认知行为与安眠药物治疗慢性失眠症临床效果对比分析

Comparison between Cognitive-behavior Therapy and Medication on Chronic Insomnia

目的 :比较认知行为、安眠药物和安慰剂治疗慢性失眠症的临床效果。方法 :48名慢性失眠症男女患者自愿受试者 ,随机分成 4组 ,分别接受认知行为、安眠药物、安眠药物和认知行为结合、安慰剂治疗。记录患者在治疗前后的主观和客观 (夜间多导睡眠图 ,简称PSG)指标。结果 :治疗开始后第 8天 ,药物组和结合组的主观记录睡眠潜伏期分别为 2 0分钟和 2 7分钟 ,睡眠效率 80 %和 82 % ,睡眠总时间分别为3 81分钟和 3 5 6分钟 ,睡眠状况显著改善 ,效果好于认知行为组。经 8周疗程治疗结束时 ,认知行为组上述睡眠 3项指标好于治疗前 ,安慰剂组与治疗前无显著差异。治疗结束 8个月时 ,认知行为组PSG记录睡眠潜伏期 2 6分钟 ,睡眠效率 84% ,睡眠总时间 3 78分钟 ,睡眠状态好于药物组和结合组 ,后两组较治疗刚结束时睡眠指标变差 ,药物组睡眠又恢复到治疗前的水平。结论 :安眠药物对睡眠改善起效快 ,短期效果好 ,认知行为治疗对睡眠改善有主观和客观 (PSG记录 )证明的长期效果 ,对与患者失眠相关的睡眠心理状态也有改善。

Objective: to compare clinical effect of cognitive-behavior therapy and pharmacological treatment on chronic insomnia Method:48 patients with chronic insomnia were divided into 4 groups, receiving treatments of cognitive-behavior therapy, medication, placebo,and cognitive-behavior plus medication separately All of the subjects were assessed with polysomnogram over night and sleep diary Result:the three active treatments were more effective than placebo at post-treatment assessment On the eighth day of treatments, medication group and combined group showed improvement, sleep latencies were 20 min and 27 min, sleep efficacy were 80% and 82%, total sleep time were 381 min and 356 min, which were better than the results before treatments At the end of 8 weeks, cognitive-behavior group showed improvement in the above three indexes At the end of 8 months' follow-up, cognitive-behavior group still showed better effect in sleep latency 26 min, sleep efficacy 80%, total sleep time 378 min than those of 8 weeks While the indexes of the medication group and combined group could not maintain the effect of treatment Conclusion:medication shows a short-term effect on chronic insomnia, cognitive-behavior therapy shows long-term effect