原发性失眠患者情绪状态及治疗的对比研究分析

发布时间：2018-06-16 02:19

本文选题：原发性失眠 + 睡眠质量　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:对原发性失眠患者睡眠质量的影响因素、情绪状态及其相关性进行研究,探讨原发性失眠患者睡眠状态的影响因素,并探讨不同治疗方式对原发性失眠患者睡眠质量和情绪状态的影响。方法:研究组选择2013年10月至2014年10月间在南昌大学第一附属医院心身医学科就诊且符合原发性失眠诊断标准的患者94例,并采取抽签的方式分为米氮平治疗组,米氮平联合认知行为治疗组,认知行为治疗组;对照组选择同时期陪同在我科就诊的47例正常睡眠者。所有研究对象均签署知情同意书,并于入组24小时内使用一般资料调查表、匹兹堡睡眠质量指数量表、睡眠状况自评量表、失眠严重指数量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表、心境状态量表、社会支持评定量表对所有入组对象进行检测,并于入组的当晚使用健身智能腕带检测患者的实际睡眠时间;两组研究对象8周后再次进行评定。所有数据均使用SPSS 17.0软件进行分析,计算出原发性失眠患者的PSQI评分,评估其睡眠质量;采用配对样本t检验检测两组患者一般人口学特点、睡眠质量以及汉密尔顿抑郁/焦虑量表、心境状态量表、社会支持度量表评分的差异性;采用多元素线性回归分析分析多种客观因素如性别、受教育年限、居住地,失眠严重程度,失眠年数,情绪状态等对失眠患者睡眠质量的影响;采用方差分析不同治疗方式对研究组睡眠状态的影响,以及治疗后失眠患者情绪状态的变化。结果:1.原发性失眠患者的睡眠质量远低于正常健康人群,其PSQI评分为(15.16±2.20),远高于正常睡眠人群得分(3.56±1.59),两者具有明显的差异性(P0.05),并且,失眠患者的得分也高于全国常模PSQI得分(14.00±3.21);且其情绪状态不佳,表现出一定程度的的焦虑和抑郁(HAMD评分为(10.04±4.93),HAMA评分为(8.15±3.60)),心境状态较差(POMS评分为(117.78±24.41)),所得到的的社会支持度低(SSRS评分为(35.11±4.41)),与正常健康人群相比((HAMD评分为(4.75±2.90),HAMA评分为(3.24±2.79),POMS评分为(84.75±19.02),SSRS评分为(49.02±3.84)),两者具有明显的差异性(P0.05)。2.影响研究组睡眠状况的单因素分析显示性别、居住地、婚姻状况、职业状态、既往服药史、自评家庭经济收入状态等6个变量存在明显的差异性(P0.05);影响研究组睡眠状况相关因素的多元素线性回归分析显示性别、中或低收入状态对原发性失眠的睡眠状态的回归作用显著(p0.05),说明性别、自评家庭经济收入状态对原发性失眠患者的睡眠质量存在明显影响。3.8周后,研究组患者的睡眠质量明显改善,PSQI评分减低(7.89±1.93),情绪状态((HAMD评分为(7.74±2.87),HAMA评分为(7.07±2.94))、心境状态(POMS评分为(68.54±21.69))、社会支持度(SSRS评分为(51.27±3.28))都有相应的改善,治疗前后的组内比较,及治疗后研究组和对照组相比,两者的睡眠质量及其情绪状态都具有明显的差异,且差异具有统计学意义(P0.05)。4.不同治疗方式的研究组患者在治疗后的睡眠质量及情绪状态都有明显的改善,前后比较均具有明显的统计学差异性(P0.05),采用单因素方差分析(ANOVA)考察治疗前后三组之间的睡眠状况和相关行为学量表评分比较,结果显示并无统计学意义(P0.05),而从其PSQI量表减分率来看,药物联合认知行为治疗的效果优于单纯药物治疗和认知行为治疗。结论:原发性失眠患者的睡眠质量较差,远低于正常健康人群,容易产生焦虑、抑郁或等负性心境,且社会支持度较差。药物和认知行为治疗均能明显改善患者的睡眠质量,但是,药物联合认知行为治疗的效果优于单纯药物治疗和认知行为治疗。
[Abstract]:Objective: To study the factors affecting the sleep quality of the patients with primary insomnia, the emotional state and its correlation, to explore the influence factors of the sleep state of the patients with primary insomnia, and to explore the effects of different treatment methods on the sleep quality and emotional state of the patients with primary insomnia. The study group chose between October 2013 and October 2014. 94 patients in the Department of psychosomatic medicine, the First Affiliated Hospital of Nanchang University, were diagnosed with primary insomnia and were divided into mirtazapine treatment group, mirtazapine, cognitive behavior therapy group, cognitive behavior therapy group, and 47 normal sleep patients accompanied by the same period in our department. All the subjects were selected. The general information questionnaire was signed and the general data questionnaire was used within 24 hours. The Pittsburgh sleep quality index scale, the sleep status self rating scale, the insomnia severity index scale, the Hamilton depression scale, the Hamilton anxiety scale, the mood state scale, the social support rating scale, and the social support rating scale were tested and included in the group. Two groups of subjects were evaluated again after 8 weeks. All the data were analyzed by SPSS 17 software. The PSQI score of the patients with primary insomnia was calculated and the quality of sleep was evaluated. A paired sample t test was used to detect the general demographic characteristics of the two groups of patients and sleep. Quality and Hamilton depression / anxiety scale, mood state scale, and social support scale score difference; multielement linear regression analysis was used to analyze the effects of many objective factors such as sex, years of education, residence, insomnia severity, insomnia years, mood state and so on on the sleep quality of insomniacs; analysis of variance analysis The effects of different treatments on the sleep state of the study group and the changes in the emotional state of the patients with insomnia after treatment. Results: 1. the sleep quality of the patients with primary insomnia was much lower than that of the normal healthy people, and the PSQI score was (15.16 + 2.20), far higher than that of the normal sleep population (3.56 + 1.59), and the difference was significant (P0.05), and the loss of sleep was significantly different. The scores of sleeping patients were also higher than the national norm PSQI score (14 + 3.21), and their emotional state was poor, showing a certain degree of anxiety and depression (HAMD score (10.04 + 4.93), HAMA score (8.15 + 3.60)), poor mood state (POMS score (117.78 + 24.41)), and low social support (SSRS score (35.11 + 4.41)), and (HAMD score was (4.75 + 2.90), HAMA score was (3.24 + 2.79), POMS score was (84.75 + 19.02), and SSRS score was (49.02 + 3.84)). The single factor analysis of the difference (P0.05).2. affected the sleep status of the study group showed that sex, residence, marital status, occupational state, history of past medication, and self-assessment of family classics. The 6 variables, such as the state of economic income, were obviously different (P0.05), and the multiple linear regression analysis of the factors related to the sleep status of the study group showed that the regression effect of sex, middle or low income on the sleep state of primary insomnia was significant (P0.05), indicating the sex and self evaluation of the family economic income state to the sleep of the primary insomnia patients. After.3.8 weeks, the sleep quality of the patients in the study group was obviously improved, the PSQI score was reduced (7.89 + 1.93), the mood state ((HAMD score was (7.74 + 2.87), HAMA score was (7.07 + 2.94)), the mood state (POMS score was 68.54 + 21.69), and the social support (SSRS score (51.27 + 3.28)) had the corresponding improvement, before and after the treatment. Compared with the treatment group and the control group, the quality of sleep and the emotional state of the two groups were significantly different, and the difference had statistical significance (P0.05). The sleep quality and emotional state of the patients in the study group with different methods of.4. were obviously improved after the treatment, and the difference was statistically significant difference before and after the treatment. P0.05, using single factor analysis of variance (ANOVA) to compare the sleep status between the three groups before and after treatment and the correlation of the related behavior scale, the results showed no statistical significance (P0.05), but from the PSQI scale reduction rate, the effect of drug combined cognitive behavior treatment was better than that of drug treatment and cognitive behavioral therapy. The quality of sleep in the patients with primary insomnia is poor, which is far lower than that of normal healthy people. It is easy to produce anxiety, depression, or negative mood, and the social support is poor. Drugs and cognitive behavior therapy can improve the sleep quality of the patients obviously, but the effect of drug combined cognitive behavior therapy is better than that of pure drug therapy and cognitive behavior therapy.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R740

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