an essential step in the onset of labor in a rat model of preterm labor. The administration of RU-486, an antiprogesterone agent, to rats induced preterm delivery 22.2 +/- 0.24 h after treatment. Changes in basal signaling events were studied in myometrial tissue from CO(2)-euthanized rats. Rats treated with RU-486 displayed a dramatically increased in vitro uterine contractility compared with gestational stage-matched, sham-treated rats. In vitro contractility was not significantly different from that during spontaneous labor. During RU-486-induced preterm labor, as previously described for spontaneous labor, ERK phosphorylation levels increased, as did phosphorylation of caldesmon at Ser(789), an ERK phosphorylation site. Also, a small but significant increase in 20-kDa myosin light chain phosphorylation was seen at a constant intracellular pCa of 7. When rats were chronically treated with an agent that prevents ERK activation, U-0126, the onset of RU-486-induced preterm labor was delayed in a statistically significant manner. Chronic in vivo treatment with U-0126 also significantly inhibited the RU-486-induced increase in in vitro contractility and ERK and caldesmon phosphorylation but did not alter the RU-486-induced increase in 20-kDa myosin light chain phosphorylation. These data indicate that ERK activation is a component of the multiple events leading to the development of labor in this rat model. We suggest that the ERK pathway could possibly be used to identify targets for the development of a novel class of tocolytic agents.     

Down-regulation of the alpha- and beta-subunits of the calcium-activated potassium channel in human myometrium with parturition

Large-conductance, calcium-dependent potassium (BKCa) channels are implicated in maintaining uterine quiescence during pregnancy. The mechanisms whereby calcium sensitivity of the BKCa channel is dramatically removed at parturition remain unknown. The aim of the present study was to investigate whether this loss of calcium sensitivity of the BKCa channel with the onset of labor is associated with changes in the protein expression of the alpha- and/or beta-subunit or arises from a physical dissociation of the alpha-subunit from the beta-subunit. The beta-subunit is a key determinant of BKCa-channel Ca2+ sensitivity. Western blot analysis, using alpha- and beta-subunit-specific antibodies, detected bands of 110-125 and 36 kDa, respectively. Protein expression levels of the alpha-subunit in term labor myometrium were significantly reduced compared with term pregnancy without labor. Furthermore, alpha-subunit levels at term pregnancy were significantly increased relative to the nonpregnant state, whereas levels at preterm gestations were unchanged. Densitometric analysis demonstrated significantly decreased beta-subunit levels in term and preterm labor samples compared with term nonlabor samples. Immunoprecipitation studies revealed the presence of both the alpha- and beta-subunits in samples taken before or after the onset of labor. We conclude that during labor, the alpha-subunit is not physically uncoupled from the beta-subunit, but a decline occurs in the level of beta-subunit protein, which may underlie the loss of calcium and voltage sensitivity of the BKCa channel with labor. Furthermore, reduced beta-subunit protein in preterm labor myometrium implies that ion channels may also contribute to pathophysiological labor.     

Licking of the Neonate and Duration of Labor in Great Apes and Man

An hypothesis recently advanced by Montagu relates the cutaneous stimulation of prolonged labor in great apes and man to the proper functioning of the newborn. These exceptional primates, according to Montagu, do not therefore stimulate the newborn by licking, as is the case for mammals in which labor is of short duration. Though man is believed to differ from other primates, especially the apes, in duration and difficulty of labor, we present data to show that the case at present rests on unstandardized measures of durations and on incomplete anatomical arguments. Until more objective criteria for charting the progress of labor are developed, there is no way of knowing if the assumption of a significant difference is correct. In any case, there seems to be no valid basis for linking differences in labor among primates with different forms of postpartum care, of which licking is but one example.