唑吡坦联合重复经颅磁刺激治疗失眠症的效果

Effect of Zolpidem combined with repeated transcranial magnetic stimulation in the treatment of insomnia

目的探讨唑吡坦联合重复经颅磁刺激（r TMS）治疗失眠症的效果,以分析r TMS的临床使用价值。方法选择2015年5月~2016年5月在淮安市第三人民医院住院治疗的84例患者,按照随机数字表法将其分为两组,其中对照组患者每晚入睡前口服唑吡坦10 mg,观察组患者在此基础上在给予r TMS治疗。两组患者共治疗2个疗程,1周为1个疗程。观察两组临床疗效,比较两组匹茨堡睡眠质量指数量表（PSQI）评分和各项睡眠参数。结果观察组临床有效率显著高于对照组,差异有统计学意义（P〈0.05）。两组患者治疗前PSQI评分差异无统计学意义（P〉0.05）,治疗后两组患者PSQI评分均较治疗前显著下降,差异有统计学意义（P〈0.05）,且观察组PSQI评分显著低于对照组（P〈0.05）。治疗后两组患者的睡眠时间、睡眠潜伏期、觉醒时间、睡眠效率等参数均较治疗前显著改善,差异有统计学意义（P〈0.05）;治疗后观察组S2睡眠百分比明显少于对照组,而S3和快速眼球运动睡眠潜伏期睡眠百分比则明显多于对照组,差异有统计学意义（P〈0.05）。对照组不良反应发生率为9.53%（4/42）,观察组为14.28%（6/42）,差异无统计学意义（P〉0.05）。结论 对于失眠症患者而言,单独使用唑吡坦可取得一定的疗效,但在唑吡坦的基础上给予r TMS治疗,效果更为显著,可以有效改善患者睡眠状况,同时不会增加不良反应,治疗安全性高,值得临床推广。

Objective To investigate the effect of Zolpidem combined with repeated transcranial magnetic stimulation （rTMS） in the treatment of insomnia, and to analyze the clinical application value of rTMS. Methods Eighty-four patients with insomnia hospitalized in the Third People＇s Hospital of Huai＇an City from May 2015 to May 2016 were selected. The subjects were randomly divided into two groups. Before the patients fell asleep every night, the control group orally took 1 mg of Zolpidem, on basis of which, the observation group was given rTMS. Both groups were taken 2 courses of treatment, one week was as a course. The clinical effect of the two groups was observed, the scores of Pittsburg sleep quality index （PSQI） and the parameters of sleeping of the two groups were evaluated. Results The clinical effective rate of observation group was higher than that of control group, the difference was statistically significant （P 〈 0.05）. Before surgery, the scores Of PSQI inthe two groups had no statistically significant difference （P 〉 0.05）; after surgery, the scores of PSQI in the two groups were all lower than those before surgery （P 〈 0.05）; the score of PSQI after surgery in the observation group was significantly lower than that of control group （P 〈 0.05）. After surgery, the parameters of sleep time, sleep latency, awakening time and sleep efficiency in the two groups were all significantly better than those before surgery （P 〈 0.05）; after surgery, the percentage of S2 accounted for total sleep time in the ob- servation group was less than that of control group, the percentages of S3 and rapid eye movement sleep accounted for total sleep time in the observation group were more than those of control group, the differences were all statistically sig- nificant （P 〈 0.05）. The incidence of adverse reactions in the control group was 9.53% （4/42）, which of observation group was 14.28% （6/42）, the differences was not statistically significant （P 〉 0.05）. Conclusion For patiems with insomnia, Zolpidem can achieve a certain effect, while, Zolpidem added with rTMS can achieve more significant effect,which can significantly improve the patients＇ sleep condition, without increasing adverse reactions, the safety is high, it is worthy of clinical promotion.