米氮平联合唑吡坦治疗原发性失眠的多导睡眠图评价

Evaluation on the influence of Mildazepine in combination with zolpidem on the Polysomnography for patients suffered Primary insomnia

目的观察米氮平联合唑吡坦对原发性失眠患者的多导睡眠图各参数的影响,并探讨其机制。方法将本院2016年7月—2017年7月睡眠门诊原发性失眠患者78例随机分成研究组和对照组,使用匹兹堡睡眠治疗指数(PSQI)评定疗效,用多导睡眠图(PSG)探讨其作用机制。对照组在睡前口服唑吡坦10 mg,研究组在对照组的基础上加服米氮平30 mg,2组均治疗8周。结果 1、研究组的PSQI分数在治疗2、4、8周末时均显著低于对照组,研究组治疗失眠的总有效率达87.2%(34/39),而对照组有效率为71.8%(28/39),两组差异有统计学意义;2、PSG检查结果提示:研究组经米氮平联合唑吡坦治疗后的总睡眠时间、睡眠效率、S3+S4时间延长;3、觉醒时间、REM睡眠时间、S2时间缩短,较治疗前明显改善;4、研究组治疗后的觉醒时间、REM睡眠时间、S2时间缩短,总睡眠时间、睡眠效率(总睡眠时间除以总记录时间)、REM睡眠潜伏期、S3+S4时间延长,睡眠质量优于对照组。结论米氮平联合唑吡坦能更快更有效地改善失眠,且不良反应无明显差异,值得临床推广。

Objective To observe the effect of Mirtazapine combined with Zolpidem on the parameters of polysomnography in patients with primary insomnia and to explore its mechanism. Methods From July 2016 to July 2017,78 patients visiting Tianjin Mental Health Center who were diagnosed as primary insomnia were enrolled,and were divided into study group and control group. The clinical efficacy was evaluated by Pittsburgh Sleep Quality Index（ PSQI） and polysomnography（ PSG） helped to explore its mechanism of action. The control group received Zolpidem 10 mg every night,and the study group was given Mirtazapine 30 mg besides on Zolpidem at night,the treatment lasted for 8 weeks. Results By compared polysomnogram characteristics and PSQI scores of two groups,we got that： 1. The PSQI score of the study group was significantly lower than that of the control group at the 2 nd,4 th and 8 th week. The total effective rate of the study group was 87. 2%（ 34/39）,while the control group was 71.8%（ 28/39）,the difference was statistically significant.2.The results of PSG showed that the total sleep time,sleep efficiency,S3＋S4 time were all prolonged after treatment.3.The awakening time,REM phase and shortened S2 time were significantly better. 4. Total sleep time,sleep efficiency（ total sleep time divided by total recording time）,REM sleep latency,S3＋S4 time,duration of sleep,the quality of sleep were superior to that of the control group. Conclusions Mirtazapine combined with Zolpidem can improve insomnia more effectively,and there is no significant difference in adverse effects,which is worthy of clinical promotion.