药物、认知-行为疗法及其联合应用治疗慢性失眠的对照研究  

Pharmacotherapy,cognitive-behavioral therapy alone or in combination for chronic insomnia

作　　者：李雁鹏[1] 张鹏[1] 储静[2] 庄建华[1] 赵忠新[1] 黄流清[1] 彭华[1] 

机构地区：[1]第二军医大学长征医院神经内科,上海200003 [2]第二军医大学训练部临床管理处

出　　处：《解放军医学杂志》2010年第1期83-87,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军医学科学技术研究"十一五"计划保健专项课题(07BJZ06);上海市科技发展基金(024119029);第二军医大学长征医院"十一五""三重三优"学科人才建设计划基金(2005312)

摘　　要：目的研究比较药物疗法、认知-行为疗法及两者联合对慢性失眠的短期和长期治疗效果。方法连续收集失眠患者65例,按随机数字表法分组,最后纳入64例患者资料进行统计,共分为3组:认知-行为疗法组(n=20),接受睡眠卫生指导、睡眠限制疗法、刺激控制疗法、认知疗法和放松疗法;药物治疗组(n=22),每晚口服酒石酸唑吡坦10mg;联合治疗组(n=22):接受认知-行为疗法的同时,每晚口服酒石酸唑吡坦10mg。记录患者治疗前基线资料后按上述分组进行4周的治疗,记录治疗结束即刻及随访第12周的客观监测(多导睡眠图)和主观记录(睡眠日记)的指标变化情况。结果多导睡眠图显示,与治疗前比较,各组患者总睡眠时间延长,睡眠效率增加,入睡潜伏期缩短(P<0.05)。各组间比较结果显示,在延长总睡眠时间方面,药物治疗组的改善比例最高(P<0.05);在缩短入睡潜伏期和减少觉醒时间方面,联合治疗组的改善比例最明显(P<0.05);在提高睡眠效率方面,三组的变化比例差异均无统计学意义(P>0.05)。睡眠日记的变化显示,与治疗前比较,治疗结束即刻、随访第12周各组总睡眠时间延长,入睡潜伏期缩短,睡眠效率提高(P<0.05)。治疗结束即刻,联合治疗组各项指标的改善比例最明显;第12周随访时,认知-行为疗法组在缩短入睡潜伏期和提高睡眠效率方面的改善比例提高,与联合治疗组相当。结论慢性失眠患者单独使用药物疗法或认知-行为疗法均可以取得明显的短期疗效,认知-行为疗法的长期效果更显著;联合疗法起效较快,其持续作用的效果与认知-行为疗法相当。Objective To study the short-and long-term clinical efficacy of pharmacotherapy and cognitive-behavioral therapy（CBT）alone or in combination on patients with chronic primary insomnia.Methods Sixty-five patients were randomized into 3 groups,and the data of 64 patients were finally accepted for analysis.In cognitive-behavior therapy group（n=20）,patients were treated with sleep hygiene program,sleep restriction,stimulus control,cognitive therapy and relaxation therapy.In pharmacotherapy group（n=22）,patients received a 10mg oral dose of zolpidem tartrate,qn.In combination group（n=22）,patients were treated with both cognitive-behavior therapy and pharmacotherapy.The baseline data were recorded followed by a 4-week treatment.The changes in results of objective（polysomnography,PSG）and subjective（sleep diaries）measures were obtained at the end of the therapy and 12-week follow-up.Results PSG data showed that,compared to pre-treatment,patients in all the groups experienced extension in total sleep time,increase in sleep efficiency and shortening in sleep latency（P〈0.05）.In comparison to the two other groups,while patients in pharmacotherapy group exhibited the highest improvement rate in the extension of total sleep time（P〈0.05）,while patients in combination group exhibited the most significant improvement rate in the shortening in sleep latency and decrease of wake after sleep onset（WASO）（P〈0.05）.Regarding to the increase of sleep efficiency,no significant difference was found among the 3 groups（P〉0.05）.Sleep diary showed that,compared to the time before treatment,patients in all groups experienced extension in total sleep time,shortening in sleep latency and increase in sleep efficiency at the end of experiment and 12-week follow-up（P〈0.05）.When the experiment ended,patients in combination group showed the greatest improvement rate on each item of outcome.At the end of 12-week follow-up,patients in cognitive-behavior therapy group were found to have the greatest

关 键 词：入睡和睡眠障碍 认知疗法 药物疗法 多道睡眠描记术 

分 类 号：R256.23[医药卫生—中医内科学]