慢性失眠症整合心身诊疗平台的建立及应用效果研究

Establishment and application of holistic integrative psychosomatic diagnostic and treatment platform in patients with chronic insomnia

目的简介慢性失眠症患者整合心身诊疗平台,并探索在该平台远程管理下,慢性失眠症患者的睡眠质量、药物减停率、就诊体验。方法 选择2016年1月~2018年8月门诊就诊的慢性失眠症患者213例并随机分为实验组108例与对照组105例。实验组在慢性失眠症整合心身诊疗平台建立档案,首次认知行为治疗采取面对面团体治疗的形式,然后在平台接受远程药物联合心理行为管理,由医师远程评估病情并推送治疗方案;药物使用唑吡坦10mgqn或等效剂量的其他镇静催眠药物,从9w始,每2w递减25%;非药物疗法包括睡眠卫生教育、失眠症的认知行为治疗运动处方、正念疗法、音乐/白噪声治疗、催眠暗示治疗、支持性治疗。对照组共同接受首次认知行为治疗,不在平台进行后续管理。两组均进行6m随访及疗效评估。结果 两组治疗3m(P=0.032)、6m时(P=0.001)匹兹堡睡眠质量指数得分的比较,差异具有统计学意义;两组减停药物的情况比较,差异有统计学意义(P=0.002)。结论 慢性失眠症整合心身诊疗平台能改善患者的睡眠质量,提高减停镇静催眠药物的成功率。

Objective To briefly introduces the holistic integrative psychosomatic diagnostic and treatment platform,and to explores the sleep quality,drug withdrawal rate and treatment experience of chronic insomnia patients under the remote management of the platform. Methods A total of 213 patients with chronic insomnia treated from January 2016 to August 2018 were randomly divided into the experimental group (108) and the control group (105). Patients in the experimental group were established medical records on the platform. First section cognitive behavioral therapy for insomnia (CBT-I) is practiced as face-to-face group therapy,and then patients received remote drug prescription and psychological-behavioral management plan from doctors on the platform weekly. 10 mg zolpidem or other equivalent dose of sedative hypnotics was given,and would be decreased by 25% every 2 weeks from the 9th week. Non-drug therapy includes sleep hygiene,CBT-I and exercise prescription,mindfulness therapy,music/white noise therapy,hypnotic and suggestive therapy,and supportive therapy. The control group received the same first section CBT-I,but did not proceed remote management on the platform. The two groups were followed up for 6 months,and the curative effect was evaluated. Results There was significant difference in Pittsburgh sleep quality index scores between the two groups at 3 months ( P =0.032) and 6 months ( P =0.001);there was significant difference in drug withdrawal rate between the two groups ( P =0.002). Conclusion The holistic integrative psychosomatic diagnostic and treatment platform for chronic insomnia could improve patients’ sleep quality and success rate of drug withdrawal.