经皮耳迷走神经刺激治疗失眠症的研究进展  

A review on treating insomnia by transcutaneous vagus nerve stimulation

作　　者：程双玉 程岩岩[2] CHENG Shuangyu

机构地区：[1]辽宁中医药大学第一临床学院,辽宁沈阳110032 [2]辽宁中医药大学附属医院,辽宁沈阳110032

出　　处：《中医临床研究》2024年第34期127-132,共6页Clinical Journal Of Chinese Medicine

基　　金：全国名中医传承工作室建设项目[国中医药办人教函(2022)245号];省自然科学基金指导计划(20180550065)。

摘　　要：失眠是由多种因素导致的常见睡眠障碍性疾病,以经常性入睡困难、难以保持睡眠、醒来后重新入睡困难或睡眠中断,或清晨觉醒为主要症状,并伴有日间功能受损。长期失眠不仅会导致疲劳、注意力不集中、免疫力下降,影响人们的日常生活和工作,还会增加患癌风险。目前,药物治疗虽见效快,但易出现耐受性、依赖性等诸多不良反应。临床及临床前证据表明经皮耳迷走神经刺激术(Transcutaneous Vagus Nerve Stimulation,taVNS)对失眠症具有明显疗效,且不良反应少、安全性高。其理论基础为中医耳穴疗法,通过刺激耳部穴位调节“心神”“脑神”“五脏神”,维持机体协调统一,共同调节睡眠。它创新性地将传统耳穴与现代神经技术相结合,通过激活迷走神经耳支,迷走神经通过孤束核进入中枢神经系统,从孤束核中投射到臂旁复合体、蓝斑和中缝核(raphe核),从臂旁复合体进一步直接或间接投射到包括大脑皮层在内的多个脑区域,对与睡眠、情感、认知记忆相关的脑网络进行调制,可广泛应用于失眠、抑郁症等神经疾病与精神疾病。taVNS治疗失眠的作用机制可能与改善脑区及脑网络间功能连接、调节神经递质释放、抑制下丘脑-垂体-肾上腺轴及减轻神经炎性反应有关。文章主要从理论基础与作用机制两个方面对ta VNS治疗失眠展开讨论,以期为今后taVNS的临床治疗提供思路与方向。Insomnia is a common sleep disorder caused by a variety of factors,with frequent difficulty falling asleep,difficulty in staying asleep,difficulty in falling asleep after waking up or sleep interruption,or early morning awakening as the main symptoms,accompanied by impaired daytime function.Long-term insomnia will not only lead to fatigue,lack of concentration,decreased immunity,affect people’s daily life and work,but also increase the risk of cancer.At present,although the drug treatment is effective quickly,it is prone to show many adverse reactions such as tolerance and dependence.Clinical and preclinical evidence suggests that taVNS is effective on insomnia,with few adverse reactions and a high safety.Its theoretical basis is the auriculotherapy of traditional Chinese medicine,which regulates the mind,brain and five viscera by stimulating the acupuncture points of the ear to maintain the coordination and unity of the body,and jointly regulate sleep.This technology innovatively combines traditional auricular point with modern neurotechnology.Through the activation of the auricular branch of the vagus nerve,the vagus nerve enters the central nervous system through the nucleus of the solitary tract,and projects from the nucleus of the solitary tract to the parabrachial complex,locus coeruleus and middle suture nucleus(raphe nucleus),and further directly or indirectly projects from parabrachial complex to multiple brain regions,including the cerebral cortex,modulating the brain network related to sleep,emotion,and cognitive memory,which can be widely used in the treatment of insomnia,depression and other neurological and mental diseases.The action mechanism of taVNS on insomnia may be related to improving the functional connectivity between brain regions and brain networks,regulating the release of neurotransmitters,inhibiting the hypothalamic-pituitary-adrenal axis,and alleviating neurinflammatory responses.In this article,the theoretical basis and action mechanism of taVNS on insomnia are mainly discussed to

关 键 词：失眠 耳迷走神经 经皮耳迷走神经刺激术 作用机制 

分 类 号：R256.23[医药卫生—中医内科学]