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论著:药物和认知行为疗法治疗社区老年人慢性失眠的随机对照研究
Pharmacological and Cognitive Behavior Therapies for Community Older Adults with Chronic Insomnia: a Randomized Controlled Trial
顾杰 江孙芳 李文昌 杨华 龚剑 周敬 陶皓珣 曾恒 祝墡珠
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作者单位:复旦大学附属中山医院全科医学科
中文关键字:老年人;慢性失眠;唑吡坦;认知行为治疗
英文关键字:Old adults; Chronic insomnia; Zolpidem; Cognitive behavior therapy
中文摘要:目的:评价药物和认知行为治疗对社区老年慢性失眠患者的疗效。方法:60例社区老年慢性失眠患者随机分为对照组、药物组、认知行为组和综合组4组,患者接受为期8周的治疗和治疗结束后3个月及6个月的随访。以睡眠潜伏期、总睡眠时间和睡眠效率的变化为效应指标。结果:治疗结束时,认知行为组总睡眠时间(384.7±78.1) min,显著高于对照组(P=0.0001),认知行为组睡眠效率(74.11±16.76)%,显著高于药物组(P=0.0096);综合组睡眠潜伏期(29.2±12.3)min,显著低于对照组(P=0.0051),综合组总睡眠时间(378.5±60.7)min,显著高于对照组(P=0.0083)。治疗结束后6个月,综合组睡眠潜伏期(16.8±4.9)min,显著低于对照组(P<0.0001)、药物组(P<0.0001)和认知行为组(P=0.0003);综合组总睡眠时间(377.5±34.9)min,显著高于对照组(P=0.0005)和药物组(P<0.0001);综合组睡眠效率(75.74±6.43)%,显著高于药物组(P<0.0001)。结论:药物治疗社区老年人慢性失眠短期疗效有限,远期“反跳”严重,综合治疗远期疗效肯定。
英文摘要:Objective:To evaluate the clinical results of pharmacological and cognitive behavior therapies for community older adults with chronic insomnia. Methods: 60 older adults with chronic insomnia were randomized into four groups, three of which were given a 8 week intervention consisting of pharmacotherapy, cognitive behavior therapy, or both; the other one was a control group. Follow up assessments were conducted at 3 and 6 months. The main outcome measures were sleep latency, total sleep time and sleep efficiency. Results: At the end of treatments, the total sleep time of the cognitive behavior therapy group was (384.7±78.1) min which was longer than the control group(P=0.0001), the sleep efficiency of the cognitive behavior therapy group was (74.11±16.76)% which was higher than the pharmacotherapy group(P=0.0096). The sleep latency of the combined group was (29.2±12.3) min which was shorter than the control group(P=0.0051), the total sleep time of the combined group was (378.5±60.7) min which was longer than the control group(P=0.0083). After 6 months’follow up, the sleep latency of the combined group was (16.8±4.9) min which was shorter than the control group (P<0.0001), pharmacotherapy group (P<0.0001) and the cognitive behavior group (P=0.0003); the total sleep time of the combined group was (377.5±34.9) min which was longer than control group(P=0.0005) and pharmacotherapy group(P<0.0001), the sleep efficiency was (75.74±6.43)% which was higher than the pharmacotherapy group(P<0.0001). Conclusions: The short term effect of the pharmacotherapy is limited, while the long term ‘rebound’ effect is serious. The combined group shows a long term effect.
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