劳拉西泮联合低频重复经颅磁刺激对慢性失眠障碍的效果

Clinical efficacy of lorazepam combined with low-frequency repetitive transcranial magnetic stimulation on chronic insomnia disorder

目的探讨劳拉西泮联合低频重复经颅磁刺激(rTMS)对慢性失眠障碍的临床疗效,为慢性失眠障碍的治疗提供参考。方法纳入符合《中国失眠障碍诊断和治疗指南》慢性失眠障碍诊断标准的患者120例,按照随机数字表法分为劳拉西泮联合低频rTMS治疗组(研究组)与劳拉西泮联合伪低频rTMS治疗组(对照组)各60例。于治疗前和治疗第4周末进行多导睡眠监测(PSG),于治疗前和治疗第1、2、4周末进行匹兹堡睡眠质量指数量表(PSQI)、汉密尔顿抑郁量表17项版(HAMD-17)和汉密尔顿焦虑量表(HAMA)评定。结果①治疗第4周末,研究组PSQI评分低于对照组(t=-3.506,P=0.001),研究组睡眠质量疗效的显效率和有效率均高于对照组(χ^2=4.658、5.926,P均<0.05);研究组实际睡眠总时间、睡眠效率均高于对照组(t=2.333~3.784,P均<0.05),睡眠潜伏期、觉醒时间、觉醒次数、快速眼球运动睡眠潜伏期均低于对照组(t=-2.903^-2.214,P均<0.05)。②治疗第4周末,研究组HAMA评分低于对照组(t=-2.072,P<0.05);治疗第1、2、4周末,研究组HAMD-17评分均低于对照组(t=-2.190^-1.701,P均<0.05)。结论劳拉西泮联合低频rTMS可能有助于改善慢性失眠障碍患者的睡眠质量,并缓解其抑郁、焦虑等负性情绪。

Objective To investigate the clinical efficacy of lorazepam combined with low-frequency repetitive transcranial magnetic stimulation(rTMS)on chronic insomnia disorder,and to provide clinical references for the treatment of chronic insomnia disorder.Methods A total of 120 patients with chronic insomnia disorder who met the diagnostic criteria for chronic insomnia in the Guidelines for the Diagnosis and Treatment of Insomnia Disorder in China were enrolled,and patients were divided into two groups according to the random number table method,with 60 cases in each group.The study group received the lorazepam combined with low-frequency rTMS,while the control group received the lorazepam combined with pseudo low-frequency rTMS.Polysomnography(PSG)was performed before treatment and 4 weeks after treatment.Before treatment and at the 1st,2nd and 4th weekend of treatment,all patients were assessed by Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Scale-17 item(HAMD-17)and Hamilton Anxiety Scale(HAMA).Results①At the 4th weekend of treatment,the PSQI score of the study group was lower than that of the control group(t=-3.506,P=0.001),the significant effective rate and effective rate of the study group were higher than those of the control group(χ^2=4.658,5.926,P<0.05).The total sleep time and sleep efficiency of the study group were higher than those of the control group(t=2.333~3.784,P<0.05),while the sleep latency,awake time,wake times and REM sleep latency were all lower than those of the control group(t=-2.903^-2.214,P<0.05).②After treatment for 4 weeks,the HAMA scores of the study group were lower than those of the control group(t=-2.072,P<0.05).At the 1st,2nd,4th weekend,HAMD-17 scores of the study group were lower than those of the control group(t=-2.190^-1.701,P<0.05).Conclusion Lorazepam combined with low-frequency rTMS for patients with chronic insomnia disorder may improve their sleep quality,and relieve their negative emotions such as depression and anxiety.