苯二氮氮类镇静剂成瘾戒断治疗的研究

李国祥,胡亚梅,刘　慧,石鹤峰,刘　宝,李书剑,王　丽

(1.河南省省直第一医院，河南 郑州 450003；2.河南省人民医院，河南 郑州 450003;3.河南省省立医院，河南 郑州 450000)



李国祥1,胡亚梅2,刘慧1,石鹤峰1,刘宝1,李书剑2,王丽3

(1.河南省省直第一医院，河南 郑州 450003；2.河南省人民医院，河南 郑州 450003;3.河南省省立医院，河南 郑州 450000)

1　临床资料

1.2治疗方法2组均给予药磁渗透辅以经络导平和认知行为干预等综合治疗，逐渐减少镇静剂用量，先用半量1周，第2周再应用1/4量，第3周内逐渐停用。对于少数有自主神经活动增强如肌肉震颤、心血管兴奋等患者，可加服心得安，然后在症状减轻或疗程结束时停用。

1.2.1药磁渗透治疗取五味子20 g、菟丝子15 g、桑葚子20 g、女贞子15 g、蛇床子15 g、首乌15 g、茯苓20 g、夜交藤15 g等制成中药汤剂，将8层的棉垫在汤剂中浸透，覆于百会、四神聪、印堂、安眠、风池等穴位上，然后再应用HX-C2型rTMS经颅磁疗仪的磁片对准该穴位做药磁穴位渗透，每次30 min，每日1次,每10次为1个疗程，共治疗2个疗程。

1.2.2经络导平治疗对于单用药磁渗透达不到理想效果者辅以经络导平技术(ZDZ-5型经络导平治疗仪)导平凤池、神庭、本神等穴位，频率2.5 Hz，每日1次，每次30 min，每10次为1个疗程，共治疗2个疗程。

1.2.3认知行为治疗所有患者均给予认知行为治疗,帮助患者重建理性的认知和行为模式，培养患者建立适合于自己的睡眠习惯，消除患者的负性情绪。

1.3观察指标观察2组治疗后随访3个月以内的睡眠情况和其伴随症状及镇静剂的停用情况。

1.4疗效判定标准痊愈：停用镇静剂，不用任何助眠药物，3个月随访睡眠正常，无其他症状，工作学习正常。显效：服用镇静催眠药物次数或量减少，睡眠改善，随访每日睡眠时间在6 h以上，或较以前睡眠时间延长2 h以上。有效：患者睡眠较以前延长但不足2 h或睡眠不足6 h但伴随症状明显减轻。无效：服用镇静催眠药物同以前，症状无明显改善或对日常生活工作仍有明显影响。

1.5统计学方法数据采用SPSS10.0统计软件进行统计分析。计数资料用百分比(%)表示，组间比较采用2检验，P<0.05为差异有统计学意义。

2　结　　果

表1　2组疗效比较　例 (%)

表2　2组治疗前后戒断症状情况比较　　　例(%)

3　讨　　论

中医认为失眠症是中医神志病中常见的一种病症，其主要病机为七情内伤导致机体脏腑阴阳失调、气血失和，或阴虚不能纳阳，或阳盛不得入阴，由这些病因引起心、肝、胆、脾、胃、肾的气血失和，阴阳失调，出现阳盛阴衰的情况。中医治疗从调节阴阳平衡的整体治疗入手，通过多层次、多靶点、多环节调节人体的神经-内分泌轴，调整大脑整体兴奋和抑制过程，维护患者失调的神经内分泌功能的平衡，逐步恢复患者对睡眠与觉醒的调控，使患者逐渐恢复自然睡眠，与目前医学理论提出的模式是一致的，临床上也有中医药戒断镇静剂治疗的报道[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

李国祥，男，副主任医师，主要从事神经内科神经症睡眠医学的研究。

2012年度河南省科技攻关计划项目(122102310057)

10.3969/j.issn.1008-8849.2016.24.004

R256.23

A

1008-8849(2016)24-2632-04

2016-02-25