孕期焦虑、失眠的临床特征及失眠的认知行为治疗疗效分析

目的探讨孕期焦虑、失眠的临床特征及失眠的认知行为治疗(CBT-I)对孕期焦虑、失眠的疗效。 方法收集重庆市妇幼保健院心理门诊2018年3月至6月伴有焦虑、失眠的孕妇48例。采用随机数字表法，将48例伴焦虑、失眠的孕妇分为CBT-I组和常规健康教育组，每组均24例，分别给予6周CBT-I和常规健康教育。在干预前、干预6周后、干预结束4周后，采用焦虑自评量表(SAS)和匹兹堡睡眠指数(PSQI)量表对患者焦虑情绪及睡眠状况进行调查，并使用心肺耦合(CPC)睡眠质量评估系统对患者睡眠潜伏期(SOL)、在床时间(TIB)、总睡眠时间(TST)及睡眠效率(SE)情况进行评估记录。 结果孕期发生焦虑、失眠者，首次怀孕36例(75.00%)，本科及以上学历44例(91.67%)，就业39例(81.25%)；轻度焦虑2例(4.17%)，中度焦虑36例(75.00%)，重度焦虑10例(20.83%)。CBT-I干预6周后，CBT-I组SAS得分(50.13±7.73)分]低于常规健康教育组(60.25±8.69)分]，差异有统计学意义(t＝－4.27，P<0.05)；而干预结束4周后，CBT-I组SAS得分(57.92±12.22)分]与常规健康教育组(61.38±5.11)分]比较，差异无统计学意义(t＝－1.28，P>0.05)。CBT-I干预6周后，CBT-I组PSQI得分(10.50±2.34)分]低于常规健康教育组(15.52±2.50)分]，差异有统计学意义(t＝－6.68，P<0.05)，干预结束4周后，CBT-I组PSQI得分(11.63±3.00)分]低于常规健康教育组(14.83±2.99)分]，差异有统计学意义(t＝－3.71，P<0.05)。CPC结果显示，干预6周后及干预结束4周后，CBT-I组SOL分别为(29.54±8.67)min、(28.88±9.18)min，均低于常规健康教育组(54.58±16.20)min、(55.67±18.39)min，差异有统计学意义(t＝－6.68，－6.36；均P<0.05)。干预6周后及干预结束4周后，CBT-I组TST分别为(347.50±38.12)min、(325.87±58.18)min，均高于常规健康教育组(230.25±68.75)min、(257.41±77.85)min，差异有统计学意义(t＝7.31, 3.45；均P<0.05)。 结论孕期伴有焦虑、失眠者主要为首次怀孕、本科及以上学历，且继续工作者，多数为中度焦虑。CBT-I能够有效改善孕妇主观睡眠感受和部分客观睡眠指标，对于孕妇焦虑情绪有一定疗效，但CBT-I对焦虑情绪的长期疗效并不理想。

Clinical features of anxiety and insomnia during pregnancy and the therapeutic effect of cognitive behavior therapy for insomnia

ObjectiveTo explore the clinical features of anxiety and insomnia during pregnancy and the therapeutic effects of cognitive behavior therapy for insomnia (CBT-I). MethodsForty-eight pregnant patients with insomnia and anxiety recruited from psychological clinic of Chongqing Women and Children Hospital from March to June 2018 were randomly divided into experimental group and control group. Experimental group received a 6-week-setting CBT-I therapy and control group was underwent health education at the same time. Assessment of Self-rating Anxiety Scale (SAS) and Pittsburg Sleep Quality Index (PSQI) were taken before intervention, 6 weeks after intervention, and 4 weeks after the end of intervention, and Cardiorespiratory Coupled Sleep Quality Assessment System (CPC) was used to measure sleep onset latency (SOL), time in bed (TIB), total sleep time (TST) and sleep efficiency (SE) at the same time points. ResultsThirty-six (75.00%) pregnant women with insomnia and anxiety had a first pregnancy, 44 (91.67%) patients had bachelor′s degree or higher and 39 (81.25%) patients were still working. As for level of anxiety, 2 (4.17%) patients were mild anxiety, 36 (75.00%) patients were moderate anxiety and 10 (20.83%) patients were severe anxiety. SAS score after intervention in experimental group (50.13±7.73)points] showed lower than that in control group (60.25±8.69)points, t=-4.27, P<0.05)]. There was no significant difference between the two groups (57.92±12.22)points, (61.38±5.11)points, t=-1.28, P>0.05)] 4 weeks after the end of intervention. PSQI score in experimental group after intervention (10.50±2.34)points] showed lower than that in control group (15.52±2.50)points, t=-6.68, P<0.05)]. PSQI score in experimental group 4 weeks after the end of intervention (11.63±3.00)points] was also lower than that in control group (14.83±2.99)points, t=-3.71, P<0.05)]. CPC showed that SOL in experimental group after intervention and 4 weeks after the end of intervention (29.54±8.67)min, (28.88±9.18)min)] were both lower than those in control group (54.58±16.20)min, (55.67±18.39)min, t=-6.68, -6.36, all P<0.05)] and TST(347.50±38.12)min, (325.87±58.18)min] were both higher than those in control group(230.25±68.75)min, (257.41±77.85)min, t=7.31, 3.45, all P<0.05)]. ConclusionsPregnant women with insomnia and anxiety are mainly for the first time pregnant, bachelor degree or higher, and still working, mostly moderate anxiety. CBT-I can improve anxiety and sleep quality in pregnant patients with insomnia and anxiety, while its long-term therapeutic effect was not satisfying.