發(fā)布時間：2018-06-25 12:10

  本文選題：TIP + 電針　； 參考：《中國中醫(yī)科學(xué)院》2013年博士論文

【摘要】：目的 研究TIP和電針對抑郁癥伴失眠患者的療效以及相關(guān)性。 方法 將90例在中國中醫(yī)科學(xué)院廣安門醫(yī)院心理科就診的抑郁癥伴失眠患者隨機(jī)分為三組,TIP組、電針組、西藥組,每組30人,觀察6個月。用抑郁自評量表、焦慮自評量表、蒙哥馬利抑郁量表評價抑郁療效,用匹茲堡睡眠質(zhì)量指數(shù)量表、多導(dǎo)睡眠圖評價睡眠療效。所有指標(biāo)在治療前、治療3個月、治療6個月評價。安全性指標(biāo)采用血常規(guī)、尿常規(guī)、肝腎功能、心電圖等來評價。TIP組每周治療2次,電針組每周治療3次,西藥組服用氫溴酸西酞普蘭片每天20mg-40mg。數(shù)據(jù)采用SPSS17.0軟件進(jìn)行統(tǒng)計分析。 結(jié)果 1.心理指標(biāo) 1.1組間對比 治療3個月TIP組、西藥組、電針組組間對比SDS、SAS評分有顯著差異,西藥組優(yōu)于TIP組、電針組(P0.05),電針組與TIP組對比無顯著差異(p0.05)； 治療6個月TIP組、西藥組、電針組組間對比SDS、SAS評分有顯著差異,西藥組SAS評分優(yōu)于TIP組、電針組；西藥組、TIP組SDS評分均優(yōu)于電針組(p0.05)；西藥組、TIP組SDS評分無明顯差異(p0.05)； 治療3個月、6個月TIP組、西藥組、電針組組間對比MADRS評分均無顯著差異(p0.05)。 1.2組內(nèi)對比 TIP組治療3個月后SAS、MADRS評分與治療前相比均有顯著改善(p0.05),治療6個月后SDS、SAS、MADRS評分與治療前相比均有顯著改善(p0.05)； 西藥組、電針組治療3個月、6個月SDS、SAS、MADRS評分與治療前相比均有顯著改善(p0.05)。 1.3組間差值對比 治療3個月后與治療前SDS評分差值西藥組顯著優(yōu)于TIP組(p0.05)；SAS、MADRS評分差值無顯著差異(p0.05)； 治療6個月后與治療前TIP組、西藥組、電針組SDS、SAS、MADRS評分差值無顯著差異(p0.05) 2.匹茲堡睡眠質(zhì)量量表 2.1組間對比 治療3個月后PSQI量表催眠藥物評分TIP組顯著低于西藥組(p0.05)；治療6個月后三組PSQI各項因子分均無顯著差異(p0.05)。 2.2組內(nèi)對比 TIP組治療3個月后PSQI評分中睡眠質(zhì)量、入睡時間、睡眠障礙、總分與治療前相比均有顯著改善(p0.05),治療6個月后PSQI評分中睡眠質(zhì)量、入睡時間、睡眠時間、睡眠效率、睡眠障礙、日間功能、總分評分與治療前相比均有顯著改善(p0.05)； 西藥組治療3個月后PSQI評分中睡眠質(zhì)量、睡眠時間、總分與治療前相比均有顯著改善(p0.05),治療6個月后PSQI評分中睡眠質(zhì)量、睡眠時間、睡眠效率、日間功能、總分評分與治療前相比均有顯著改善(p0.05)； 電針組治療3個月后PSQI評分中睡眠質(zhì)量、入睡時間、睡眠時間、睡眠效率、催眠藥物、總分與治療前相比均有顯著改善(p0.05),治療6個月后PSQI評分中睡眠質(zhì)量、入睡時間、睡眠時間、睡眠效率、睡眠障礙、催眠藥物、日間功能、總分評分與治療前相比均有顯著改善(p0.05)。 2.3組間差值 治療3個月后與治療前PSQI中睡眠效率評分差值電針組顯著高于TIP組(p0.05)； 治療6個月后與治療前PSQI中睡眠效率評分差值電針組顯著高于TIP組、西藥組(p0.05)。 3.多導(dǎo)睡眠圖 3.1組間比較 治療3個月、6個月后與治療前TIP組、西藥組、電針組PSG各項因子無顯著差異(p0.05) 3.2組內(nèi)比較 TIP組治療3個月后PSG中REM睡眠時間、REM期睡眠百分比、NREM睡眠百分比、NREM期潛伏期與治療前相比均有顯著改善(p0.05),治療6個月后PSQI評分中覺醒次數(shù)、REM睡眠時間、REM期睡眠百分比、NREM睡眠百分比與治療前相比均有顯著改善(p0.05)； 西藥組治療3個月后PSG中睡眠時間、NREM期睡眠時間、NREM潛伏期與治療前相比均有顯著改善(p0.05),治療6個月后PSG評分中睡眠時間、REM期次數(shù)、3+4期睡眠時間、3+4期睡眠百分比、REM期睡眠時間與治療前相比均有顯著改善(p0.05) 電針組治療6個月后PSG中覺醒次數(shù)與治療前相比均有顯著改善(p0.05)。 3.3組間差值 治療3個月后TIP組治療前PSG中REM期時間、REM期百分比差值顯著高于西藥組(p0.05)；NREM期百分比西藥組差值顯著高于TIP組； 治療6個月后TIP組治療前PSG中REM期時間、REM期百分比差值顯著高于西藥組、電針組(p0.05)；NREM期百分比西藥組、電針組差值顯著高于TIP組(p0.05) 4.心理和睡眠指標(biāo)相關(guān)性分析 抑郁自評量表(SDS)與焦慮自評量表(SAS)、蒙哥馬利量表(MADRS)呈顯著性正相關(guān)(p0.01)；蒙哥馬利抑郁量表、焦慮自評量表和PSQI中睡眠障礙呈顯著正相關(guān)性,和PSQI中其他項目無顯著相關(guān)性；焦慮自評量表和1期睡眠時間、1期睡眠時間百分呈顯著正相關(guān),蒙哥馬利抑郁量表和2期睡眠時間、2期睡眠時間百分比、REM潛伏期呈顯著負(fù)相關(guān)。 治療6個月后SDS、SAS、MADRS、PSG、PSQI和治療前的差值相關(guān)性,結(jié)果顯示PSQI中睡眠質(zhì)量的改善和SDS、SAS改善呈正相關(guān),總分的改善和SAS改善呈顯著正相關(guān)；PSG中REM次數(shù)和SDS呈顯著負(fù)相關(guān),PSG中NREM百分比和SAS呈顯著負(fù)相關(guān)。 結(jié)論 1.TIP治療、西藥治療、電針治療對抑郁癥伴失眠患者的抑郁、焦慮等情緒有明顯的改善作用；在治療6個月時TIP、電針組與西藥組對抑郁、焦慮的改善效果相當(dāng),在治療3個月時西藥的療效優(yōu)于TIP、電針組。 2.TIP、西藥治療、電針治療對抑郁癥伴失眠患者的睡眠結(jié)構(gòu)、睡眠進(jìn)程有明顯的改善作用；TIP組和電針組、西藥組相比REM期時間、REM期百分比顯著減少,NREM期百分比顯著增加。 3.抑郁自評量表與焦慮自評量表、蒙哥馬利抑郁量表呈顯著性正相關(guān)；蒙哥馬利抑郁量表、焦慮自評量表和PSQI中睡眠障礙呈顯著正相關(guān)性,和PSQI中其他項目無顯著相關(guān)性；焦慮自評量表和1期睡眠時間、1期睡眠時間百分呈顯著正相關(guān),蒙哥馬利抑郁量表和2期睡眠時間、2期睡眠時間百分比、REM潛伏期呈顯著負(fù)相關(guān)。 4.PSQI中睡眠質(zhì)量的改善和SDS、SAS改善正相關(guān),總分的改善和SAS改善顯著正相關(guān)；PSG中REM次數(shù)和SDS呈顯著負(fù)相關(guān),PSG中NREM百分比和SAS呈顯著負(fù)相關(guān)。
[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.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R245

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