本文選題：原發(fā)性失眠 + 睡眠質(zhì)量��； 參考：《南昌大學(xué)》2015年碩士論文

【摘要】：目的:對原發(fā)性失眠患者睡眠質(zhì)量的影響因素、情緒狀態(tài)及其相關(guān)性進行研究,探討原發(fā)性失眠患者睡眠狀態(tài)的影響因素,并探討不同治療方式對原發(fā)性失眠患者睡眠質(zhì)量和情緒狀態(tài)的影響。方法:研究組選擇2013年10月至2014年10月間在南昌大學(xué)第一附屬醫(yī)院心身醫(yī)學(xué)科就診且符合原發(fā)性失眠診斷標(biāo)準(zhǔn)的患者94例,并采取抽簽的方式分為米氮平治療組,米氮平聯(lián)合認(rèn)知行為治療組,認(rèn)知行為治療組;對照組選擇同時期陪同在我科就診的47例正常睡眠者。所有研究對象均簽署知情同意書,并于入組24小時內(nèi)使用一般資料調(diào)查表、匹茲堡睡眠質(zhì)量指數(shù)量表、睡眠狀況自評量表、失眠嚴(yán)重指數(shù)量表、漢密爾頓抑郁量表、漢密爾頓焦慮量表、心境狀態(tài)量表、社會支持評定量表對所有入組對象進行檢測,并于入組的當(dāng)晚使用健身智能腕帶檢測患者的實際睡眠時間;兩組研究對象8周后再次進行評定。所有數(shù)據(jù)均使用SPSS 17.0軟件進行分析,計算出原發(fā)性失眠患者的PSQI評分,評估其睡眠質(zhì)量;采用配對樣本t檢驗檢測兩組患者一般人口學(xué)特點、睡眠質(zhì)量以及漢密爾頓抑郁/焦慮量表、心境狀態(tài)量表、社會支持度量表評分的差異性;采用多元素線性回歸分析分析多種客觀因素如性別、受教育年限、居住地,失眠嚴(yán)重程度,失眠年數(shù),情緒狀態(tài)等對失眠患者睡眠質(zhì)量的影響;采用方差分析不同治療方式對研究組睡眠狀態(tài)的影響,以及治療后失眠患者情緒狀態(tài)的變化。結(jié)果:1.原發(fā)性失眠患者的睡眠質(zhì)量遠(yuǎn)低于正常健康人群,其PSQI評分為(15.16±2.20),遠(yuǎn)高于正常睡眠人群得分(3.56±1.59),兩者具有明顯的差異性(P0.05),并且,失眠患者的得分也高于全國常模PSQI得分(14.00±3.21);且其情緒狀態(tài)不佳,表現(xiàn)出一定程度的的焦慮和抑郁(HAMD評分為(10.04±4.93),HAMA評分為(8.15±3.60)),心境狀態(tài)較差(POMS評分為(117.78±24.41)),所得到的的社會支持度低(SSRS評分為(35.11±4.41)),與正常健康人群相比((HAMD評分為(4.75±2.90),HAMA評分為(3.24±2.79),POMS評分為(84.75±19.02),SSRS評分為(49.02±3.84)),兩者具有明顯的差異性(P0.05)。2.影響研究組睡眠狀況的單因素分析顯示性別、居住地、婚姻狀況、職業(yè)狀態(tài)、既往服藥史、自評家庭經(jīng)濟收入狀態(tài)等6個變量存在明顯的差異性(P0.05);影響研究組睡眠狀況相關(guān)因素的多元素線性回歸分析顯示性別、中或低收入狀態(tài)對原發(fā)性失眠的睡眠狀態(tài)的回歸作用顯著(p0.05),說明性別、自評家庭經(jīng)濟收入狀態(tài)對原發(fā)性失眠患者的睡眠質(zhì)量存在明顯影響。3.8周后,研究組患者的睡眠質(zhì)量明顯改善,PSQI評分減低(7.89±1.93),情緒狀態(tài)((HAMD評分為(7.74±2.87),HAMA評分為(7.07±2.94))、心境狀態(tài)(POMS評分為(68.54±21.69))、社會支持度(SSRS評分為(51.27±3.28))都有相應(yīng)的改善,治療前后的組內(nèi)比較,及治療后研究組和對照組相比,兩者的睡眠質(zhì)量及其情緒狀態(tài)都具有明顯的差異,且差異具有統(tǒng)計學(xué)意義(P0.05)。4.不同治療方式的研究組患者在治療后的睡眠質(zhì)量及情緒狀態(tài)都有明顯的改善,前后比較均具有明顯的統(tǒng)計學(xué)差異性(P0.05),采用單因素方差分析(ANOVA)考察治療前后三組之間的睡眠狀況和相關(guān)行為學(xué)量表評分比較,結(jié)果顯示并無統(tǒng)計學(xué)意義(P0.05),而從其PSQI量表減分率來看,藥物聯(lián)合認(rèn)知行為治療的效果優(yōu)于單純藥物治療和認(rèn)知行為治療。結(jié)論:原發(fā)性失眠患者的睡眠質(zhì)量較差,遠(yuǎn)低于正常健康人群,容易產(chǎn)生焦慮、抑郁或等負(fù)性心境,且社會支持度較差。藥物和認(rèn)知行為治療均能明顯改善患者的睡眠質(zhì)量,但是,藥物聯(lián)合認(rèn)知行為治療的效果優(yōu)于單純藥物治療和認(rèn)知行為治療。
[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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R740

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