远程认知行为治疗对高血压共病性失眠的疗效研究  

The efficacy of internet-based cognitive behavior therapy on blood pressure for comorbid hypertension and insomnia

作　　者：杨信举 张远凤[1] 刘娟[1] 刘雅贞[1] 郎莹[1] 王延江[1] 蒋晓江[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所神经内科,重庆400042

出　　处：《解放军医学杂志》2017年第4期331-335,共5页Medical Journal of Chinese People's Liberation Army

基　　金：第三军医大学转化基金项目(2014XHZ10)~~

摘　　要：目的观察远程认知行为治疗(CBT-I)对高血压共病性失眠的疗效。方法收集符合JNC-8高血压诊断标准和DSM-5失眠诊断标准的高血压共病性失眠患者106例,随机分为远程CBTI治疗组(n=53)和常规高血压治疗组(n=53),进行8周治疗,观察8周后两组收缩压(SBP)、舒张压(DBP)的下降幅度、睡眠参数及焦虑抑郁状态水平的差异。结果与治疗前相比,治疗8周后两组SBP、DBP均下降(P<0.01),远程CBTI组SBP下降幅度较常规高血压治疗组明显(P<0.01)。在睡眠指标上,治疗8周后,远程CBTI组睡眠潜伏期(44.49±22.75min)、睡眠效率(72.31%±9.15%)、睡眠时间(302.65±43.76min)、焦虑水平评分(17.14±6.45)均较常规高血压治疗组改善更为显著(55.50±34.96min、57.70%±11.53%、262.70±50.64min、21.02±6.64),差异具有统计学意义(P<0.05)。结论远程CBTI能有效缩短睡眠潜伏期、改善睡眠效率、延长睡眠时间、改善焦虑情绪,同时通过CBT-I优化睡眠能有效降低高血压共病性失眠患者的血压。Objective To evaluate the effectiveness ofinternet-based cognitive behavior therapy （CBT-I） on blood pressure in patients with hypertension comorbid with insomnia. Methods One hundred and six patients met the JNC-8 diagnostic criteria for hypertension and DSM-5 diagnostic criteria for insomnia were selected, and randomly assigned to CBT-I group （n=53） and regular treatment group （n=53）. All the patients accepted relevant treatment for 8 consecutive weeks. Changes of systolic blood pressure （SBP）, diastolic blood pressure （DBP）, the sleep parameters and the anxiety and depression levels were observed between baseline and 8 weeks of follow-up. Results Compared with pre-treatment, SBP and DBP decreased significantly in both CBT-I group and regular treatment group （P〈0.01）, the decrease was more significant in CBT-I group than in regular treatment group （P〈0.01）. The sleep latency, sleep efficiency, bed time and rating anxiety scale were improved more significantly in CBT-I group than in regular treatment group （44.49 ±22.75min vs. 55.50 ± 34.96min; 72.31% ±9.15% vs. 57.70% ± 11.53%; 302.65 ± 43.76min vs. 262.70 ±50.64min and 17.14 ±6.45 vs. 21.02 ± 6.64, respectively）, the differences were of statistical significance （P〈0.05）. In addition, no significant difference was found in the level of depression between CBT-I group and regular treatment group. Conclusion CBT-I can effectively shorten sleep latency, improve sleep efficiency, extend bed time and improve anxiety, meanwhile effectively lower the blood pressure of patients with hypertension comorbid with insomnia by optimizing sleep quality.

关 键 词：失眠症 高血压 认知疗法 

分 类 号：R749.7[医药卫生—神经病学与精神病学]