TIP和电针对抑郁症伴失眠患者情绪及多导睡眠图特征的影响研究

发布时间：2018-06-25 12:10

本文选题：TIP + 电针　；参考：《中国中医科学院》2013年博士论文

【摘要】：目的研究TIP和电针对抑郁症伴失眠患者的疗效以及相关性。方法将90例在中国中医科学院广安门医院心理科就诊的抑郁症伴失眠患者随机分为三组,TIP组、电针组、西药组,每组30人,观察6个月。用抑郁自评量表、焦虑自评量表、蒙哥马利抑郁量表评价抑郁疗效,用匹兹堡睡眠质量指数量表、多导睡眠图评价睡眠疗效。所有指标在治疗前、治疗3个月、治疗6个月评价。安全性指标采用血常规、尿常规、肝肾功能、心电图等来评价。TIP组每周治疗2次,电针组每周治疗3次,西药组服用氢溴酸西酞普兰片每天20mg-40mg。数据采用SPSS17.0软件进行统计分析。结果 1.心理指标 1.1组间对比治疗3个月TIP组、西药组、电针组组间对比SDS、SAS评分有显著差异,西药组优于TIP组、电针组(P0.05),电针组与TIP组对比无显著差异(p0.05)；治疗6个月TIP组、西药组、电针组组间对比SDS、SAS评分有显著差异,西药组SAS评分优于TIP组、电针组；西药组、TIP组SDS评分均优于电针组(p0.05)；西药组、TIP组SDS评分无明显差异(p0.05)；治疗3个月、6个月TIP组、西药组、电针组组间对比MADRS评分均无显著差异(p0.05)。 1.2组内对比 TIP组治疗3个月后SAS、MADRS评分与治疗前相比均有显著改善(p0.05),治疗6个月后SDS、SAS、MADRS评分与治疗前相比均有显著改善(p0.05)；西药组、电针组治疗3个月、6个月SDS、SAS、MADRS评分与治疗前相比均有显著改善(p0.05)。 1.3组间差值对比治疗3个月后与治疗前SDS评分差值西药组显著优于TIP组(p0.05)；SAS、MADRS评分差值无显著差异(p0.05)；治疗6个月后与治疗前TIP组、西药组、电针组SDS、SAS、MADRS评分差值无显著差异(p0.05) 2.匹兹堡睡眠质量量表 2.1组间对比治疗3个月后PSQI量表催眠药物评分TIP组显著低于西药组(p0.05)；治疗6个月后三组PSQI各项因子分均无显著差异(p0.05)。 2.2组内对比 TIP组治疗3个月后PSQI评分中睡眠质量、入睡时间、睡眠障碍、总分与治疗前相比均有显著改善(p0.05),治疗6个月后PSQI评分中睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能、总分评分与治疗前相比均有显著改善(p0.05)；西药组治疗3个月后PSQI评分中睡眠质量、睡眠时间、总分与治疗前相比均有显著改善(p0.05),治疗6个月后PSQI评分中睡眠质量、睡眠时间、睡眠效率、日间功能、总分评分与治疗前相比均有显著改善(p0.05)；电针组治疗3个月后PSQI评分中睡眠质量、入睡时间、睡眠时间、睡眠效率、催眠药物、总分与治疗前相比均有显著改善(p0.05),治疗6个月后PSQI评分中睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能、总分评分与治疗前相比均有显著改善(p0.05)。 2.3组间差值治疗3个月后与治疗前PSQI中睡眠效率评分差值电针组显著高于TIP组(p0.05)；治疗6个月后与治疗前PSQI中睡眠效率评分差值电针组显著高于TIP组、西药组(p0.05)。 3.多导睡眠图 3.1组间比较治疗3个月、6个月后与治疗前TIP组、西药组、电针组PSG各项因子无显著差异(p0.05) 3.2组内比较 TIP组治疗3个月后PSG中REM睡眠时间、REM期睡眠百分比、NREM睡眠百分比、NREM期潜伏期与治疗前相比均有显著改善(p0.05),治疗6个月后PSQI评分中觉醒次数、REM睡眠时间、REM期睡眠百分比、NREM睡眠百分比与治疗前相比均有显著改善(p0.05)；西药组治疗3个月后PSG中睡眠时间、NREM期睡眠时间、NREM潜伏期与治疗前相比均有显著改善(p0.05),治疗6个月后PSG评分中睡眠时间、REM期次数、3+4期睡眠时间、3+4期睡眠百分比、REM期睡眠时间与治疗前相比均有显著改善(p0.05) 电针组治疗6个月后PSG中觉醒次数与治疗前相比均有显著改善(p0.05)。 3.3组间差值治疗3个月后TIP组治疗前PSG中REM期时间、REM期百分比差值显著高于西药组(p0.05)；NREM期百分比西药组差值显著高于TIP组；治疗6个月后TIP组治疗前PSG中REM期时间、REM期百分比差值显著高于西药组、电针组(p0.05)；NREM期百分比西药组、电针组差值显著高于TIP组(p0.05) 4.心理和睡眠指标相关性分析抑郁自评量表(SDS)与焦虑自评量表(SAS)、蒙哥马利量表(MADRS)呈显著性正相关(p0.01)；蒙哥马利抑郁量表、焦虑自评量表和PSQI中睡眠障碍呈显著正相关性,和PSQI中其他项目无显著相关性；焦虑自评量表和1期睡眠时间、1期睡眠时间百分呈显著正相关,蒙哥马利抑郁量表和2期睡眠时间、2期睡眠时间百分比、REM潜伏期呈显著负相关。治疗6个月后SDS、SAS、MADRS、PSG、PSQI和治疗前的差值相关性,结果显示PSQI中睡眠质量的改善和SDS、SAS改善呈正相关,总分的改善和SAS改善呈显著正相关；PSG中REM次数和SDS呈显著负相关,PSG中NREM百分比和SAS呈显著负相关。结论 1.TIP治疗、西药治疗、电针治疗对抑郁症伴失眠患者的抑郁、焦虑等情绪有明显的改善作用；在治疗6个月时TIP、电针组与西药组对抑郁、焦虑的改善效果相当,在治疗3个月时西药的疗效优于TIP、电针组。 2.TIP、西药治疗、电针治疗对抑郁症伴失眠患者的睡眠结构、睡眠进程有明显的改善作用；TIP组和电针组、西药组相比REM期时间、REM期百分比显著减少,NREM期百分比显著增加。 3.抑郁自评量表与焦虑自评量表、蒙哥马利抑郁量表呈显著性正相关；蒙哥马利抑郁量表、焦虑自评量表和PSQI中睡眠障碍呈显著正相关性,和PSQI中其他项目无显著相关性；焦虑自评量表和1期睡眠时间、1期睡眠时间百分呈显著正相关,蒙哥马利抑郁量表和2期睡眠时间、2期睡眠时间百分比、REM潜伏期呈显著负相关。 4.PSQI中睡眠质量的改善和SDS、SAS改善正相关,总分的改善和SAS改善显著正相关；PSG中REM次数和SDS呈显著负相关,PSG中NREM百分比和SAS呈显著负相关。
[Abstract]:objective
Objective to study the efficacy and correlation between TIP and electroacupuncture on depressive patients with insomnia.
Method
90 cases of depression with insomnia were randomly divided into three groups: group TIP, electroacupuncture group and Western medicine group, 30 people in each group, 30 people in each group, for 6 months. The self rating depression scale, self rating anxiety scale, Montgomerie depression scale were used to evaluate the effect of depression, and the Pittsburgh sleep quality index scale and polysomnography were used. Evaluate the effect of sleep. All indexes were treated for 3 months before treatment and 6 months of treatment. Safety indexes were evaluated by blood routine, urine routine, liver and kidney function, electrocardiogram and so on to evaluate 2 times a week in group.TIP, 3 times a week in electroacupuncture group, and SPSS17.0 software for the 20mg-40mg. data of Citalopram Hydrobromide Tablets in the western medicine group. Analysis.
Result
1. psychological indicators
Comparison between the 1.1 groups
In the treatment of group TIP for 3 months, the scores of SDS and SAS in the western medicine group and the electroacupuncture group were significantly different. The western medicine group was superior to the TIP group, the electroacupuncture group (P0.05), the electroacupuncture group and the TIP group had no significant difference (P0.05).
In the treatment of group TIP for 6 months, the scores of SDS and SAS were significantly different between the western medicine group and the electroacupuncture group. The SAS score of the western medicine group was better than that of the TIP group. The SDS scores in the electroacupuncture group, the western medicine group and the TIP group were all superior to the electroacupuncture group (P0.05), and the SDS score of the western medicine group and the TIP group had no significant difference (P0.05).
For 3 months and 6 months, there was no significant difference in MADRS score between TIP group, western medicine group and EA group (P0.05).
Comparison of the 1.2 groups
After 3 months of treatment in group TIP, SAS, MADRS scores were significantly improved compared with before treatment (P0.05). After 6 months of treatment, SDS, SAS, MADRS scores were significantly improved compared with before treatment (P0.05).
Western medicine group, EA group for 3 months, 6 months SDS, SAS, MADRS score compared with before treatment were significantly improved (P0.05).
Difference comparison between 1.3 groups
After 3 months treatment, the difference between the western medicine group and the SDS group was significantly better than that of the TIP group (P0.05); the difference between SAS and MADRS score was not significant (P0.05).
After 6 months of treatment, there was no significant difference in the scores of SDS, SAS and MADRS between TIP group, western medicine group and EA group (P0.05).
2. Pittsburgh sleep quality scale
Comparison between the 2.1 groups
After 3 months of treatment, the hypnotic drug score of the PSQI scale was significantly lower in the TIP group than in the western medicine group (P0.05). After 6 months, there was no significant difference in the scores of PSQI between the three groups (P0.05).
Comparison of the 2.2 groups
After 3 months of treatment in group TIP, the quality of sleep, sleep time, sleep disorder and total score were significantly improved (P0.05). After 6 months of treatment, the quality of sleep, time of sleep, sleep time, sleep efficiency, sleep disorder, daytime function and total score were significantly improved (P0.05) after 6 months of treatment (P0.05).
The quality of sleep, sleep time and total score in the PSQI score of the western medicine group were significantly improved after 3 months of treatment (P0.05). The quality of sleep, sleep time, sleep efficiency, daytime function and total score of the PSQI score were significantly improved after 6 months of treatment (P0.05).
The quality of sleep, time of sleep, sleep time, sleep efficiency, hypnotic drugs and total score were significantly improved (P0.05) in the PSQI score after 3 months of electroacupuncture treatment. The quality of sleep, time of sleep, sleep time, sleep time, sleep efficiency, sleep disorders, hypnotic drugs, day function, day function, total score and treatment before treatment in the PSQI score after 6 months were treated. The comparison was significantly improved (P0.05).
Difference between 2.3 groups
The difference between the 3 months after treatment and the PSQI before treatment was significantly higher than that in the TIP group (P0.05).
After 6 months treatment, the difference of sleep efficiency score between PSQI and before treatment was significantly higher than that of TIP group, western medicine group (P0.05).
3. polysomnography
Comparison between the 3.1 groups
After treatment for 3 months, 6 months later, there was no significant difference in PSG between the TIP group, the western medicine group and the EA group (P0.05).
Internal comparison of 3.2 groups
In group TIP 3 months after treatment, the time of REM sleep in PSG, the percentage of REM sleep, the percentage of NREM sleep, and the latency of NREM phase were significantly improved (P0.05). The number of awakening, the REM sleep time, the REM sleep percentage and the NREM sleep percentage were significantly improved after 6 months of treatment (P0.05).
After 3 months of treatment in the western medicine group, the sleep time, the NREM phase sleep time, the NREM latency and the NREM latency were significantly improved (P0.05). After 6 months of treatment, the sleep time, the number of REM phase, the 3+4 phase sleep time, the 3+4 phase sleep percentage and the REM phase sleep time were significantly improved (P0.05).
After 6 months of treatment, the frequency of arousal in PSG was significantly improved compared with that before treatment (P0.05).
Difference between 3.3 groups
After 3 months of treatment, the REM period of PSG in group TIP before treatment was significantly higher than that in western medicine group (P0.05), and the difference between the western medicine group and the NREM group was significantly higher than that of the TIP group.
After 6 months of treatment, the REM period of PSG in group TIP before treatment was significantly higher than that in the western medicine group and the electroacupuncture group (P0.05), the percentage of the western medicine group in the NREM period, and the difference value of the electroacupuncture group was significantly higher than that of the TIP group (P0.05).
4. correlation analysis of psychological and sleep indexes
The self rating Depression Scale (SDS), the self rating Anxiety Scale (SAS) and the Montgomerie scale (MADRS) showed significant positive correlation (P0.01). The Montgomerie depression scale, the self rating Anxiety Scale and the sleep disorder in PSQI had significant positive correlation, and there was no significant correlation with other items in PSQI; the self rating Anxiety Scale and the 1 phase sleep time, and the 1 phase sleep time were 100%. There was a significant positive correlation. There was a significant negative correlation between the Montgomerie depression scale and the 2 stage sleep time, the 2 period sleep time percentage and the latency period of REM.
6 months after treatment, SDS, SAS, MADRS, PSG, PSQI and the difference before treatment were correlated. The results showed that the improvement of sleep quality in PSQI was positively correlated with the improvement of SDS, SAS, and the improvement of total score was positively correlated with the improvement of SAS; REM times in PSG was negatively correlated with SDS, and there was a significant negative correlation between the percentage and the percentage of PSG.
conclusion
1.TIP treatment, western medicine treatment, electroacupuncture treatment of depression with insomnia patients with depression, anxiety and other emotions have a significant improvement. In the 6 months of treatment, TIP, electroacupuncture group and Western Medicine Group on depression, anxiety improvement effect is equivalent, in the 3 month treatment of Western medicine is better than the TIP, Electroacupuncture group.
2.TIP, western medicine treatment, electroacupuncture treatment of depression with insomnia patients sleep structure, sleep process has a significant improvement effect. TIP and electroacupuncture group, western medicine group, compared with the REM time, the percentage of REM phase decreased significantly, the percentage of NREM stage increased significantly.
3. the self rating Depression Scale was significantly positively correlated with the self rating Anxiety Scale and the Montgomerie depression scale, and the Montgomerie depression scale, the self rating Anxiety Scale and the sleep disorder in PSQI had significant positive correlation, and there was no significant correlation with other items in PSQI; the self rating Anxiety Scale and the time of sleep and sleep were significantly positively correlated with the 1 stages of sleep time. There was a significant negative correlation between the Montgomerie depression scale and the 2 stage sleep time, the 2 period sleep time percentage and the latency period of REM.
The improvement of sleep quality in 4.PSQI was positively correlated with the improvement of SDS and SAS, the improvement of total score was significantly positively correlated with the improvement of SAS; the REM times in PSG was negatively correlated with SDS, and the percentage of NREM in PSG was negatively correlated with SAS.
【学位授予单位】：中国中医科学院
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R245

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