认知行为疗法在耳鸣治疗中的研究

Study on cognitive behavioral therapy in the treatment of tinnitus

目的探究认知行为疗法联合药物较单纯药物治疗对原发性耳鸣患者疗效差异。方法选择2013年12月—2015年12月在本院就诊的100例原发性耳鸣患者作为研究对象,以随机数表法分为实验组和对照组两组,每组各50例。对照组予以单纯药物治疗(血塞通软胶囊+甲钴胺片,影响睡眠者加艾司唑仑片);实验组予以认知行为疗法辅助药物治疗。治疗干预8周,前4周为1次/周;后4周为1次/2周,1/2~2 h/次。在干预前和干预后2、4、8周末,采用耳鸣残疾评估量表(tinnitus handicap inventory,THI)及患者耳鸣日记对患者治疗情况进行评估。结果患者主观感受分析,对照组中自觉有效31例,无效19例,总有效率62.00%;实验组中自觉有效42例,无效8例,总有效率84.00%,两组比较差异有统计学意义(χ~2=19.55,P<0.001)。治疗前,实验组患者与对照组THI得分相比较,差异无统计学意义(P>0.05);治疗2周后两组THI得分相比较,差异无统计学意义(P>0.05);治疗4周后、8周后后两组THI得分相比较,差异有统计学意义(P<0.05)。结论药物联合认知行为疗法治疗耳鸣较单纯药物治疗疗效显著。

Objective To explore the therapeutic effect of cognitive behavioral therapy combined with drugs on primary tinnitus patients compared with drug therapy alone.Methods A total of 100 patients with primary tinnitus diagnosed in our hospital from December 2013 to December 2015 were enrolled in the study and they were randomly divided into the experimental group and the control group by the random number method, 50 cases in each group. The control group was treated with drugs alone(xuesetong capsules + mecobalamin tablets, if the drugs affected the sleep of the patients, estazolam tablets should be added). The experimental group was treated with cognitive behavioral therapy and drug therapy. Treatment intervention lasted for 8 weeks, once a week during the first 4 weeks.After 4 weeks,it was once per 2 weeks,a half to 2 hours per time. The tinnitus handicap inventory( THI) scale and the patient’s tinnitus diary were used to assess the patient’s treatment efficacybefore and at the 2 nd,4 thand 8 thweekends after the intervention.Results In the control group,there were 50 cases of subjective feeling analysis,31 cases felt effective,19 cases felt ineffective,and the effective rate was 62.00%.In the experimental group,there were 50 cases,including 42 cases felt effective and 8 cases felt without efficacy,the total effective rate of 84. 00%. The difference was statistically significant( χ~2= 19. 55,P < 0. 001). Before treatment,the THI scores of the experimental group and the control group were not statistically significant( P>0.05). After 2 weeks of treatment,the THI scores of the two groups were not statistically significant( P > 0. 05).After 4 weeks and 8 weeks of treatment,the THI scores of the two groups were compared,the difference was statistically significant( P < 0. 05). Conclusions Drug combined cognitive behavioral therapy is more effective than drug alone in treating tinnitus.