经颅重复磁刺激辅助治疗老年焦虑症继发睡眠障碍的效果观察

目的 探讨米氮平合用经颅重复磁刺激法治疗伴睡眠障碍的老年焦虑症的疗效.方法 将100例符合“老年焦虑症”诊断标准并伴有失眠的患者随机分为研究组（米氮平合并经颅重复磁刺激法）和对照组（单用米氮平）各50例.观察8周.治疗前及治疗后第2,4,8周采用汉密尔顿焦虑量表（HAMA）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评定焦虑和抑郁症状;治疗前及治疗第8周采用多导睡眠监测技术（PSG）和匹兹堡睡眠质量指数量表（PSQI）评定睡眠状况.结果 （1）两组临床疗效有效率分别为87.23％和68.89％,两组比较差异有统计学意义（x2=4.55,P＜0.05）;（2）治疗后4、8周后,研究组HAMA、SAS及SDS分值量表分值与对照组比较较低,且差异有统计学意义（t分别为3.997 3,4.937 7,3.359 9;P＜0.05）;（3）治疗后研究组实际睡眠总时间、睡眠潜伏期、REM潜伏期、REM睡眠比例、夜间觉醒次数、觉醒总时间评分结果与对照组比较差异有统计学意义（t分别为3.565 6,3.105 7,2.705 7,2.699 1,3.614 9,19.898 8;P＜0.05）;（4）治疗后研究组PSQI评分低于对照组,两组比较差异有统计学意义（t=3.327 8,P＜ 0.05）;（5）两组不良反应的发生率分别为10.64％和17.78％,经比较差异无统计学意义（x2=0.97,P＞0.05）.结论 米氮平合用经颅重复磁刺激法治疗老年焦虑症伴发的睡眠障碍有较好的效果.

Effect of repetitive transcranial magnetic stimulation in adjuvant treatment on sleep disorder secondary to anxiety in the elderly

Objective To study the effect of mirtazapine combined with repetitive transcranial magnetic stimulation in patients with sleep disorder secondary to anxiety in the elderly.Methods Total of 100 cases of “elderly anxiety” met the diagnostic criteria and having insomnia were randomly recruited into study group （mirtazapine combined with repetitive transcranial magnetic stimulation） and control group （mirtazapine）.The study duration was 8 weeks.Study data were collected before treatment and 2,4,and 8 weeks after the treatment using Hamilton Anxiety Scale（HAMA）,Self Rating Anxiety Scale （SAS）,and Self Rating Depression Scale （SDS）.The symptoms of anxiety and depression were assessed eighth weeks with polysomnography（PSG） and the sleep state was evaluated using Pittsburgh Sleep Quality Index table （PSQI）.Results The two treatment groups showed improvement in 87.23％ and 68.89％ respectively,with difference statistically significant （x2 =4.55,P ＜ 0.05）.HAMA,SAS and SDS score scale scores of the study group were lower than those in the control group （t =3.997 3,4.937 7,3.359 9,respectively; P ＜ 0.05） at the end of the 4th,8th week.In study group,the actual total sleep time,sleep latency,REM latency,REM sleep,nocturnal awakenings,group awareness total time score were significant different from that in the control group （t =3.565 6,3.105 7,2.705 7,2.699 1,3.614 9,19.898 8,respectively; P ＜ 0.05）.The PSQI score of study group was lower compared with the control group （t =3.327 8,P＜ 0.05）.The incidence rate of adverse reaction in the two groups of 10.64％ and 17.78％,with no statistical significance （x2 =0.97,P ＞ 0.05）.Conclusions Mirtazapine combined with repetitive transcranial magnetic stimulation provides superior effect in the treatment of anxiety-induced in elderly patients.