药物和认知行为疗法治疗社区老年人慢性失眠的随机对照研究  

Pharmacological and Cognitive-Behavior Therapies for Community Older Adults with Chronic Insomnia: a Randomized Controlled Trial

作　　者：顾杰[1] 江孙芳[1] 李文昌[1] 杨华[1] 龚剑[1] 周敬[1] 陶皓珣[1] 曾恒[1] 祝墡珠[1] 

机构地区：[1]复旦大学附属中山医院全科医学科,上海200032

出　　处：《中国临床医学》2012年第1期27-30,共4页Chinese Journal of Clinical Medicine

基　　金：上海市科委科研基金(编号:044119704)

摘　　要：目的:评价药物和认知行为治疗对社区老年慢性失眠患者的疗效。方法:60例社区老年慢性失眠患者随机分为对照组、药物组、认知行为组和综合组4组,患者接受为期8周的治疗和治疗结束后3个月及6个月的随访。以睡眠潜伏期、总睡眠时间和睡眠效率的变化为效应指标。结果:治疗结束时,认知行为组总睡眠时间(384.7±78.1)min,显著高于对照组(P=0.0001),认知行为组睡眠效率(74.11±16.76)%,显著高于药物组(P=0.0096);综合组睡眠潜伏期(29.2±12.3)min,显著低于对照组(P=0.0051),综合组总睡眠时间(378.5±60.7)min,显著高于对照组(P=0.0083)。治疗结束后6个月,综合组睡眠潜伏期(16.8±4.9)min,显著低于对照组(P<0.0001)、药物组(P<0.0001)和认知行为组(P=0.0003);综合组总睡眠时间(377.5±34.9)min,显著高于对照组(P=0.0005)和药物组(P<0.0001);综合组睡眠效率(75.74±6.43)%,显著高于药物组(P<0.0001)。结论:药物治疗社区老年人慢性失眠短期疗效有限,远期"反跳"严重,综合治疗远期疗效肯定。To evaluate the clinical results of pharmacological and cognitive-behavior therapies for community older adults with chronic insomnia. Methods： 60 older adults with chronic insomnia were randomized into four groups, three of which were given a 8-week intervention consisting of pharmacotherapy, cognitive-behavior therapy, or both; the other one was a con- trol group. Follow-up assessments were conducted at 3 and 6 months. The main outcome measures were sleep latency, total sleep time and sleep efficiency. Results： At the end of treatments, the total sleep time of the cognitive-behavior therapy group was （384.7 ± 78. 1） min which was longer than the control group（P = 0. 0001）, the sleep efficiency of the cognitive-behavior therapy group was （74. 11 ± 16. 76）% which was higher than the pharmacotherapy group（P = 0. 0096）. The sleep latency of the combined group was （29.2 ± 12.3） rain which was shorter than the control group（P= 0. 0051）, the total sleep time of the combined group was （378.5 ± 60. 7） win which was longer than the control group（P = 0.0083）. After 6 months＇follow-up, the sleep latency of the combined group was （16.8 ± 4.9） rain which was shorter than the control group （P〈0. 0001）, pharmacotherapy group （P〈0. 0001） and the cogni- tive-behavior group （P = 0. 0003） ; the total sleep time of the combined group was （377. 5 - 34.9） win which was longer than control group（P = 0. 0005） and pharmacotherapy group（P〈0. 0001）, the sleep efficiency was （75.74 ± 6. 43） %0 which was higher than the pharmaeotherapy group（P-（0. 0001）. Conclusions： The short-term effect of the pharmacotherapy is limited, while the long-term ＇re- bound＇ effect is serious. The combined group shows a long-term effect.

关 键 词：老年人 慢性失眠 唑吡坦 认知行为治疗 

分 类 号：R163[医药卫生—公共卫生与预防医学]