团体认知行为治疗在社区就诊中老年持续性失眠患者中的应用效果

Application effect of group cognitive behavior therapy in middle-aged and elderly patients with persistent insomnia in community

目的研究团体认知行为治疗对社区就诊中老年持续性失眠患者睡眠的改善效果。方法选取2018年12月至2019年1月就诊于右安门社区卫生服务中心门诊的84例持续性失眠患者(≥45岁)为研究对象。按照随机数字表法将患者分为三组,每组28例,去除脱落病例后,认知组25例、联合组24例、治疗组26例,分别给予团体认知行为治疗、团体认知行为治疗结合药物治疗、药物治疗。比较三组患者的临床疗效、PSQI、ISI、GAD-7和PHQ-9评分以及失眠药物使用情况。结果认知组和联合组的治疗总有效率均高于治疗组,差异具有统计学意义(P<0.05)。治疗后,三组的PSQI、ISI、GAD-7和PHQ-9评分均较治疗前显著降低,差异具有统计学意义(P<0.05);治疗后,认知组、联合组的PSQI、ISI、GAD-7和PHQ-9评分均低于治疗组,差异具有统计学意义(P<0.05)。认知组、联合组随访3、6个月的PSQI、ISI评分均显著低于治疗后,差异具有统计学意义(P<0.05)。随访3、6个月,三组患者失眠药物使用情况比较,差异具有统计学意义(P<0.05)。结论给予中老年持续性失眠患者团体认知行为治疗,可显著改善患者的睡眠及不良情绪,有效减少患者对失眠药物的使用,且远期疗效较好,值得在社区失眠人群中的推广应用。

Objective To study the improvement effect of group cognitive behavior therapy on the sleep of middle-aged and elderly patients with persistent insomnia in community.Methods Eighty-four patients(≥45 years old)with persistent insomnia visited in the clinic of Youanmen community health service center from December 2018 to January 2019 were selected as the research objects.According to the random number table method,the patients were divided into three groups,with 28 cases in each group.After removing the cases,there were 25 cases in the cognitive group,24 cases in the combination group and 26 cases in the treatment group that were given group cognitive behavior therapy,group cognitive behavior therapy combined with drug treatment and drug treatment respectively.The clinical efficacy,the scores of PSQI,ISI,GAD-7 and PHQ-9 and the use of insomnia drugs were compared among the three groups.Results The total effective rate of treatment in the cognitive group and the combination group was higher than that in the treatment group,and the differences were statistically significant(P<0.05).After treatment,the scores of PSQI,ISI,GAD-7 and PHQ-9 of the three groups were significantly lower than those before treatment,and the differences were statistically significant(P<0.05);after treatment,the scores of PSQI,ISI,GAD-7 and PHQ-9 of the cognitive group and the combination group were lower than those of the treatment group,and the differences were statistically significant(P<0.05).The scores of PSQI and ISI at the 3 and 6-month follow-up in the cognitive group and the combination group were significantly lower than those after treatment,and the differences were statistically significant(P<0.05).After 3 and 6 months of follow-up,there were significant differences in the use of insomnia drugs among the three groups(P<0.05).Conclusion Group cognitive behavior therapy for middle-aged and elderly patients with persistent insomnia can significantly improve their sleep and bad emotions,effectively reduce the use of insomnia drugs,and has a good long-term effect,which is worthy of promotion and application in community insomnia population.