综合干预模式对慢性主观性头晕患者情绪、睡眠及生活质量的影响

Effect of comprehensive intervention on mood,sleep and quality of life in patients with chronic subjective dizziness

目的：探讨前庭康复训练联合药物及心理治疗的综合干预模式对慢性主观性头晕患者情绪、睡眠及生活质量的影响。方法：将120例慢性主观性头晕的患者,随机分为前庭康复组、前庭康复＋心理治疗组、前庭康复＋药物组、综合治疗组,每组各30例。干预方式包括前庭康复训练,每天两次,每次20 min;心理治疗主要以认知行为治疗为主,每周一次,每次60～90 min;药物治疗给予艾司西酞普兰10～20 mg/d口服。疗程均为8周。于基线和治疗第8周末,采用临床疗效总评量（CGI）、头晕残障程度评定量表（DHI）、医院焦虑抑郁量表（HAD）、匹茨堡睡眠质量指数问卷（PSQI）及健康调查简表（SF-36）评定患者的临床疗效、情绪、睡眠及生活质量。结果：治疗8周后,综合治疗组总有效率明显优于前庭康复组和前庭康复＋心理治疗组,显效率明显高于前庭康复＋药物组（P〈0.05）;综合治疗组DHI各项评分、HAD各项评分及情绪异常（HAD≥12分）者较前庭康复组和前庭康复＋心理治疗组明显下降（P〈0.05）,而DHI总分、躯体及功能因子分、HAD-A评分及情绪异常（HAD≥12分）者较前庭康复＋药物组明显下降（P〈0.05）;综合治疗组PSQI评分及睡眠障碍（PSQI〉7分）者明显低于前庭康复组（P〈0.05）,但与其他两组变化相近（P〉0.05）;4组SF-36各维度评分较治疗前均有不同程度改善,但综合治疗组改善幅度较其他三组更明显（P〈0.05）。结论：前庭康复训练联合艾司西酞普兰、认知行为疗法的综合治疗模式对慢性主观性头晕临床疗效显著,且对患者伴发的情绪症状及睡眠障碍疗效显著,生活质量大幅度提升,其中在情绪和生活质量方面产生的积极作用,较其他治疗方案更具有优势。

AIM： To explore the effect of comprehensive intervention model of vestibular rehabilitation training combined with medication and psychotherapy on the mood,sleep and quality of life of patients with chronic subjective dizziness. METHODS： 120 cases of chronic subjective dizziness patients were randomly divided into vestibular rehabilitation group,vestibular rehabilitation combined psychotherapy group,vestibular rehabilitation combined drug group and combined modality therapy group,30 cases in each group. Intervention methods included the vestibular rehabilitation training, two times a day,each time 20 min; psychological treatment is mainly based on cognitive behavioral therapy,once a week,each time 60-90 min; drug therapy for escitalopram 10-20 mg / d oral administration.The course of treatment was 8 weeks. At baseline and eighth weeks after treatment,the Clinical Global Impression（ CGI）,the Dizziness Handicap Inventory（ DHI）, the Hospital Anxiety and Depression Scale（ HAD）,the Pittsburgh Sleep Quality Index（ PSQI） and Short Form Health Survey（ SF-36）were used to assess clinical efficacy,mood,sleep and quality of life. RESULTS： After 8 weeks of treatment,the total effective rate of the comprehensive treatment group was significantly better than that of the vestibular rehabilitation group and vestibular rehabilitation group combined psychological treatment group. The effective rate was significantly higher than that of vestibular rehabilitation combined drug group（ P〈0. 05）; compared with the vestibular rehabilitation group and vestibular rehabilitation combined psychological treatment group,the combined treatment group＇s DHI score,HAD score and mood disorders（ HAD≥12） decreased significantly（ P〈0. 05）,while the total score of DHI,somatization and functional factor score,HAD-A score and mood disorders（ HAD≥12） were obviously lower in vestibular rehabilitation combined drug group（ P〈0. 05）; comprehensive treatment group PSQI score and sleep disorders（ PSQI 7） were significantly lower than those in the vestibular rehabilitation group（ P〈0. 05）,but there was no significant difference with the other two groups（ P〈0. 05）; the comprehensive treatment group improved significantly more than the other three groups（ P〈0. 05）. CONCLUSION： Comprehensive treatment of vestibular rehabilitation training combined with escitalopram,cognitive behavioral therapy, can give significant clinical curative effect on chronic subjective dizziness,also on patients who showed mood symptoms and sleep disorders,whose quality of life is greatly improved. The scheme presented better results than other treatments in improving the emotion and quality of life.