Effects of different intervention methods on psychological flexibility,negative emotions and sleep quality in chronic hepatitis B

BACKGROUND Patients with chronic hepatitis B(CHB)experience various problems,including low psychological flexibility,negative emotions,and poor sleep quality.Therefore,effective nursing interventions are required to reduce adverse events.Acceptance and commitment therapy(ACT)combined with enabling cognitivebehavioral education(ECBE)can improve patients'psychological and sleep.Therefore,we speculate that this may also be effective in patients with CHB.AIM To investigate the effects of different intervention methods on psychological flexibility,negative emotions,and sleep quality in patients with CHB.METHODS This retrospective study examined clinical and evaluation data of 129 patients with CHB.Intervention methods were divided into a conventional group(routine nursing,n=69)and a combination group(ACT combined with ECBE,n=60).We observed changes in psychological flexibility,negative emotions,sleep quality,and self-care ability in both groups.Observation items were evaluated using the Acceptance and Action Questionnaire-2nd Edition(AAQ-II),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Pittsburgh Sleep Quality Index(PSQI),and Exercise of Self-Care Agency Scale(ESCA).RESULTS Compared with the conventional group,the AAQ-II score of the combined group was lower(F_(between-group effect)=8.548;F_(time effects)=25.020;F_(interaction effects)=52.930;all P<0.001),the SAS score(t=5.445)and SDS score(t=7.076)were lower(all P<0.001),as were the PSQI dimensions(tsleep quality=4.581,tfall sleep time=2.826,tsleep time=2.436,tsleep efficiency=5.787,tsleep disorder=5.008,thypnotic drugs=3.786,tdaytime dysfunction=4.812);all P<0.05).The ESCA scores for all dimensions were higher(thealth knowledge level=6.994,t self-concept=5.902,tself-responsibility=19.820,tself-care skills=8.470;all P<0.001).CONCLUSION ACT combined with ECBE in patients with CHB can improve psychological flexibility and sleep quality,alleviate negative emotions,and improve self-care.

Relation between sleep quality and glycemic control among type 2 diabetic patients

Objective:To investigate the relation between sleep quality and glycemic control among type 2 diabetic patients.Methods:Across sectional descriptive design was used;the study sample including 125 diabetic patients was recruited at diabetic clinics in Zagazig University hospitals.The interview questionnaire sheet consists of 4 par ts:(1)demographic data,(2)medical history,(3)an Arabic version of the Pittsburgh sleep quality index(PSQI),and(4)glycated hemoglobin A1c(Hb A1c)analysis test.Results:The mean of sleep duration was the highest score of PSQI components,96.8%of diabetic patients had poor sleep quality,and 90.4%of diabetic patients had poor glycemic control.A highly statistically significant relationship was found between Hb A1c and sleep quality.Moreover,income,duration of disease and smoking were independent positive predictors of Hb A1c level,while the female gender was a statistically significant negative predictor.Additionally,female gender and income were statistically significant independent positive predictors of PSQI score.Conclusions:Poor sleep quality and poor glycemic control were very common among type 2 diabetic patients.There was a highly significant relation between sleep quality and glycemic control.

Electroacupuncture treatment of chronic insomniacs

Background Due to the quick rhythm of life and work pressure, more and more people suffer from sleep quality problems. In this study, we investigated the effect of electroacupuncture on sleep quality of chronic insomniacs and the safety of electroacupuncture therapy. Methods Four courses of electroacupuncture treatment were applied to 47 patients. With pre-treatment and post-treatment self-control statistical method, Pittsburgh sleep quality index （PSQI） scores were used for evaluating sleep quality. Polysomnogram was used for detecting insomniacs＇ changes in sleep architecture. The safety of electroacupuncture was evaluated by monitoring the self-designed adverse events and side effects during treatment and post-treatment. Results Electroacupuncture considerably improved insomniacs＇ sleep quality and social function during the daytime. Electroacupuncture had certain repairing effect on the disruption in sleep architecture. At the same time, electroacupuncture prolonged slow wave sleep （SWS） time and relatively rapid eye movement sleep （REM sleep） time. There was no hangover, addiction or decrements in vigilance during the daytime （incidence rate was 0）. However, insomnia rebound rate was about 23% within one month. Conclusions These results suggest that electroacupuncture has beneficial effect on sleep quality improvement in the patients with chronic insomnia, which may be associated with repairing sleep architecture, reconstructing sleep continuity as well as prolonging SWS time and REM sleep time. Electroacupuncture treatment for chronic insomnia is safe. Therefore, electroacupuncture therapy could be a promising avenue of treatment for chronic insomnia.

Sleep Quality in Non Dialysis Chronic Kidney Disease: Associated Factors and Influence on Prognosis

Deficient sleep quality (SQ) has been linked with a higher hospitalization rate and mortality in dialysis patients, however the prevalence of sleep disorders and their influence on prognosis in non-dialysis chronic kidney disease (CKD) has been poorly investigated. The aim of this study was to assess factors related with SQ in CKD patients (stages I-IV) followed in a nephrology outpatient clinic as well as the long-term impact of SQ on patient’s outcome. Between January and May 2008, Pittsburgh Sleep Quality Index (PSQI) was self-administered by 122 patients (68 males and 54 females) with a mean age of 65 years. Patients were classified as “good” (global PSQI < 6) and “poor” sleepers (global PSQI ≥ 6). We identified 66 (54%) poor sleepers (PS), characterized by an older age (66 ± 14.2 vs 57 ± 17.0, p < 0.01), female predominance (59% vs 26%, p < 0.01) and worse renal function (49 ± 19.1 vs 57 ± 23.2 ml/min, p < 0.05). There was a significant correlation between phosphate and PSQI score (r = 0.234, p = 0.01), however no correlation with calcium or PTH. Vitamin D was also lower in PS (17 ± 7.2 vs 23 ± 15.1 ng/ml, p < 0.05). Until June 2015, hospitalization rate was higher among PS (64% vs 44%, p < 0.05). In this period, there was also a trend towards higher mortality for PS (18% vs 16%). In summary, over 50% of CKD patients have poor SQ, which was associated with older age, female gender, worse renal function, lower vitamin D and higher phosphate levels. Deficient sleep was associated with a greater probability of hospitalization and might be a prognostic marker in CKD.

Analysis of the Clinical Effect of Chinese Medicine Combined with Acupuncture and Moxibustion on Insomnia

Objective:To explore and analyze the clinical efficacy of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia.Method:80 patients with primary insomnia were selected as the study sample,with 20 cases randomly selected as the control group and the rest as the observation group.The control group was treated with ordinary western medicine,while the observation group patients were treated with traditional Chinese medicine combined with acupuncture and moxibustion based on this syndrome differentiation.The comparison items were treatment effect,sleep quality,mental health,quality of life,specific sleep indicators,cerebral blood flow and neurotransmitters.Result:The treatment effectiveness showed that the observation group had a higher treatment effectiveness rate than the control group(P<0.05);The results of sleep quality showed that after treatment,the scores of the observation group were lower than those of the control group in seven dimensions:sleep quality,sleep time,sleep onset time,sleep efficiency,sleep disorders,hypnotic drugs,and daytime dysfunc‐tion score(P<0.05);The quality of life results showed that after treatment,the observa‐tion group had higher scores than the control group in eight dimensions:physiological function,physiological function,physical pain,health status,energy,social function,emotional function,and mental health(P<0.05);The results of slow wave sleep time and fast eye movement sleep time showed that after treatment,the HAMA and HAMD scores of the physiological mechanism in the observation group were lower than those in the control group(P<0.05);The results of cerebral blood flow and neurotransmitter indica‐tors show that after treatment,glutamateγ-The peak systolic blood flow velocity of ami‐nobutyric acid,vertebral artery,and basilar artery in the observation group was higher than that in the control group(P<0.05).Conclusion:The clinical treatment of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia patients can significantly improve the clinical treatment effect,and improve the cerebral hemorrhage and neurotransmitter status of patients,promote the improvement of their physical and mental status,can more significantly improve the quality of sleep,reduce sleep difficulties,reduce the dosage of sleeping pills,which has important clinical application value.

Insomnia in Patients Suffering from Chronic Medical Illnesses: Prevalence and Impact of IAYT

Background: Sleep is an important lifestyle factor to be addressed in patients having chronic non-communicable diseases. Data revealing prevalence of insomnia in chronic medical illnesses (CMIs) in Indian population are lacking. Yoga has been found effective in improving sleep quality in patients with chronic medical illnesses (CMIs). Aim: To find the prevalence of insomnia in major chronic medical illnesses and to assess the effect of Integrated Approach of Yoga Therapy (IAYT) on them. Methods and Material: From the outpatients and inpatients of our integrative therapy clinics, 200 patients (116 males;84 females) in the age range 49.57 ± 11.71 years, who satisfied the inclusion criteria and were diagnosed by the physician with any of the four major categories of CMIs: cardio-pulmonary, diabetes, musculoskeletal, and psychiatric were screened for insomnia using Insomnia Severity Index (ISI) scale. Those found suffering from clinically significant insomnia (ISI score > 14) were admitted and a residential IAYT intervention was given for a week. Before and after the intervention, ISI and Pittsburg insomnia rating scale (PIRS) were administered to assess extent of insomnia. Data was analyzed before and after the intervention using paired t-test. Results: Taking all patients of CMIs together, we found that 35% suffered from clinical insomnia, out of which, 12.5% had severe and 22.5% had moderate insomnia. We also found that prevalence of clinical insomnia was highest among those suffering from psychiatric illnesses (62.07%) and minimum in those having musculoskeletal disorders (28.05%). Those suffering from diabetes mellitus and cardio-pulmonary disorders reported prevalence of 32.25% and 31.94% respectively. After IAYT intervention of one week, extent of clinical insomnia reduced from 35% at the baseline to 8.5% in all patients of CMIs taken together. Following changes were observed in percentage of patients suffering from clinical insomnia in different CMIs before and after one week of IAYT intervention: 1) In psychiatric patients, the percentage reduced from 62.07% to 24.13%;2) In diabetic patients, the percentage reduced from 32.27% to 3.0%;3) In patients having musculoskeletal disorders, the percentage reduced from 28.05% to 8.53%;and 4) In patients having cardio-pulmonary illnesses, the percentage reduced from 31.94% to 2.7%. Conclusion: Prevalence of insomnia is higher in patients suffering from chronic medical illnesses. IAYT intervention of one week may be helpful in reducing extent of insomnia in this population.

Relationship of depression and sleep quality,diseases and general characteristics

BACKGROUND Depression is the most common type of depressive disorder.The most common sleep disorder associated with depression is insomnia.Insomnia and depression are closely related.AIM To investigate the relationship of designed questionnaire items and depression,and analyze the related factors with depression.METHODS Questionnaire included Patient Health Questionnaire-9(PHQ-9)and Pittsburgh sleep quality index(PSQI),12 kinds of diseases,8 general characteristics,and 20 insomnia characteristics,totally 56 items were filled out by 411 patients enrolled.RESULTS All the 9 items of PHQ-9,6 components of PSQI(except sleep duration),education,living situation,exercise,years of insomnia,western medicine treatment,Chinese medicine treatment,psychotherapy,kinds of insomnia,treatment expected to treat insomnia,psychological counseling,habit of 1 h before bed,habit of lunch break,diagnosed depression,coronary heart disease,mental illness showed significant difference between without and with depression group.By univariate analysis and multivariate analysis.The odds ratio of education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression,coronary heart disease(P=0.01)showed significant difference.Their odds ratios were 0.71(0.55,0.93),2.09(1.32,3.31),0.76(0.63,0.91),0.89(0.81,0.98),0.32(0.17,0.60),0.43(0.23,0.79).CONCLUSION We demonstrated that education,exercise,kinds of insomnia,habit of 1 h before bed,diagnosed depression and coronary heart disease affect the depression.

Clinical Study on the Effect of Acupuncture and Moxibustion with the Method of Acupoints on the Treatment of Chronic Gastritis with Sleep Disorder

Objective:To explore the clinical effect of acupuncture and moxibustion with acupoints on the treatment of chronic gastritis with sleep disorders.Methods:Sixty patients with chronic gastritis and sleep disorders in our hospital from January 2018 to January 2019 were selected and recruited.These patients were divided into two groups,namely the control group and experimental group by using random number table method.Each group consisted of 30 cases.The control group was treated with conventional drugs,whereas the observation group was treated with acupuncture and moxibustion with acupoints on top of the treatment prescribed for the patients in control group.The TCM syndrome score,gastrin level,and sleep quality level were compared between the two groups.Results:After four weeks of treatment,the Traditional Chinese Medicine(TCM)symptom score,gastrin level,and Pittsburgh Sleep Quality Index(PSQI)score in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion:Acupuncture and moxibustion with acupoints can improve TCM symptom scores,reduce gastrin levels,and improve sleep quality in patients with chronic gastritis and sleep disorders.

乐眠操对抑郁伴失眠患者睡眠质量的效果观察

目的探讨乐眠操对抑郁伴失眠患者睡眠质量的影响。方法选取2022年2至8月在北京大学第六医院住院的抑郁伴失眠患者79例,根据是否进行乐眠操干预分为对照组(n=40)和试验组(n=39)。试验组患者除常规治疗、护理外,每天早晚各1次乐眠操干预,对照组患者进行常规治疗和护理。采用匹兹堡睡眠质量指数量表(PSQI)、失眠严重程度指数(ISI)、健康调查量表36(SF-36)评估患者在干预前、后的相应指标。结果试验组和对照组一般资料比较差异均无统计学意义(P均>0.05)。乐眠操干预2周后,与对照组比较,试验组患者PSQI、ISI总分明显减少,SF-36总分明显增加(P均<0.001)。结论乐眠操可以改善抑郁伴失眠患者的睡眠质量。

基于气机升降理论的针灸组方对心肾不交型失眠患者睡眠质量和睡眠进程的影响

目的探讨分析基于气机升降理论的针灸组方对心肾不交型失眠患者睡眠质量和睡眠进程的影响。方法前瞻性选取2019年1月—2021年12月收治入院的84例心肾不交型失眠患者根据随机数字表法分为治疗A组(42例)和治疗B组(42例)。治疗A组予以常规针法治疗,治疗B组患者则予以基于气机升降理论的针灸组方治疗。评估两组患者的实际睡眠总时间、PSQI量表评分、睡眠进程参数、入睡时间、日间功能障碍以及不良反应。结果干预后两组纳入患者的PSQI量表评分较干预前均有了显著改善(P<0.05),且干预后治疗B组患者的PSQI量表评分显著低于治疗A组(P<0.05);干预后两组纳入患者的睡眠进程参数指标较干预前均有显著改善(P<0.05),且干预后治疗B组患者的总睡眠时间、睡眠效率指标显著高于治疗A组,而睡眠潜伏期、觉醒时间指标则显著低于治疗A组(P<0.05);干预后两组纳入患者入睡时间、日间功能障碍较干预前均显著降低(P<0.05),且干预后治疗B组患者的入睡时间、日间功能障碍均显著低于治疗A组(P<0.05);干预后两组纳入患者的实际睡眠总时间较干预前均有了显著改善(P<0.05),且干预后治疗B组患者的实际睡眠总时间显著高于治疗A组(P<0.05);两组心肾不交型失眠患者在治疗期间均未出现严重不良反应,干预方案安全性良好。治疗A组患者出现穿刺处血肿4例、穿刺处感染2例、滞针4例,总出现率为23.81%(10/42);治疗B组患者出现穿刺处血肿1例、穿刺处感染0例、滞针1例,总出现率为4.76%(2/42),且治疗B组患者的总出现率显著低于治疗A组(P<0.05)。结论基于气机升降理论的针灸组方治疗心肾不交型失眠患者,其临床干预效果显著,可有效改善患者的PSQI量表评分以及睡眠进程参数,缩短入睡时间,提高实际睡眠总时间,缓解日间功能障碍,且不良反应少。

TIP睡眠调控技术联合耳穴磁疗对乳腺癌患者围手术期睡眠质量的影响

目的观察低阻抗意念导入疗法(thought induction psychotherapy,TIP)睡眠调控技术联合耳穴磁疗对乳腺癌患者围术期睡眠质量、情绪状态和恢复质量的影响。方法将60例行乳腺癌手术的心肾不交证型失眠患者随机分为研究组和对照组,每组30例。对照组接受围手术期常规护理和耳穴磁疗,研究组在对照组基础上辅助TIP睡眠调控技术,每天1次,从术前1 d开始治疗至术后3 d。观察两组术前和术后3 d的匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、中医证候积分、临床疗效、焦虑自评量表(self-rating anxiety scale,SAS)评分和抑郁自评量表(self-rating depression scale,SDS)评分,以及15项恢复质量评分(quality of recovery-15,QoR-15)。结果治疗后,两组患者的PSQI各因子评分,SAS、SDS评分,中医证候积分均低于治疗前(P<0.05),且研究组睡眠质量、入睡时间、睡眠效率、睡眠障碍及日间功能障碍评分,SAS、SDS评分,中医证候积分下降幅度显著大于对照组(P<0.05)。治疗后,研究组总有效率为93.3%,明显高于对照组的66.7%。与对照组比较,研究组术后1、3 d QoR-15评分升高(P<0.05);与术前1 d比较,研究组术后1 d、3 d QoR-15评分降低(P<0.05);与术后1 d比较,研究组术后3 d QoR-15评分升高(P<0.05)。结论TIP睡眠调控技术联合耳穴磁疗可以减轻乳腺癌患者围手术期睡眠障碍,降低焦虑和抑郁水平,有助于提高患者的睡眠质量和术后恢复质量。

聚焦解决模式护理对COPD患者呼吸功能、睡眠质量及症状改善的影响

目的研究聚焦解决模式护理对慢性阻塞性肺疾病(COPD)患者呼吸功能、睡眠质量及症状改善的影响。方法选取2020年1月至2022年5月收入的COPD患者90例,按随机数字表法均分2组,对照组接受常规护理,观察组接受聚焦解决模式护理,比较2组的临床干预效果。结果干预后,观察组各症状改善时间包括喘憋[(2.51±0.87)d]、咳嗽[(4.11±1.02)d]及肺部啰音时间[(4.65±1.32)d]均短于对照组,差异有统计学意义(P<0.05)。出院6个月显示观察组治疗依从性各项得分包括运动锻炼[(82.33±2.31)分]、改变生活方式[(85.18±2.24)分]、饮食[(88.25±2.42)分]、服药[(90.59±2.74)分]均高于对照组,差异有统计学意义(P<0.05)。2组干预前R5与R20值比较,差异无统计学意义(P>0.05);干预后,观察组R5[(0.39±0.06)kPa·L^(-1)·s^(-1)]与R20[(0.23±0.03)kPa·L^(-1)·s^(-1)]测定值均低于对照组,差异有统计学意义(P<0.05)。2组干预前PSQI量表评分比较,差异无统计学意义(P>0.05);干预后,观察组该项评分[(9.31±1.05)分]低于对照组,差异有统计学意义(P<0.05)。结论聚焦解决模式护理能够更好地控制COPD患者的临床症状,改善其呼吸功能及睡眠质量,值得临床推广借鉴。

滋水清心方治疗绝经期失眠的疗效观察

目的:观察并分析滋水清心方治疗绝经期失眠的临床疗效。方法:纳入我院2017年3月至2019年12月绝经期失眠患者80人,随机分为对照组(40人)和治疗组(40人),对照组采用常规治疗,治疗组在对照组基础上加服滋水清心方。治疗后,观察两组中医证候积分、每周的睡眠质量(PSQI)、多导睡眠图(PSG)变化,进行对比。结果:两组治疗后中医证候积分、PSQI、PSG参数(觉醒次数、觉醒时间、睡眠潜伏期、快波睡眠潜伏期)均低于治疗前(P<0.05),PSG参数(睡眠效率、快波睡眠、慢波睡眠)均高于治疗前(P<0.05),且治疗组优于对照组(P<0.05)。治疗组总有效率(95%)高于对照组(77.5%)(P<0.05)。结论:滋水清心方治疗绝经期失眠患者疗效较好,可有效改善失眠症状,提高睡眠质量。

调神方针刺改善慢性失眠患者入睡潜伏期及过度觉醒的临床研究

目的:观察调神方针刺对改善慢性失眠患者入睡潜伏期和过度觉醒状态的临床疗效。方法:将100例慢性失眠患者随机分为治疗组和对照组,各50例。治疗组予调神方针刺得气,穴取百会、神庭、四神聪、本神、神门、内关和三阴交;对照组取治疗失眠无效的经穴浅刺。每次均留针30 min,3次/周,治疗4周,给予相同的睡眠卫生指导。比较两组患者治疗前后及治疗结束后第8周随访期睡眠日记记录的入睡潜伏期、匹兹堡睡眠质量指数(PSQI)评分及过度觉醒量表(HAS)评分变化,并分析治疗后入睡潜伏期改善情况与过度觉醒水平变化的相关性。结果:治疗4周后,治疗组入睡潜伏期较前减短,差异具有统计学意义(P<0.01),随访期,两组入睡潜伏期均较前减短,差异具有统计学意义(P<0.05);治疗后及随访期,两组PSQI评分及HAS评分均较治疗前降低,差异具有统计学意义(P<0.05)。治疗4周后,治疗组入睡潜伏期低于对照组,差异具有统计学意义(P<0.01),治疗后及随访期PSQI评分及HAS评分均较对照组明显下降,差异具有统计学意义(P<0.05)。入睡潜伏期减少与过度觉醒水平降低呈正相关。结论:调神方针刺能有效减短慢性失眠患者的入睡潜伏期,提高睡眠质量,而降低过度觉醒水平是减少睡眠潜伏期的潜在机制。

专病一体化护理联合协同护理模式对老年慢性心力衰竭患者的影响

目的:探讨专病一体化护理联合协同护理模式对老年慢性心力衰竭(CHF)患者的影响。方法:选取2022年2月1日~2023年2月28日收治的98例老年CHF患者作为研究对象,依据入院时间采用抽签法分为对照组和观察组各49例,对照组给予常规护理,观察组在此基础上实施专病一体化护理联合协同护理模式;比较两组入院时、出院时、出院3个月的积极度评分,护理前后生命质量[简明健康状况调查问卷(SF-36)]评分、睡眠质量(明尼苏达心力衰竭睡眠质量量表)评分、自我护理(欧洲心力衰竭自我护理行为量表)评分、汉密顿焦虑量表(HAMA)评分、汉密顿抑郁量表(HAMD)评分,护理满意度。结果:干预后,两组积极度评分逐渐提高(P<0.01),观察组出院时、出院3个月积极度评分高于对照组(P<0.01);护理后,两组生命质量评分高于护理前(P<0.05),且观察组高于对照组(P<0.01);护理后,两组睡眠质量、自我护理评分及HAMA、HAMD评分低于护理前(P<0.05),且观察组低于对照组(P<0.01);观察组护理满意度高于对照组(P<0.01)。结论:专病一体化护理联合协同护理模式能够有效改善CHF患者的不良情绪和积极度,提高睡眠质量和生命质量,提升护理满意度。

基于调和阴阳理论针灸组方治疗老年肝郁化火型失眠

目的探讨基于调和阴阳理论针灸组方治疗老年肝郁化火型失眠的临床疗效。方法将老年肝郁化火型失眠患者80例按照随机数表法分为对照组与观察组,各40例。对照组采用西药治疗,观察组在对照组基础上联合调和阴阳法针灸治疗。观察2组治疗前后中医证候积分、多导睡眠图、匹兹堡睡眠质量指数量表(PSQI)、失眠严重程度指数量表(ISI)、爱普沃斯嗜睡量表(ESS)、血清单胺递质指标5-羟色胺(5-HT)、谷氨酸(GA)、神经肽Y(NPY)、γ-氨基丁酸(GABA)变化,并评价2组治疗总有效率和治疗安全性。结果观察组治疗后各项中医证候积分、睡眠潜伏期、觉醒时间、PSQI评分、ISI评分、ESS评分均低于对照组(P<0.05),睡眠总时间、快速眼动睡眠期、5-HT、GA、NPY、GABA指标均高于对照组(P<0.05);观察组治疗总有效率(92.5%,37/40)高于对照组(77.5%,31/40)(P<0.05);2组不良反应发生情况比较,差异无统计学意义(P>0.05)。结论基于调和阴阳理论的针灸组方联合西药治疗老年肝郁化火型失眠疗效明显,能够缓解患者不适症状,减轻日间嗜睡程度,调节神经递质表达,改善睡眠质量,且不良反应少。

声刺激联合认知行为治疗慢性耳鸣的初步探讨

目的 探讨声刺激联合认知行为治疗(CBT)对慢性耳鸣的临床疗效。方法 本研究将49例慢性耳鸣患者按照随机数字表法分为干预组(25例)和对照组(24例),所有患者均行声音刺激1个月。干预组患者同时接受持续1个月的个体化的CBT,对照组患者不接受个体化CBT。所有患者在治疗前和治疗后30 d均需填写问卷,包括耳鸣残疾评估量表(THI)、焦虑自评量表(SAS)及匹兹堡睡眠质量指数(PSQI)。结果 两组患者均完成临床试验。治疗1个月后观察,对照组患者THI、SAS、PSQI的平均值分别下降15.58、15.46、4.96,干预组患者THI、SAS、PSQI的平均值分别下降40.52、41.76、7.72,差异具有统计学意义(P<0.05);且干预组患者THI、SAS、PSQI的得分均明显低于对照组。结论 声音刺激和CBT可以预测治疗效果,声音刺激联合CBT的治疗效果优于单独的声音刺激。性别、年龄和听力障碍是耳鸣最相关的危险因素。

安神定志汤联合经颅磁刺激治疗心胆气虚型失眠临床研究

目的:观察安神定志汤联合经颅磁刺激(TMS)治疗心胆气虚型失眠的临床疗效。方法:选取98例心胆气虚型失眠患者,按随机数字表法分为对照组和研究组各49例。对照组给予艾司唑仑片治疗,研究组给予安神定志汤联合TMS治疗。2组均治疗4周。比较2组临床疗效、中医证候积分、匹兹堡睡眠质量指数(PSQI)评分、睡眠进程参数、神经递质及不良反应发生率。结果:治疗4周后,研究组总有效率89.80%,高于对照组73.47%(P<0.05)。2组睡眠时间、睡眠质量、入睡时间、睡眠障碍、睡眠效率、日间功能障碍评分均较治疗前降低(P<0.05),研究组上述6项PSQI细则评分均低于对照组,差异均有统计学意义(P<0.05)。2组睡眠潜伏期、快速眼动睡眠(REM)潜伏期、觉醒时间均较治疗前缩短(P<0.05),总睡眠时间均较治疗前延长(P<0.05),睡眠效率均较治疗前提高(P<0.05);研究组睡眠潜伏期、REM潜伏期、觉醒时间均短于对照组(P<0.05),总睡眠时间长于对照组(P<0.05),睡眠效率高于对照组(P<0.05)。2组主症、次症积分及中医证候总分均较治疗前降低(P<0.05),研究组主症、次症积分及中医证候总分均低于对照组(P<0.05)。2组5-羟色胺(5-HT)水平均较治疗前升高,多巴胺(DA)水平均较治疗前降低(P<0.05);研究组5-HT水平高于对照组,DA水平低于对照组(P<0.05)。治疗期间,研究组不良反应发生率4.08%,低于对照组18.37%(P<0.05)。结论:安神定志汤联合TMS治疗心胆气虚型失眠临床疗效较好,可有效改善睡眠质量,调节神经递质,安全性好。

芳香疗法及耳穴贴压在脑卒中失眠患者中应用效果的研究

目的:研究芳香疗法及耳穴贴压治疗脑卒中失眠患者的临床效果。方法:采用便利抽样法,选取天津市某三级甲等神经专科医院脑卒中失眠住院患者120例为研究对象。采用随机数字表将研究对象分为对照组、芳香组、耳穴组和联合组,每组30例。比较四组患者入院时、干预7天、干预1个月睡眠质量[匹兹堡睡眠质量评估表(Pittsburgh Sleep Quality Index,PSQI)]以及抑郁情绪[汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)]的变化,并比较各组住院时间及护理服务总体满意情况的差异。结果:干预7天后,芳香组、联合组PSQI得分均低于对照组(P<0.05),耳穴组与其他三组间PSQI得分差异无统计学意义(P>0.05);而HAMD得分四组间差异无统计学意义(F=2.462,P>0.05)。干预1个月后,芳香组、耳穴组、联合组PSQI得分均低于对照组(P<0.05);芳香组、联合组HAMD得分低于对照组(P<0.05),但耳穴组与对照组相比差异无统计学意义(P>0.05)。住院时间方面联合组住院时间短于其他三组(F=3.213,P<0.05);住院患者满意度方面组间比较差异无统计学意义(H=6.629,P>0.05)。结论:芳香疗法在短期内(7天)使用即可改善脑卒中后失眠患者的睡眠质量,持续使用还可改善其抑郁情绪;耳穴贴压需要经长时间(>1月)持续治疗方可对脑卒中后失眠患者睡眠有改善作用;芳香疗法联合耳穴贴压有助于缩短住院时间,有利于维持良好的护患关系。

快速康复护理模式对老年慢性鼻窦炎行鼻内镜手术患者的效果

目的探讨老年慢性鼻窦炎行鼻内镜手术患者采用快速康复护理模式的干预效果。方法选取2020年6月—2022年6月厦门大学附属第一医院收治的老年慢性鼻窦炎行鼻内镜手术患者114例,随机数字表法分为研究组与对照组,各57例。对照组与研究组分别采用常规护理干预、快速康复护理模式,对比2组的护理效果。结果干预后,研究组汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分(6.22±1.56)分,汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分(6.77±1.53)分,均低于对照组的(9.64±2.91)分、(10.46±2.78)分(t=7.820、8.779,P<0.05)。研究组术后3 d的口干、耳鸣、流泪及眼胀痛、头痛、鼻塞、鼻部疼痛评分均低于对照组(P<0.05)。研究组生活质量(WHO quality of life-100,WHOQOL-100)评分高于对照组(P<0.05)。研究组匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评分低于对照组(P<0.05)。结论老年慢性鼻窦炎行鼻内镜手术患者采用快速康复护理模式不仅能有效缓解负面情绪,还可以显著减轻其临床症状,提高其生活质量和睡眠质量。此文的研究结果为老年慢性鼻窦炎行鼻内镜手术患者围手术期的护理标准制定提供了借鉴内容。