开设中医失眠门诊在社区老年失眠患者管理中的应用效果

Effects of TCM insomnia clinic on community management of elderly patients with insomnia

目的探讨开设中医失眠门诊在社区老年失眠患者管理中的应用效果。方法将2015年1月—2016年1月间在青田县中医院所属社区卫生服务中心、杭州市小河湖墅街道社区卫生服务中心中医失眠门诊就诊的90例老年失眠患者设为观察组及同期在丽水市中医院、嘉兴市第一医院普通门诊就诊的100例老年失眠患者作为对照组进行研究。对照组在三级医院普通门诊给予常规抗失眠方案进行治疗,观察组则在社区中医失眠门诊给予中药、针灸、理疗及心理支持等综合治疗,同时建立健康档案加以统一管理。1个月后对2组患者的临床疗效及患者满意度进行对比观察。结果治疗后观察组睡眠改善有效率优于对照组,差异具有统计学意义(u=-2.93,P=0.042)。治疗前观察组睡眠状况自评量表(SRSS)评分为35.11±6.18,对照组为34.93±7.07,2组比较差异无统计学意义(t=2.37,P>0.05);治疗后观察组SRSS评分为17.24±5.01,低于对照组的23.44±7.52,差异具有统计学意义(t=6.91,P<0.05)。治疗后观察组在治疗效果、就诊体验、医生态度、诊疗技术、时间安排及疾病知识宣教6项满意度得分上均高于对照组,差异具有统计学意义(t值分别为14.73、11.67、7.02、6.39、16.88、21.49,P<0.05或<0.01)。结论在社区开设中医失眠门诊可以有效管理社区老年失眠患者,充分改善该类患者的睡眠质量,提高老年失眠患者对治疗的满意度。

Objective To explore the effects of insomnia clinic of traditional Chinese medicine （TCM） on community management of elderly patients with insomnia. Methods Total 90 elderly patients with insomnia admitted in TCM insom- nia clinic of community health service centers of Qingtian TCM Hospital and Hangzhou Xiaohehushu Street from January, 2015 to January,2016 were selected as the observation group,while 100 elderly patients with insomnia admitted in normal outpatient of Lishui TCM and Jiaxing First Hospital in the same period were selected as the control group. The control group of the normal outpatient in tertiary hospitals was given regular anti-insomnia treatment, while the observation group of the community TCM insomnia chnic was given comprehensive treatments including TCM, acupuncture, physical therapy and psychological support, etc. , and healthy document was also set for unified, management. The clinical curative effects and satisfaction were compared one month later between the two groups. Results The efficiency of sleep improvement was superior in the observation group than that in the control group after the treatment, with statistically significant differ- ences （ u = - 2.93, P = 0.042）. SRSS score was 35.11 ＋ 6.18 in the observation group while 34.93 ± 7.07 in the control group before the treatment, and there were no statistically significant differences （t = 2.37, P 〉 0.05 ） ;and after the treat- ment,SRSS score was 17.24 ± 5.01 in the observation group, which was lower than that （23.44 ± 7.52） of control group, and the differences were statistical significance（ t = 6.91 ,P 〈 0.05 ）. The observation group had higher satisfaction scores in 6 items including therapeutic effect, treatment experiences, doctors＇ attitude, diagnosis and treatment technology, schedule,and disease knowledge education than the control group, with statistically significant differences （t= 14.73, 11.67,7.02,6.39,16.88 and 21.49;P〈0.05 or 〈0.01）. Conclusion Setting insomnia clinic of traditional Chinese medicine in community can effectively manage elderly patients with insomnia in community, fully improve the sleep quality of these patients, and improve their satisfaction with treatment.