重复经颅磁刺激在失眠患者苯二氮[艹卓]类药物撤药过程中的应用  

Application of repetitive transcranial magnetic stimulation in the process of benzodiazepine withdrawal in patients with insomnia

作　　者：李蕊 李自祥 合浩[1] LI Rui;LI Zixiang;HE Hao(Yunnan Psychiatric Hospital,Kunming 650224,China)

机构地区：[1]云南省精神病医院,云南昆明650224

出　　处：《精神医学杂志》2023年第5期453-456,共4页Journal of Psychiatry

基　　金：昆明市卫生科技人才培养项目医学科技学科后备人才培养计划[编号:2022-SW(后备)-45]。

摘　　要：目的评估重复经颅磁刺激(rTMS)治疗在苯二氮[艹卓]类药物撤药过程中对失眠障碍患者的疗效和安全性。方法选取100例失眠障碍患者,随机分为研究组和对照组各50例。两组均按照失眠障碍的治疗原则选用苯二氮[艹卓]类药物治疗,在使用苯二氮[艹卓]类药物第2周末时开始减药,按照减药的原则分两次递减完毕,第3周末时完全停用苯二氮[艹卓]类药物。研究组在入院时药物治疗的基础上合并rTMS治疗。比较两组疗效、两组在基线及治疗后第1,2,3,4周末临床总体印象-严重度量表(CGI-S)、17项汉密尔顿抑郁量表(HAMD-17)、匹兹堡睡眠质量指数(PSQI)、14项汉密尔顿焦虑量表(HAMA-14)评分并评估治疗安全性。结果研究组治疗总有效率高于对照组(P<0.05)。两组治疗后第1、2、3、4周末CGI-S、HAMD-17、PSQI、HAMA-14评分均较基线时下降(P<0.05),研究组治疗后第3、4周末CGI-S、HAMD-17、PSQI、HAMA-14评分均低于对照组(P<0.01)。两组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论rTMS可以作为失眠障碍患者长期治疗的一种有效补充,能够帮助患者顺利撤药,改善睡眠质量,且具有一定的安全性。Objective To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)in the treatment of insomnia during benzodiazepine withdrawal.Methods A total of 100 inpatients with insomnia disorder were randomly selected and divided into control group and study group,with 50 patients in each group.Both groups were treated with benzodiazepines according to the principles of insomnia treatment.The medications were gradually reduced twice starting from the second weekend of the benzodiazepine use and were completely stopped by the third weekend.The study group received rTMS in addition to medication upon admission.All subjects were assessed with Clinical General Impression-Severity Scale(CGI-S),Hamilton Depression Scale-17 items(HAMD-17),Pittsburgh Sleep Quality Index(PSQI),and Hamilton Anxiety Scale-14 items(HAMA-14)at the baseline and at the 1st,2nd,3rd,4th weekends after treatment.Results The total effective rate of study group was significantly higher than that of control group(P<0.05).At the 1st,2nd,3rd,4th weekends after treatment,the total scores of CGI-S,HAMD-17,PSQI and HAMA-14 decreased significantly compared with those at the baseline(P<0.05).At the 3rd,4th weekends after treatment,the total scores of CGI-S,HAMD-17,PSQI and HAMA-14 in study group were all significantly lower than those in control group(P<0.01).There existed no difference in incidence rates of adverse reactions between two groups(P>0.05).Conclusion rTMS can be an effective supplement for long-term treatment of insomnia,and may help patients to withdraw from medication smoothly,improving sleep quality,and is relatively safe.

关 键 词：失眠障碍 苯二氮[艹卓]类药物 重复经颅磁刺激治疗 撤药 

分 类 号：R256.23[医药卫生—中医内科学]