米氮平联合重复经颅磁刺激治疗伴睡眠障碍的老年焦虑症患者的疗效观察

Clinical observation of Mirtazapine Combined with repetitive transcranial magnetic stimulation in the treatment of elderly patients with anxiety disorders accompanied by sleep disorders

目的探究老年焦虑症伴睡眠障碍患者应用米氮平联合重复经颅磁刺激(rTMS)治疗的临床效果。方法选取2015年2月~2017年2月本院经治的老年焦虑症伴睡眠障碍患者92例,对照组(n=46)给予米氮平口服,研究组(n=46)在米氮平基础上联合rTMS,两组均治疗4周。观察两组焦虑评分、多导睡眠(PSG)指标、匹兹堡睡眠质量量表(PSQI)评分、临床疗效。结果治疗前两组各指标比较无显著差异(P>0.05)。治疗后,两组SAS、HAMA评分均较治疗前提高(P<0.05);组间比较,研究组SAS、HAMA评分均低于对照组(t=11.873,4.181,P<0.05)。两组患者实际睡眠总时长、睡眠效率、REM潜伏期均较治疗前提高(P<0.05),睡眠潜伏期、夜间觉醒次数及夜间觉醒总时间均较治疗前降低(P<0.05);组间比较,研究组患者PSG睡眠改善情况优于对照组(P<0.05)。两组PSQI评分均较治疗前改善(P<0.05),研究组PSQI评分较对照组低(t=6.154,P<0.05)。研究组临床疗效、总有效率均优于对照组(Z=-2.205,P<0.05;χ2=5.845,P<0.05)。结论米氮平联合r TMS治疗老年焦虑症伴睡眠障碍患者,改善焦虑状态及睡眠质量优于单纯应用米氮平治疗。

Objective To explore the clinical effect of Mirtazapine Combined with repetitive transcranial magnetic stimulation（rTMS）in elderly patients with anxiety disorders accompanied by sleep disorders. Methods From February 2015 to February 2017,92 patients of anxiety disorders with sleep disorders were recruited. They were divided into two groups,the control group（n=46）received mirtazapine,the study group（n=46）treated with rTMS on basis of mirtazapine. SAS,HAMA,polysomnography（PSG）and Pittsburgh sleep quality scale（PSQI）were assessed in both groups. Results Before treatment,there were no differences in SAS,HAMA,PSQI and PSG between two groups（P〈0.05）. After treatment,the SAS and HAMA scores of two groups were increased（P〈0.05）,SAS and HAMA scores of the study group were lower than the control group（t=11.873,4.181,P〈0.05）. The actual total sleep time,sleep efficiency,latency of REM were increased（P〈0.05）,sleep latency,nighttime awakenings and the total time of awakening during the night lower than before treatment（P〈0.05）;the improvements of PSG in the study group were better than the control group（P〈0.05）. PSQI scores of the two groups were improved compared with before treatment（P〈0.05）,PSQI scores in the study group were lower than the control group（t=6.154,P〈0.05）. Both clinical efficacy and total effective rate of the study group were better than the control group（Z=-2.205,P〈0.05;χ2=5.845,P〈0.05）. Conclusion Mirtazapine combined with rTMS can improve anxiety and sleep quality more effectively than mirtazapine alone in the treatment of senile anxiety disorder accompanied by sleep disorders.