无抽搐电休克治疗顽固性原发性失眠患者疗效观察

Effect of modified electric convulsive therapy in the treatment of patients with refractory primary insomnia

目的探讨无抽搐电休克对顽固性原发性失眠患者的临床治疗效果。方法收集重庆三峡中心医院心身医学科2014年1月至2015年12月收治的46例顽固性原发性失眠患者,采用随机数表法将其分为对照组和电休克组,每组23例。两组均给予综合治疗,在此基础上电休克组行无抽搐电休克治疗6次,每周3次,治疗时间2周。于治疗前、后1周分别对两组患者进行汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数量表(PSQI)评估及多导睡眠监测。结果 (1)治疗后两组患者的HAMD、PSQI总分较治疗前降低,且电休克组降低程度较对照组更明显,差异均有统计学意义(P<0.05);(2)多导睡眠监测示治疗后两组患者的总睡眠时间均较治疗前明显延长,差异有统计学意义(P<0.05);治疗后电休克组快眼动期、3期睡眠比例较治疗前明显升高,差异均有统计学意义(P<0.05);治疗后对照组快眼动期、3期睡眠比例较治疗前明显降低,差异均有统计学意义(P<0.05)。结论无抽搐电休克治疗能有效改善顽固性原发性失眠患者的抑郁症状,延长睡眠时间,纠正紊乱的睡眠结构,是治疗顽固性原发性失眠的有效方法。

Objective To study the therapeutic effect of modified electric convulsive therapy（MECT） on patients with refractory primary insomnia. Methods Forty-six patients with the refractory primary insomnia admitted to Department of Psychosomatic Medicine, Chongqing Three Gorges Central Hospital from January 2014 to December2015 were colleced. They were randomly divided into the control group and ECT group by random number table, with23 patients in each group. The control group and ECT group were given comprehensive treatment, and the ECT group received electroconvulsive therapy for 6 times, 3 times a week, with the course for 2 weeks. Pittsburgh Sleep Quality Index（PSQI）, Hamilton Depression Scale（HAMD）, and Polysomnography（PSG） were used to evaluate the sleep quality one week before and after treatment. Results The total scores of PSQI and HAMD in both groups after treatment were significantly lower than those of before treatment, and the decrease in ECT group was more significnat than that in control group（P〈0.05）. PSG showed that the total sleep time between the two groups after treatment were significantly longer than those of before treatment, with statistically significant difference（P〈0.05）. After treatment, the proportion of sleep in phase 3, rapid eye movement sleep of ECT group was significantly higher than that before treatment, with statistically significant difference（P〈0.05）. After treatment, the proportion of sleep in phase 3, rapid eye movement sleep of control group was significnatly lower than that before treatment, with statistically significant difference（P〈0.05）.Conclusion MECT can effectively improve the depressive symptoms of patients with refractory primary insomnia, prolong sleep time, and correct disorder of sleep structure, which is an effective method for the treatment of refractory primary insomia.