| Objective:Insomnia is very common in patients with malignant tumors.Antitumor treatments such as surgery,chemotherapy,and radiation therapy can aggravate the insomnia of patients with malignant tumors,but the pathogenesis is not yet clear.Cancer patients have a heavy psychological burden.Because of the toxic and side effects of drugs that improve insomnia,such as addiction and residual effects the next day,patients refuse to use drugs to improve insomnia.Insomnia symptoms cannot be effectively improved,which affects the effect of antitumor treatment and quality of life of patients,and even shortens the survival time of patients.In this study,the postoperative patients with gastric cancer were taken as the starting point.Through questionnaire survey and statistical analysis,the characteristics of insomnia and related factors of patients with gastric cancer were summarized.The correlation between insomnia characteristics and syndrome types was discussed to guide the clinical treatment of traditional Chinese medicine.The clinical efficacy of Fuzheng Jiedu Decoction(扶正解毒方)in the treatment of insomnia after gastric cancer surgery was evaluated,providing objective evidence for clinical treatment and research.Methods:This study used a prospective study design.It’s included a total of 58 patients with insomnia after gastric cancer surgery in the Oncology Clinic of Guang’ammen Hospital,China Academy of Chinese Medical Sciences.At the time of enrollment,patients filled out general information forms and TCM syndrome survey forms.Patients were treated with Fuzheng Jiedu Decoction(扶正解毒方)based on syndrome differentiation based on the addition and subtraction of the treatment for 2 cycles(200ml/time,2 times/day,a cycle is 28 days).At the time of enrollment,after the first cycle of intervention and after the second cycle,patients were required to complete the PSQI scale,PFS-CV scale,and HADS scale to analyze the characteristics of patients with insomnia and related factors.Through the self-control before and after,it’s explored the treatment effect of Fuzheng Jiedu Decoction(扶正解毒方)on patients with insomnia and other symptoms.Finally,SPSS 24.0 was used for statistical analysis.Results:(1)Correlation analysis of insomnia with general data and gastric cancer data:there were no statistically significant differences in the total PSQI scores among the groups of gender,age,KPS score,gastric cancer lesion site,differentiation grade,Lauren classification,clinical stage,T stage,and N stage(P>0.05).The total PSQI score(13.71 ± 3.34)for patients with chemotherapy cycles>6 cycles was significantly higher than the total PSQI score(10.88± 2.66)for patients with chemotherapy cycles:≤6 cycles(P<0.01).With the number of chemotherapy cycles>6 compared with the number of chemotherapy cycles:6,the risk of insomnia aggravating increased(OR=5.526,95%CI:1.382-22.104,P=0.016).(2)Correlation analysis between insomnia characteristics and TCM syndrome types:the insomnia characteristics of patients with gastric cancer after operation are mainly those who wake up early and wake up easily(62.07%),followed by those with shallow sleep and more dreams(39.66%);those with difficulty falling asleep account for 29.31%,those with short sleep time and residual effects during the day They accounted for 15.52%and 13.79%,respectively.TCM syndrome differentiation in patients with early awakening,awakening,sleeplessness,and daytime residual effects is mainly based on deficiency syndromes,patients with difficulty falling asleep are mainly based on evidence,and patients with short sleep time are mainly based on deficiency and solidness.The syndrome differentiation in patients with difficulty falling asleep is mainly based on liver-fire disturbance of heart syndrome(70.59%);the syndrome differentiation in early awakening and awakening is syndrome of heart and spleen deficiency(83.33%);the main symptoms of sleepless and more dreamers are heart and kidney non-commitment(60.87%);the short sleep time and daytime residual effect type of insomnia are also common in heart and spleen deficiency,and heart and kidney incompatibility.(3)Correlation analysis of insomnia with fatigue and emotion:there was a positive correlation between the degree of insomnia and the degree of fatigue and depression in patients with gastric cancer.The Pearson correlation coefficient between the total score of PSQI and the final score of the fatigue scale was 0.402,P=0.002<0.01.The Pearson correlation coefficient between the total PSQI score and the depression sub-table score was 0.260,P=0.049<0.05.There was no significant correlation between insomnia and anxiety(P>0.05).Patients with moderate or severe fatigue after gastric cancer surgery have an increased risk of insomnia aggravating compared to patients without or mild fatigue(OR=4.714,95%CI:1.428-1 5.458,P=0.010).(4)In addition to scoring the hypnotic drug components in the PSQI scale,Fuzheng Jiedu Decoction(扶正解毒方)has an improvement effect on the six component scores of sleep quality,sleep time,sleep time,sleep efficiency,sleep disturbance,daytime dysfunction,and total PSQI score(P<0.05).Through sequential intervention of 2 cycles,Chinese medicine has a continuous improvement effect on the degree of insomnia(P<0.05).In addition,the syndrome differentiation of Fuzheng Jiedu Decoction(扶正解毒方)can also improve the degree of fatigue,depression,and anxiety in patients with gastric cancer after surgery(P<0.05).Conclusion:(1)In this study,insomnia in patients with gastric cancer was most commonly awakened early and easily.(2)The degree of insomnia was significantly correlated with the number of chemotherapy cycles,the degree of fatigue and depression.The number of chemotherapy cycles of>6 and moderate to severe fatigue were significant risk factors for the aggravation of insomnia in patients with gastric cancer after surgery.The risk of insomnia aggravating with chemotherapy cycles>6 is 5.526 times the number of chemotherapy cycles≤6.The risk of insomnia aggravating in patients with moderate or severe fatigue after gastric cancer surgery is 4.714 times that of patients without or mild fatigue.(3)Patients with insomnia after gastric cancer are mainly deficiency,and those with deficiency of heart and spleen are more common.The syndrome differentiation characteristics of common type 3 insomnia are as follows:those who wake up early and are awakened mainly with deficiency of heart and spleen.Those who sleep shallowly and have more dreams mainly do not have the heart and kidney.(4)Fuzheng Jiedu Decoction(扶正解毒方)can improve the degree of insomnia,fatigue,depression,and anxiety in patients with gastric cancer after surgery. |
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