老年人失眠的评估工具及非药物治疗的研究进展

介绍了有关失眠的客观评估和主观评估工具．重点阐述了睡眠卫生教育、睡眠行为疗法、限制疗法、认知疗法、时相疗法、诱导睡眠、光照疗法、物理疗法等非药物治疗失眠的方法，以期对老年失眠病人提供有效的评估工具和非药物干预措施。     

光疗在失眠症中的应用

失眠症（insomnia）是最常见的一种睡眠障碍性疾病,是多种躯体、精神和行为疾病所具有的常见临床表现[1].在人群中,男女老幼均可发生.失眠指睡眠的发生和/或维持发生障碍致使睡眠缺失,表现为入睡困难（起始失眠）、易醒（持续失眠）和晨间早醒,也可指患者感觉未得到充分的休息,常主诉嗜睡、萎靡、疲劳等.治疗失眠较理想的方法是综合治疗,包括药物疗法和非药物疗法,药物疗法因产生药物副作用和必须长期服用,经常给患者和医生带来不便.而非药物疗法则无上述副作用,能有效地缓解症状,所以应该向患者推荐使用.非药物疗法包括光疗、心理治疗、睡眠教育、认知治疗、放松疗法等.本文将对光疗在失眠症中的应用作以综述.     

影响老年患者睡眠质量的因素及其护理干预

综述了影响老年患者睡眠质量的因素及其护理干预,指出影响老年患者睡眠质量的因素包括年龄因素、生理和病理因素、环境因素、心理社会因素．药物因素等;主要护理干预措施有：创造舒适的睡眠环境,实施睡眠限制,提高睡眠效率,纠正患者对失眠的错误认知和不良习惯,诱导睡眠,饮食调整,排除药物干扰,光疗和运动疗法,心理护理等。建议关注老年患者的睡眠质量,用标准化的评估工具测量并评估影响因素,针对相关的因素进行前瞻性干预试验,以提供更有说服力的护理措施。     

耳针结合心理疏导治疗失眠87例分析

失眠是指以入睡困难、早醒、睡眠过浅及睡眠时间不足或质量差等为主要症状的睡眠障碍。失眠的治疗分为药物和非药物疗法两大类。镇静安眠药都有一定的副作用,耐受性及依赖性也比较差,而中医在治疗失眠上有很多的优势^[1-3],     

多感官刺激疗法在脑卒中合并原发性失眠老年患者中的应用

目的 探究多感官刺激疗法在改善脑卒中合并原发性失眠老年患者睡眠质量中的应用价值。方法 选取河南科技大学第一附属医院2020年12月至2022年12月127例脑卒中合并原发性失眠老年患者作为研究对象,依照干预方式分为药物组和非药物组。药物组63例行常规药物治疗方案,非药物组64例行多感官刺激疗法,连续治疗6周,对比两组患者睡眠质量、睡眠结构参数、血清相关因子水平、生活质量。结果 两组干预前、干预6周后匹兹堡睡眠质量指数(PSQI)评分比较,差异无统计学意义(P>0.05);两组干预6周后总睡眠时间(TST)水平较干预前升高,非药物组高于药物组;睡眠潜伏期(SL)水平较干预前降低,非药物组低于药物组(P<0.05)。两组干预6周后五羟色胺(5-HT)水平较干预前升高,非药物组高于药物组;白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平较干预前降低,非药物组低于药物组(P<0.05)。两组干预6周后躯体功能、认知功能、心理功能评分水平较干预前升高,非药物组高于药物组(P<0.05)。结论 多感官刺激疗法可调节脑卒中合并原发性失眠老年患者睡眠结构参数,改善睡眠质量...     

高电位疗法改善失眠患者睡眠质量的研究

目的研究高电位疗法对临床伴有失眠患者的治疗效果及作用机制.方法将70例失眠患者随机分为治疗组和对照组.治疗组接受高电位疗法,对照组按常规给予药物处理.用匹兹堡睡眠质量指数量表评定患者治疗前后的睡眠状况.结果治疗组和对照组在治疗后睡眠质量都有明显改善(P＜0.001).治疗后两组在睡眠质量、入睡时间、睡眠时间、睡眠效率方面比较差异无统计学意义(P＞0.05),但在用药情况、睡眠紊乱改善比较均有统计学意义(P＜0.001),且日间精力治疗组较对照组佳、结论高电位疗法能有效改善患者的睡眠质量,明显减少药物的使用,是一种较为理想的非药物治疗方法.     

失眠的物理因子治疗

失眠指患者对睡眠时间和（或）质量不满足并影响白天社会功能的一种主观体验。失眠的发病率很高,影响患者的生存质量,同时造成巨大的经济损失。失眠治疗主要有药物治疗和非药物治疗（包括心理行为治疗、物理因子治疗等）。药物治疗易产生耐受和依赖,心理行为治疗周期较长。大量的临床资料表明,物理因子治疗失眠有其独特之处,现从高压静电疗法,脑电生物反馈疗法,紫外线光量子透氧疗法,低能量He-Ne激光治疗等方面,对近年来国内外临床对失眠的治疗作一综述。     

非药物疗法对失眠病人有益

很多人都曾有过短暂失眠的经历,失眠的主要原因有抑郁、压力、倒班制工作、急性疾病、时差变化等。治疗失眠最常用的药物是镇静催眠药,它对由抑郁及时差变化所致的的短期失眠有效,但长期服用可改变睡眠时相,产生副作用、耐受性、依赖性、失眠反跳及其他疾病。 非药物治疗对长期失眠的病人有明显的持续的改善作用,而无大的副作用。美国弗吉尼亚医学院的研究人员最近的一项研究证实了非药物疗法对长期失眠的效果。从1974年到1993年共对2102例患有入睡困难或易醒以及两者并存的病人进行了59项回顾性研究,效果的检测主要依据于接受如下治疗失眠病人的每天睡眠记录,结果表明以下治疗有助于改善睡眠。(1)减少刺激:建立一个作息时间     

正念冥想调节失眠的研究现状及分析

失眠作为常见的公共健康问题,带来了严重的社会负担,近年来,随着睡眠医学的快速发展,正念冥想作为新兴的非药物疗法,在失眠领域逐渐兴起.该文将对失眠的治疗现状,正念冥想的相关概念、调节失眠的原理、干预方式、在不同失眠群体中的运用情况作一综述,并通过文献分析汇总正念冥想调节失眠目前存在的问题,旨在提高医务人员对失眠的重视,促...     

离退休干部失眠的非药物综合干预

目的探讨非药物综合干预治疗离退休干部失眠的临床疗效。方法对2013-01—10离退休干部中失眠患者60例,采用中医疗法、温泉水疗法、音乐疗法、光疗、心理疗法、运动疗法等非药物综合疗法进行干预,15 d为一疗程。结果经过1个疗程的非药物综合干预,60例失眠患者中,痊愈30例,好转28例,无效2例,总有效率为96.7%。结论非药物综合干预是一套行之有效的治疗失眠的方案,杜绝了西医药物治疗失眠的很多弊端,具有安全、可靠、无风险、患者易于接受等特点。     

失眠症的心理治疗

失眠症患者普遍存在焦虑、抑郁、神经衰弱、躯体化、癔症、人际关系敏感、情绪不稳定等人格特征及缺乏睡眠感、过高估价睡眠潜伏期和过低估价睡眠时间、企图控制睡眠、过份夸大失眠的后果等认知行为特征,针对这些特征建议运用心理治疗,并对失眠症的认知行为疗法、森田疗法、精神分析、漂浮疗法等心理治疗方法作一综述,介绍了它们的原理及具体操作方法,指出失眠症的原因是多方面的,治疗也必须是多方面的,根据具体情况选择合适的治疗方法,才会取得较好的疗效。     

Evidenced-based hypnotherapy for the management of sleep disorders

There is a plethora of research suggesting that combining cognitive-behavioral therapy with hypnosis is effective for a variety of psychological, behavioral, and medical disorders. Yet, very little empirical research exists pertaining to the use of hypnotherapy as either a single or multitreatment modality for the management of sleep disorders. The existing literature is limited to a small subset of nonbiologic sleep disorders. The objectives of this paper are: to provide a review of the most common sleep disorders, with emphasis on insomnia disorders; discuss the cognitive-behavioral approaches to insomnia; and review the existing empirical literature on applications of hypnotherapy in the treatment of sleep disturbance. The overreaching goal is to educate clinicians on how to incorporate sleep therapy with hypnotherapy. There is an immediate need for research evaluating the efficacy of hypnotherapy in the management of sleep disturbance.     

Pharmacologic management of chronic insomnia

Chronic insomnia is a common disorder that is under recognized, under diagnosed and under treated. Initial assessment should focus on identifying and treating, if present, any secondary causes of insomnia. Primary insomnia can be treated with behavioral and/or pharmacological therapy. A thorough sleep history can identify the type of insomnia present, its severity, and can consequently guide therapy. Behavioral therapy has been shown to be equivalent to or superior to pharmacologic therapy, at least in some patients. It is a reasonable initial approach, although there are barriers to its use. There are several pharmacologic agents available, some of which are more effective at reducing time to fall asleep and others for maintaining sleep. There is some evidence to indicate that combining the approaches may impair outcomes. There is little data on the long-term use of pharmacologic agents.     

Detection and assessment of insomnia.

Insomnia is one of the most common complaints encountered by the primary care physician. Yet, in many cases, physicians treat the symptom of insomnia rather than evaluating and treating the underlying causes of insomnia. Because the subjective complaint of insomnia does not always correlate with evidence of objective sleep disruption, a careful history and evaluation are required. Assessment of the duration of insomnia and quantification of the impact of nocturnal sleep disruption on daytime functioning provide the most reliable indices of severity. Primary insomnia may be due to a number of different causes, such as poor sleep hygiene or circadian rhythm disruption. Insomnia may also be the presenting symptom of other primary sleep disorders, such as sleep apnea syndrome or nocturnal myoclonus, or of a variety of medical or psychiatric illnesses. The treatment of the patient with insomnia should address the underlying cause, when identifiable. When the cause cannot be identified, treatment should be conservative; nonpharmacologic therapies should be used whenever possible. When pharmacologic approaches are indicated, short-acting benzodiazepines should be administered in concordance with strict prescribing guidelines. Frequent follow-up is necessary to ensure continued therapeutic efficacy of the prescribed therapy.     

Cognitive behavioural therapy for primary insomnia: a systematic review

AIM: This paper reports a systematic review of seven studies evaluating the efficacy of cognitive behavioural therapy (CBT) for persistent primary insomnia. BACKGROUND: Insomnia is one of the most common health complaints reported in the primary care setting. Although non-pharmacological treatments such as the CBT have been suggested to be useful in combating the persistent insomnia, the efficacy and clinical utility of CBT for primary insomnia have yet to be determined. METHOD: A systematic search of Ovid, MEDLINE, psychINFO, PsycARTICLES, CINAHL, and EMBASE databases of papers published between 1993 and 2004 was conducted, using the following medical subject headings or key words: insomnia, primary insomnia, psychophysiological insomnia, sleep maintenance disorders, sleep initiation disorders, non-pharmacological treatment, and cognitive behavioural therapy. A total of seven papers was included in the review. FINDINGS: Stimulus control, sleep restriction, sleep hygiene education and cognitive restructuring were the main treatment components. Interventions were provided by psychiatrists except for one study, in which the CBT was delivered by nurses. Among beneficial outcomes, improvement of sleep efficacy, sleep onset latency and wake after sleep onset were the most frequently reported. In addition, participants significantly reduced sleep medication use. Some studies gave follow-up data which indicated that the CBT produced durable clinical changes in total sleep time and night-time wakefulness. CONCLUSIONS: These randomized controlled trial studies demonstrated that CBT was superior to any single-component treatment such as stimulus control, relaxation training, educational programmes, or other control conditions. However, heterogeneity in patient assessment, CBT protocols, and outcome indicators made determination of the relative efficacy and clinical utility of the therapy difficult. Therefore, the standard components of CBT need to be clearly defined. In addition, a comprehensive assessment of patients is essential for future studies.     

腹腔镜保留肾单位手术围术期预防性使用抗凝药物的安全性

目的 分析腹腔镜保留肾单位手术患者在围术期预防性使用抗凝药物的安全性。方法 回顾性分析接受腹腔镜保留肾单位手术的84例患者资料,包括其基线资料及术中出血量、术中输血率、术后再次出血发生率、术后血红蛋白下降值及术后住院时间等。比较围术期预防性使用抗凝药物患者（药物组,50例）与未使用抗凝药物患者（非药物组,34例）的上述...     

从循证医学证据探讨糖尿病高血压治疗

本文根据多中心随机对照临床药物试验、系统评价、队列研究等循证医学证据，对近年糖尿病合并高血压患者临床常用的降压治疗（包括非药物治疗）以及常用的几类降压药物的降压疗效、预防肾脏病变、心脑血管事件、不良反应等进行介绍。     

Treatment of insomnia in hospitalized patients.

OBJECTIVE: To provide recommendations for the short-term management of insomnia in hospitalized patients and review patient assessment, nonpharmacologic treatment modalities, and selection of hypnotic medications. DATA SOURCES: Review articles and primary literature representative of current knowledge regarding the treatment of insomnia were identified by MEDLINE search (1966-January 2001). Search terms included insomnia (sleep initiation and maintenance disorders), benzodiazepines, zaleplon, zolpidem, and trazodone. DATA SYNTHESIS: Literature regarding the management of insomnia in hospitalized patients is limited; therefore, data pertinent to the treatment of ambulatory patients must be extrapolated to the inpatient setting. When evaluating insomnia in hospitalized patients, it seems reasonable to obtain a thorough history and physical examination to identify potential underlying etiologies. Treatment of these underlying etiologies should be considered. When the use of a sedative-hypnotic agent is necessary, medication and dose selection should be based on the pharmacokinetic and adverse effect profiles of each agent. Patent-specific characteristics should also be considered to provide effective treatment while minimizing adverse effects. CONCLUSIONS: Nonpharmacologic approaches to the treatment of insomnia should be considered for hospitalized patients. When sedative-hypnotic medications must be administered, the pharmacokinetic profile of intermediate-acting benzodiazepines (e.g., lorazepam, temazepam) makes them good first-line agents. Zaleplon and zolpidem are also attractive hypnotic agents; however, they are typically reserved for second-line therapy due to cost. Trazodone may be an alternative for patients unable to take benzodiazepines.     

失眠症的临床诊断学特征及其正念疗法的研究进展

失眠症的正念疗法(MBT-I)通过培育正念的习惯(初学者心态、不执着、放下、非评判、接纳、信任和耐心)、正念减压练习(关注呼吸、坐姿冥想、身体扫描、正念行走以及瑜伽等)及调整痛苦情绪的认知策略来减轻睡眠失调,并将失眠症的认知行为治疗(CBT-I)中刺激控制、睡眠限制及睡眠卫生的元素置于正念减压的框架内实施。MBT-I以团体体验形式进行,每周1次每次2 h,连续8周,有助于减少躯体疾病或心理问题对睡眠的负面影响;训练注意力控制,减少过度焦灼;降低睡眠相关过度觉醒,增强对情绪的调控能力;接纳当下的体验,而不是评判;减少对失眠的担忧,不过度努力入睡。