重复经颅磁刺激联合认知行为心理治疗对失眠症患者的治疗作用

摘要

Objective: To investigate therapeutical effects of repetitive transcranial magnetic stimulation ( rTMS ) combined with cognitive-behavioral therapy ( CBT) for insomnia. Methods:93 patients meeting ICD-10 criteria of insomnia were randomized into study group (n=31, treated with rTMS combined with CBT) and control group (n=62, treated with rTMS or CBT). All patients were assessed with Pittsburgh sleep quality index (PSQI) at baseline and the end of the 2nd and 24th week of the treatment to evaluate the efficacy. Results:There were significant differences in response rate at the end of the 24th week among study group and control group (87. 1% vs 48. 4%, 38. 7%, x2=26. 082, P<0. 05), and the differences of the total response rates among the three groups were statistically significant (x2=16. 692, P<0. 05). The scores of PSQI in the three groups decreased significantly at the end of the 24th week when compared with the baseline (P<0. 01), and there were also significant differences among the three groups (P<0. 05). Two weeks after the treatment, the score of PSQI of CBT group was significantly higher than those of the other two groups;however, 24 weeks later, the score of study group was obviously lower than those of the other two groups. Conclusions:Repetitive transcranial mag-netic stimulation combined with cognitive behavioral psychotherapy is superior to any single therapy in the treatment of insomnia.%目的：：探讨重复经颅磁刺激( rTMS)联合认知行为心理治疗( CBT)对失眠症患者的治疗作用。方法：对符合ICD-10诊断的93例失眠症患者随机分为研究组、rTMS组和CBT组,每组各31例。研究组患者给予rTMS合并认知行为治疗；rTMS组患者单纯给予rTMS治疗；CBT组患者单纯给予认知行为治疗。在基线、2周末、24周末采用匹兹堡睡眠质量指数( PSQI)对3组患者进行疗效评估。结果：在完成24周治疗后,研究组、rTMS组和CBT组患者的有效率分别为87.1%、48.4%、38.7%,3组患者的疗效分布存在显著差异( x2=26.082,P<0.05)。3组患者的总有效率比较差异有统计学意义(x2=16.692,P<0.05)。治疗后第24周末,3组患者的PSQI总分与其治疗前比较均显著下降(P<0.01),组间对比差异显著(P<0.05)。干预2周后,CBT组患者的得分要显著高于其它两组；干预24周后,治疗组患者得分显著低于其余两组。结论：重复经颅磁刺激联合认知行为心理治疗治疗失眠症患者的疗效要优于任一单一治疗。