針刺治療苯二氮（艸卓）類藥物依賴性失眠的前瞻性病例系列研究

陳穎 范竹青 于文艷

[摘要] 目的 探討針刺治療對苯二氮（艸卓）類藥物依賴性失眠的臨床療效和藥物戒減作用。 方法 采用前瞻性病例系列研究，對15例服用苯二氮（艸卓）類藥物超過3個月，日劑量折算地西泮≤10 mg，且減藥困難的原發性失眠患者進行針刺治療同時按規則指導減藥。取穴百會、神庭、四神聰、神門（雙）、三陰交（雙），每周5次，治療4周，分別于基線期、治療第4周末、治療結束后第4周末進行匹茲堡睡眠指數量表（Pittsburgh sleep quality index，PSQI）減藥率評估，比較治療前后的差異；同時，在治療中第1周末、第2周末、第3周末、第4周末、治療結束后第4周末，采用苯二氮（艸卓）類藥物戒斷癥狀量表（Benzodiazepine withdrawal symptom questionnaire，BWSQ）對減藥過程中的戒斷反應進行評估，并以此來調整減藥速度。 結果 依據PSQI評分，總有效率85.71%。口服藥物減量或停藥，總有效率為92.86%。隨訪4周，總有效率均無變化。治療后患者PSQI總分及各維度評分均較治療前明顯下降（P<0.01，P<0.05）。治療期間，出現乏力等不良反應，以第1周為著，均與減藥相關。調整減藥速度，癥狀減輕或消失。 結論 針刺對苯二氮（艸卓）類藥物依賴性失眠癥睡眠質量改善、藥物戒減有較好療效和安全性。

[關鍵詞] 苯二氮（艸卓）類藥物依賴；失眠；針刺；苯二氮（艸卓）戒斷癥狀問卷

[中圖分類號] R741.5 [文獻標識碼] B [文章編號] 1673-9701（2018）21-0134-04

[Abstract] Objective To investigate the clinical efficacy and drug withdrawal effects of acupuncture on benzodiazepine-dependent insomnia. Methods A prospective case series study was applied. For 15 patients with primary insomnia who had been taking benzodiazepines for more than 3 months， with the daily dose equivalent to 10 mg of diazepam， and had difficulty in reducing dosage， acupuncture treatment was given and reduction of dosage was prescribed according to the rules. Acupuncture was given to acupoints such as Baihui， Shenting， Sishencong， Shenmen （bilateral） and Sanyinjiao （bilateral）， 5 times a week for a total of 4 weeks. Pittsburgh sleep quality index（PSQI） and dosage reduction rate were assessed at the baseline period， at the end of the fourth week of treatment and at the end of the fourth week after the end of treatment， and the difference was compared before and after the treatment； at the same time， Benzodiazepine Withdrawal Symptom Questionnaire（BWSQ） was used to assess the withdrawal response during drug dosage reduction at the end of the first week， second week， third week， fourth week and at the end of the fourth week after the treatment， so as to adjust the dosage reduction rate. Results According to the PSQI score， the total effective rate was 85.71%. After dosage reduction or withdrawal of the oral drug， the total effective rate was 92.86%. After 4 weeks of follow-up， there was no change in total effective rate. After treatment， the total PSQI scores and scores of all dimensions were decreased significantly compared with those before treatment（P<0.01， P<0.05）. During the treatment period， fatigue and other adverse reactions were detected， which were significant in the first week， and were associated with the dosage reduction. When the rate of dosage reduction was adjusted， the symptoms were alleviated or disappeared. Conclusion Acupuncture has a better efficacy and safety for the improvement of sleep quality and dosage reduction or drug withdrawal in benzodiazepine-dependent insomnia.

[Key words] Benzodiazepine-dependent； Insomnia； Acupuncture； Benzodiazepine withdrawal symptom questionnaire （BWSQ）

失眠癥是以難以入睡和睡眠維持困難為特征的一種最常見的睡眠障礙，目前以藥物治療為主[1]。苯二氮（艸卓）類藥物（Benzodiazepines，BZDs）是臨床上應用最廣泛的一類鎮靜催眠藥[2-3]。在老年人中使用率較高，其中長期服用者占33%。苯二氮（艸卓）類藥物安全性高、起效快，但長期服用易導致依賴，表現為藥量增加睡眠質量不能繼續改善，減藥、停藥出現失眠加重，焦慮、知覺障礙等戒斷癥狀。BZDs還可以導致睡眠結構的改變，對于老年人，會加劇認知損害、增加跌倒風險?！?br>