失眠认知行为疗法联合星状神经节阻滞对新型冠状病毒感染后失眠的影响  

Effect of cognitive behavioural therapy for insomnia combined with stellate ganglion block on insom⁃nia after corona virus disease-2019

作　　者：张桦 李晴 王城 张璐璐 李亚峰[1] ZHANG Hua;LI Qing;WANG Cheng;ZHANG Lulu;LI Yafeng(Department of Anesthesiology,Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nanchang 330038,China)

机构地区：[1]南昌市洪都中医院麻醉科,330038

出　　处：《临床麻醉学杂志》2024年第8期842-847,共6页Journal of Clinical Anesthesiology

基　　金：江西省中医药管理局科技计划(2023A0261)。

摘　　要：目的观察失眠认知行为疗法(CBT-I)联合星状神经节阻滞(SGB)对新型冠状病毒感染后失眠的治疗效果。方法选择麻醉睡眠门诊中新型冠状病毒感染后失眠患者84例,男26例,女58例,年龄18~64岁,BMI 20~32 kg/m^(2)。采用随机数字表法将患者分为两组:CBT-I联合SGB组(S组)和CBT-I组(C组),每组42例。两组患者均执行6周相同的CBT-I方案。S组在第1周每日左右侧交替行SGB,注入1%利多卡因3 ml,维生素B 11 ml(50 mg),维生素B_(6)1 ml(50 mg),共5 ml。第2至6周每周行1次SGB,共计12次。C组不行SGB。记录治疗前、治疗后6周、3个月和6个月的匹兹堡睡眠质量指数(PSQI)评分。记录治疗前、治疗后1周、6周的失眠严重程度指数(ISI)、阿森斯(AIS)失眠量表评分、血清皮质醇(Cor)和5-羟色胺(5-HT)浓度。记录患者对治疗方案的依从性。结果与治疗前比较,治疗后6周、3个月和6个月两组PSQI评分明显降低(P<0.05),S组治疗后1和6周的ISI评分、AIS评分和血清Cor浓度均明显降低(P<0.05),血清5-HT浓度明显升高(P<0.05),C组治疗后6周ISI评分、AIS评分和血清Cor浓度明显降低(P<0.05),血清5-HT浓度明显升高(P<0.05)。与C组比较,S组治疗后6周PSQI评分明显降低(P<0.05),治疗后1周、6周ISI评分、AIS评分和血清Cor浓度明显降低(P<0.05),血清5-HT浓度明显升高(P<0.05),S组对治疗方案的依从性明显升高(P<0.05)。结论失眠认知行为疗法联合星状神经节阻滞可改善新型冠状病毒感染后失眠患者的短期睡眠质量,并能提高患者对治疗方案的依从性。Objective To observe the effect of cognitive behavioural therapy for insomnia(CBT-I)combined with stellate ganglion block(SGB)on insomnia after corona virus disease-2019(COVID-19).Methods Eighty-four patients with insomnia after COVID-19 were selected from the anesthesia sleep clinic,26 males and 58 females,aged 18-64 years,BMI 20-32 kg/m^(2).The patients were randomly divided into two groups:CBT-I combined with SGB(group S)and CBT-I(group C),42 patients in each group.Both groups of patients underwent the same CBT-I regimen for 6 weeks.Patients in group S underwent SGB alternately on both sides every day in the first week,inject 3 ml of 1%lidocaine,1 ml of vitamin B_(1)(50 mg),and 1 ml of vitamin B_(6)(50 mg),totaling 5 ml,and SGB was performed once a week from week 2 to week 6,for a total of 12 times.Group C patients cannot undergo SGB.Record the Pittsburgh sleep quality index(PSQI)scores of patients before treatment,6 weeks,3 months,and 6 months after treatment.Record the insomnia severity index(ISI),Athens insomnia scale(AIS)scores,and serum concentrations of cortisol(Cor)and serotonin(5-HT)before and 1 week and 6 weeks after treatment.Record the patient s compliance with the treatment plan.Results Compared with before treatment,the PSQI scores of the two groups of patients significantly decreased at 6 weeks,3 months,and 6 months after treatment(P<0.05),the ISI score,AIS score,and serum Cor concentration in group S were significantly reduced after 1 week and 6 weeks of treatment(P<0.05),while the serum 5-HT concentration was significantly increased(P<0.05),the ISI score,AIS score,and serum Cor concentration in group C were significantly reduced after 6 weeks of treatment(P<0.05),while the serum 5-HT concentration was significantly increased(P<0.05).Compared with group C,patients in group S showed a significant decrease in PSQI scores 6 weeks after treatment(P<0.05),the ISI score,AIS score,and serum Cor concentration in group S were significantly reduced after 1 week and 6 weeks of treatment(P<0.05),while the s

关 键 词：失眠认知行为疗法 星状神经节阻滞 新型冠状病毒 失眠 匹兹堡睡眠指数 

分 类 号：R511[医药卫生—内科学] R740[医药卫生—临床医学]