语言诱导结合古琴音乐用于原发性失眠的随机对照研究

Hypnotic suggestion combined with Guqin music in the treatment of primary insomnia-a 8-week randomized controlled trial

目的观察以语言诱导结合中国传统文化古琴音乐，对香港地区原发性失眠症患者的临床疗效。方法针对香港人语言的特点，采用粤语版语言诱导结合以古琴为背景音乐的方法，对患者进行心理诱导治疗。按随机分组法将86例符合（DSM-IV）原发性失眠症的患者分为对照组29例、语言诱导组29例、古琴语言诱导组28例，连续观察8周，每天在患者睡前干预30min。分别在入组后第2、4、8周末在门诊部评估疗效和安全性。观察阿森斯失眠量表（AJS）、症状自评量表（SCL．90）和心率变异性生物反馈（HRV）的变化。结果在治疗后第4、8周语言组总分降低[分别为（8．70±4．50）分、（7．20±4．40）分]、语言古琴组总分降低[分别为（7_30±3．30）分、（6．80±2．60）分]、与对照组同时段[（10．30±5．10）分、（9．80±5．00）分]比较，差异有统计学意义（P均〈0．05）。治疗后第4、8周，语言诱导组SCL．90中“恐怖”因子分数[分别为（-0．20±0．60）分、（0．00±0．60）分]，古琴音乐组SCL．90中“恐怖”因子分数[分别为（～0．20±0．50）分、（-0．20±0．50）分]改善，与对照组[分别为（0．00±0．20）分、（0．10±0．30）分]比较，差异均有统计学意义沪均〈0．05）。在第4周的HRV、VLFper、HFper、LF／HF的改善情况在组间有统计学差异（P〈0．05）。结论语言诱导、语言诱导结合古琴音乐治疗原发性失眠症均改善患者的失眠以及缓解其心理紊乱等症状，并可帮助部分失眠者停用安眠药。

Objective To investigate the therapeutic effect and the improvement of sleep quality in applying Hypnotic Suggestion with combination of traditional Chinese culture, Guqin music, for patients with primary insomnia in Hong Kong area. Methods According to the characteristics of speaking language in Hong Kong, Cantonese Hypnotic Suggestion combined with Guqin background music was induced to the patients as the psychological treatment. 87 cases of compliance （DSM-IV） diagnostic criteria for primary insomnia and screened successfully into 3 groups to enter an 8-week intervention in random. Therapeutic effects were assessed on the 0th, 4th and 8th at clinics to evaluate efficacy and safety. Patients were assigned in random into the hypnotic suggestion group, the hypnotic suggestion with Guqin music group and the control group for listening of intervention respectively. Athens insomnia scale （A IS） , Self-reporting Inventory （SCL-90） and Heart Rate Variability （HRV） were used as the therapeutic indexes. Safety evaluation included change in vital signs, and medical examination before and after treatment. Results Hypnotic suggestion group had lower AIS scores, AIS total （8.70--＋4.50） , （7.20-＋4.40） and the hypnotic suggestion with Guqin music group had lowerAIS scores, AIStotal （7.30-＋3.30） , （6.80-＋2.60） were also significantly lowerext than the control group [AIS total （10.30-＋ 5.10）, （9.80＋5.00） after four-week and eight-week intervention （P〈0.05） . The hypnotic suggestion group, indicated a decline in ＂terror＂ of SCL-90 scores, SCL-90 total （ --0.20＋0.60）, （0.00-＋0.60） and the hypnotic suggestion with Guqin music group also indicated a decline in ＂terror＂ of SCL-90 scores, SCL-90 total （ --0.20 ＋ 0.50）, （--0.20-＋0.50） when comparing to the control group, SCL-90 total （0.004-0.20）, （0.10_＋0.30）. After four-week and eight-week intervention （P〈0.05）. Percentage Very Low Frequency （VLFper）, Percentage High Frequency （HFper） and LF/HF indicated an improvement on average （P〈0.05） . Conclusion Hypnotic suggestion and combination of hypnotic suggestion with Guqin music in the treatment of primary insomnia, both improve the patient＇s symptoms such as insomnia and alleviate their ＂terror＂psychological disorders, and can help some insomnia to stop using sleeping pills.