| 摘要: |
| 目的比较认知行为疗法联合右佐匹克隆片与单用右佐匹克隆片治疗ICU转出患者睡眠障碍的临床疗效与安全性。方法采用随机数字表法将符合DSM-5失眠诊断标准、年龄18~55岁的58例患者分为研究组和对照组各29例，两组均服用右佐匹克隆片1~3mg/d；研究组加用4周认知行为疗法。入组患者均接受问卷调查，记录患者在ICU住院期间存在疼痛、焦虑、失眠等不适经历，希望家属陪护，以及对机械通气、各种侵入性操作的疼痛记忆比例。治疗前后分别进行多导睡眠监测（PSG）、匹兹堡睡眠质量指数（PSQI）量表、焦虑自评量表（SAS）、抑郁自评量表（SDS）、不良反应量表（TESS）评估。结果治疗后，研究组入睡时间、觉醒时间、睡眠时间均优于对照组（均P＜0.05）；研究组PSQI总分低于对照组（P＜0.05），睡眠效率、Ⅲ期和快速眼动睡眠时间均优于对照组（均P＜0.05）。治疗后，研究组SAS、SDS评分均显著低于对照组；研究组及对照组治疗后SAS、SDS评分均显著低于治疗前（均P＜0.01）。结论认知行为疗法联合右佐匹克隆片治疗ICU转出患者睡眠障碍的疗效更优。 |
| 关键词: 认知行为疗法 右佐匹克隆片 睡眠障碍 ICU 转出患者 |
| DOI：10.12056/j.issn.1006-2785.2018.40.7.2017-1854 |
| 分类号: |
| 基金项目:浙江省医药卫生科技项目（2015KYA184）；浙江省中医药科技计划（2017ZA115）；杭州市医学重点专科专病基金资助项目（20140733Q44） |
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| Efficacy of cognitive behavioral therapy for insomnia combined with eszopiclone in treatment of sleep disorder in patients discharged from ICU |
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Hangzhou Seventh People's Hospital
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| Abstract: |
| Objective To evaluate the efficacy and safety of cognitive behavioral therapy for insomnia (CBT-I) combined with eszopiclone tablets in treatment of sleep disorder in patients discharged from ICU. Methods Fifty eight patients aged 18～
55 years, who met the DSM- Ⅳ criteria of primary insomnia, were randomly assigned to receive CBT-I combined with eszopiclone tablets (study group, n=29) or eszopiclone tablets alone (control group, n=29) for treatment of insomnia. All enrolled patients were interviewed, and the uncomfortable experiences during ICU stay were recorded, including the pain，anxiety， insomnia, loneliness, mechanical ventilation and invasive procedures. The polysomnogram (PSG) was examined; and the
Pittsburgh Sleep Quality Index (PSQI), Self-rating anxiety scale (SAS), Self-rating depression scale (SDS) and Treatment Emergent Symptom Scale (TESS) scores were assessed before and after the study. Results The sleep disorders in patients with
ICU stays ＞ 7 days was associated with use of benzodiazepines, experienced anxiety, insomnia and mechanical ventilation. PSG
showed that the sleep onset latency, wakeup after sleep onset and total sleep time in study group were more significantly improved than those in control group(P＜0.05). PSQI total scores were significantly lower in the study group(P＜0.05); the sleep efficiency, Ⅲ phase sleep and rapid eye movement in the study group were also more markedly improved than those in the control group (P＜0.05). The SAS and SDS scores were decreased significantly after treatment in both groups (P＜0.01), while those in study group were improved more markedly. Conclusion The efficacy of CBT-I combined with eszopiclone is better than eszopiclone in the treatment of sleep disorders in patients discharged from ICU. |
| Key words: Cognitive behavioral therapy for insomnia Eszopiclone tablets Sleep disorders ICU transferred out pa- tients |
