[关键词]
[摘要]
目的 探讨艾司唑仑联合经颅磁刺激(rTMS)治疗老年慢性失眠的临床效果。方法 前瞻性选取2018年10月—2020年10月遂宁市中心医院收治的148例老年慢性失眠患者为研究对象,随机数字表法将患者分为药物组(n=49)、rTMS组(n=49)、联合组(n=50),药物组给予艾司唑仑片,晚上入睡前口服1 mg,每天1次;rTMS组给予低频rTMS,应用YRD CCY-1型经颅磁刺激器,取坐位,将其安放于四神聪、安眠、本神、百会、神庭穴位,刺激频率1 Hz,刺激时间每个序列选定50 s,间歇5 s,连续治疗1 500次脉冲,每天1次;联合组给予艾司唑仑片+低频rTMS,艾司唑仑片用法用量同药物组,低频rTMS具体步骤同rTMS组。3组均治疗1个月。对比3组临床疗效和不良反应情况,对比3组患者治疗前后匹兹堡睡眠质量指数(PSQI)、多导睡眠图(PSG)相关指标[睡眠潜伏期(SOL)、睡眠效率(SE)、快速眼动期(REM)]、情景记忆指标[听觉词语记忆测验(AVMT),包括短延迟回忆、长延迟回忆、即刻记忆]、焦虑自评量表(SAS)、抑郁自评量表(SDS)、神经递质[γ-氨基丁酸(GABA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)]水平。结果 治疗1个月后,联合组治疗总有效率为92.00%,药物组和rTMS组治疗总有效率分别为75.51%和71.43%,联合组总有效率显著高于药物组和rTMS组(P<0.05),药物组和rTMS组治疗总有效率比较差异无统计学意义(P>0.05)。治疗前3组患者睡眠质量指标PSQI评分、SOL、SE、REM比较,差异无统计学意义(P>0.05),治疗1个月后3组患者睡眠质量指标PSQI评分、SOL、SE、REM均较治疗前明显改善(P<0.05);治疗1个月后联合组PSQI评分显著低于药物组和rTMS组(P<0.05),SOL显著短于药物组和rTMS组(P<0.05),SE、REM显著高于药物组和rTMS组(P<0.05);治疗1个月后药物组SOL显著短于rTMS组,SE、REM显著高于rTMS组(P<0.05)。治疗前3组AVMT评分比较,差异无统计学意义(P>0.05),治疗1个月后3组AVMT评分各项水平均较治疗前显著提高(P<0.05);治疗1个月后联合组短延迟回忆、长延迟回忆、即刻记忆评分均高于药物组和rTMS组(P<0.05),且rTMS组各项指标显著高于药物组(P<0.05)。治疗前3组患者SAS、SDS评分比较,差异无统计学意义(P>0.05);治疗1个月后3组患者SAS、SDS评分均较治疗前显著降低(P<0.05);治疗1个月后联合组患者SAS、SDS评分显著低于药物组和rTMS组(P<0.05),治疗1个月后药物组和rTMS组患者SAS、SDS评分比较,差异无统计学意义(P>0.05)。治疗前3组患者血清GABA、5-HT、NE水平比较,差异无统计学意义(P>0.05);治疗1个月后3组患者血清GABA、5-HT水平均较治疗前显著升高(P<0.05),NE水平较治疗前显著降低(P<0.05);治疗1个月后联合组患者血清5-HT、GABA水平显著高于药物组和rTMS组(P<0.05),NE水平显著低于药物组和rTMS组(P<0.05);治疗1个月后药物组和rTMS组血清5-HT、GABA、NE水平比较,差异均无统计学意义(P>0.05)。3组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 艾司唑仑联合rTMS治疗老年慢性失眠效果确切,有利于调节神经递质水平,改善睡眠质量,减轻焦虑、抑郁程度,提高记忆功能,且安全性高。
[Key word]
[Abstract]
Objective To investigate the effect of estazolam combined with repetitive transcranial magnetic stimulation (rTMS) in treatment of elderly patients with chronic insomnia. Methods A total of 148 elderly patients with chronic insomnia treated in Suining Central Hospital from October 2018 to October 2020 were prospectively selected as the research objects. The patients were randomly divided into drug group (n= 49), rTMS group (n= 49) and combined group (n= 50). Patients in the drug group were given Estazolam Tablets, 1 mg orally before going to sleep at night, once a day. Patients in the rTMS group were given lowfrequency rTMS and applied YRD CCY-1 transcranial magnetic stimulator. The sitting position was taken and placed at the acupoints of Sishencong, Anmian, Benshen,Baihui and Shenting. The stimulation frequency was 1 Hz. The stimulation time was selected for 50 s in each sequence, with an interval of 5 s. 1 500 pulses were treated continuously, once a day. Patients in the the combined group were given Estazolam Tablets + low-frequency rTMS. The usage and dosage of Estazolam Tablets were the same as those in the drug group, and the specific steps of low-frequency rTMS were the same as those in the rTMS group. All three groups were treated for one month. The clinical efficacy and adverse reactions of the three groups were compared. Before and after treatment, Pittsburgh sleep quality index (PSQI), polysomnography (PSG) related indexes [sleep latency (SOL), sleep efficiency (SE), rapid eye movement (REM)], episodic memory indexes [auditory word memory test (AVMT), including short delayed memory, long delayed memory, immediate memory], self rating anxiety scale (SAS), self rating depression scale (SDS), neurotransmitters[γ -aminobutyric acid (GABA), 5-hydroxytryptamine (5-HT), norepinephrine (NE)] levels. Results After one month of treatment, the total effective rate of the combined group was 92.00%, and that of the drug group and rTMS group were 75.51% and 71.43% respectively. The total effective rate of the combined group was significantly higher than that of the drug group and rTMS group (P<0.05). There was no statistical difference between the drug group and rTMS group (P>0.05). There was no significant difference in PSQI score, SOL, SE and REM among the three groups before treatment (P>0.05). One month after treatment, the PSQI score, SOL, SE and REM of the three groups were significantly improved compared with those before treatment (P<0.05). One month after treatment, the PSQI score of the combined group was significantly lower than that of the drug group and rTMS group (P<0.05), the SOL was significantly shorter than that of the drug group and rTMS group (P<0.05), and the SE and REM were significantly higher than that of the drug group and rTMS group (P<0.05). After one month of treatment, SOL in the drug group was significantly shorter than that in the rTMS group, and SE and REM were significantly higher than those in the rTMS group (P<0.05). There was no significant difference in AVMT scores between the three groups before treatment (P>0.05). After one month of treatment, the AVMT scores of the three groups were significantly higher than those before treatment (P<0.05). One month after treatment, the scores of short delayed memory, long delayed memory and immediate memory in the combined group were higher than those in the drug group and rTMS group (P<0.05), and the indexes in rTMS group were significantly higher than those in the drug group (P<0.05). There was no significant difference in SAS and SDS scores among the three groups before treatment (P>0.05). After one month of treatment, the scores of SAS and SDS in the three groups were significantly lower than those before treatment (P<0.05). After one month of treatment, the scores of SAS and SDS in the combined group were significantly lower than those in the drug group and rTMS group (P<0.05). There was no significant difference between the drug group and rTMS group (P>0.05). There was no significant difference in serum GABA, 5-HT and NE levels among the three groups before treatment (P>0.05). One month after treatment, the levels of serum GABA and 5-HT in the three groups were significantly higher than those before treatment (P<0.05), and the level of NE was significantly lower than those before treatment (P<0.05). After one month of treatment, the levels of serum 5-HT and GABA in the combined group were significantly higher than those in the drug group and rTMS group (P<0.05), and the levels of NE were significantly lower than those in the drug group and rTMS group (P<0.05). After one month of treatment, there was no significant difference in the levels of serum 5-HT, GABA and NE between the drug group and rTMS group (P>0.05). There was no significant difference in the total incidence of adverse reactions among the three groups (P>0.05). Conclusion Estazolam combined with rTMS is effective in the treatment of chronic insomnia in the elderly. It is beneficial to regulate the level of neurotransmitters, improve sleep quality, reduce the degree of anxiety and depression, improve memory function, and has high safety.
[中图分类号]
R971
[基金项目]