15-美抒玉治療抑郁癥睡眠障礙多導(dǎo)睡眠圖變化hd

1、美抒玉治療抑郁癥睡眠障礙多導(dǎo)睡眠圖變化宋雪祥王國(guó)祥趙彥平h的：探討抑郁癥合并睡眠障礙患者多導(dǎo)睡眠圖特點(diǎn)，并與正常人比較，探討藥物美抒玉治療效果及 多導(dǎo)睡眠圖變化。材料及方法：用polysmith型多導(dǎo)睡眠圖,對(duì)21名抑郁癥合并睡眠障礙患者及10名正 常對(duì)照者進(jìn)行測(cè)定，抑郁癥患者美抒玉治療2月后復(fù)査多導(dǎo)睡眠圖，并進(jìn)行治療前后將神量表測(cè)定。測(cè)量 數(shù)據(jù)以x±s來(lái)表示,統(tǒng)計(jì)方法采用spss 11.0進(jìn)行分析。結(jié)果：抑郁癥合并睡眠障礙患者覺(jué)醒次數(shù)、rem 睡眠時(shí)間顯著延長(zhǎng)，總睡眠時(shí)間、睡眠效率、rem睡眠潛伏期、慢波睡眠明顯縮短。美抒玉治療后總睡眠 時(shí)間、睡眠效率、慢波睡眠時(shí)間顯著延長(zhǎng)，覺(jué)糜次

2、數(shù)顯著縮短。治療后抑郁自評(píng)量表改善。結(jié)論：抑郁癥 合并睡眠障礙患者美抒玉治療有效，且多導(dǎo)睡眠圖異常指標(biāo)有改善。關(guān)鍵詞：多導(dǎo)睡眠圖睡眠障礙抑郁癥美抒玉song xue-xiang, wang guo-xiang, zhao yan-ping(department ofneurology, people's hospital of yixing city, yixing 214200)purpose: to explore the varieties of polysomnography in patients with depression in comparison with norm

3、al people; to assess the effects and varieties of polysomnography with trazodonemethods: polysmith polysomnography was performed on 21 insomnia patients with depression and 10 normal people insomnia patients with depression were cared with trazodone and polysomnography was examined two months later.

4、 rating scales for mental health were investigated before and after trazodone cares data was measured by x ± s . spss 11.0 software was used to analyze data.results: wake after sleep onset、rem sleep in insomnia patients with depression were longer than those in controls and had significant diff

5、erence; compared with total sleep time、sleep efficiency index、rem latency、 nrem slow-wave sleep, insomnia patients with depression were lower. after trazodone cared, there were significant longer in total sleep time、sleep efficiency index> nrem slow-wave sleep. while wake after sleep onset was ob

6、vious lower and self-rating depression scale was better.conclusions: trazodone is effective in the treatment of antidepressant-associated insomnia and is good to abnormal night physiological signals on polysomnography. zopidem caused an improvement in subjective and objective sleep quality.key words

7、: polysomnography(psg) sleep disorders depression trazodone隨著社會(huì)的發(fā)展，生活節(jié)奏的加快，抑郁癥發(fā)生率有上升的趨勢(shì)，其屮札i當(dāng)一部分患者 突出表現(xiàn)為睡眠障礙，現(xiàn)將2005年3月2006年5月在我院神經(jīng)科門(mén)診因睡眠障礙而就診 的抑郁癥患者21名行多導(dǎo)睡眠圖檢查，美抒玉治療后進(jìn)行復(fù)查，結(jié)果如下。對(duì)象與方法一、研究對(duì)象：所有對(duì)象來(lái)自2005年3月-2006年5月我院神經(jīng)科門(mén)診就診的患者，小學(xué)以上文化程 度，符合ccmd-2-r失眠癥和標(biāo)準(zhǔn)第三版抑郁癥的診斷標(biāo)準(zhǔn)。排除標(biāo)準(zhǔn)：孕期、哺乳期婦 女；加體、精神疾病所致的失眠；飲酒、服用中機(jī)興奮藥物導(dǎo)

8、致的失眠；未便用精神 藥物或停用兩周以上；復(fù)班工作者。共入主21例，男6名，女15名；年齡3058歲， 平均38. 6歲，病程6月3年，平均1. 6年。開(kāi)始服美抒玉25mgqn,逐漸加量到loomgqn。 對(duì)照組睡眠正常，共10名，男性6名，女性4名；年齡2049歲，平均31. 6歲。均為學(xué) 生或我院工作人員。二、方法1監(jiān)測(cè)方法:受試前対所有患者進(jìn)行病史、體格檢查、精神量表測(cè)定(抑郁自評(píng)量表、漢 密頓焦慮量表)?；颊咛顚?xiě)睡眠日記，進(jìn)行睡眠信念和態(tài)度、睡眠衛(wèi)生知識(shí)和睡眠衛(wèi)生習(xí)慣 的檢測(cè)，藥物治療2刀后復(fù)查上述精神雖表。實(shí)驗(yàn)室為無(wú)干擾的單人屏蔽睡眠室(遮光、隔咅，適宜的溫濕度)及單獨(dú)描記間，記錄儀

9、器 為英國(guó)產(chǎn)polysmith型多導(dǎo)睡眠儀。操作及電極放置參照rechetschaffen等的標(biāo)準(zhǔn)。受試者單獨(dú)睡一房間，由受試者口行安排睡眠和起床時(shí)間，囑其按個(gè)人日常睡眠習(xí)慣提 前1 h來(lái)到睡眠實(shí)驗(yàn)室，熟悉睡眠監(jiān)測(cè)環(huán)境，工作人員講述檢杳目的和方法，解除其心理緊張, 安置電極后進(jìn)行整夜psg描記。若當(dāng)夜睡眠因環(huán)境改變不能反映平時(shí)睡眠情況，則資料舍棄 不用。美抒玉治療2月后復(fù)查多導(dǎo)睡眠圖。2. 測(cè)量指標(biāo):總記錄時(shí)間；總睡眠時(shí)間；睡眠效率；睡眠潛伏期；覺(jué)醒次數(shù)； (6)n-rem睡眠各期時(shí)間；(9)rem睡眠時(shí)間;(10)rem睡眠潛伏期；(1drem睡眠次數(shù)。3. 統(tǒng)計(jì)學(xué)處理：木研究所得數(shù)據(jù)以均數(shù)

10、土標(biāo)準(zhǔn)差(x土s)表示，組間比較采用t檢驗(yàn)，所 冇數(shù)據(jù)應(yīng)用sp11. 0統(tǒng)計(jì)軟件包處理，檢驗(yàn)標(biāo)準(zhǔn)為p二0. 05 o結(jié)果1.各組受試者多導(dǎo)睡眠圖各指標(biāo)比較，結(jié)果見(jiàn)表1。表1:四組受試者多導(dǎo)睡眠圖各指標(biāo)比較(x±s)睡眠指標(biāo)抑郁癥治療前抑郁癥治療后正常對(duì)照總記錄時(shí)間(min)451.6±37.2448.7+48.2412.2+34.8總睡眠吋間(min)350.3+29.6*392.6±27.4a379.9+31.7睡眠效率(%)0.74±0.02*0.86±0.3a0.92 ±0.01睡眠潛伏期(min)19.8±5.717

11、.6+4.316.7+5.4覺(jué)醒次數(shù)(次)9.3+1.6*6.1±1.3a4.6+1.5n rem各期時(shí)間s1 時(shí)間(min)25.8±2.925.9+2.520.1+3.8s2 時(shí)間(min)135.1 ±4.6140.7±3.8128.1 ±7.8s3+s4 時(shí)間(min)30.3+3.2*38.8+2.1a38.9+5.1rem睡眠時(shí)間(min)106.7+3.1*97.9±2.781.6+3.9rem睡眠潛伏期(min)65.1+13.4*68.1±12.579.9+15.7rem睡眠次數(shù)(次)4.20+0.364.

12、31+0.424.71+0.68與正常對(duì)照組相比：p<0. 05； p<0. 01 ；與治療前比較:ap<0. 052.藥物治療兩月后復(fù)查精神量表，與治療前比較，見(jiàn)表2:表2:藥物治療前后梢神量表對(duì)比(x 土 s )抑郁自評(píng)量表漢密頓焦慮量表治療前治療后治療前治療后0.63+0.060.48+0.05*19.18+6.4617.15+5.38與治療前相比:如<0.05；討論睡眠障礙是抑郁癥垠常見(jiàn)臨床癥狀z，患者常訴睡眠維持困難、早醒、晨起時(shí)心境惡 劣等。本結(jié)果顯示，抑郁癥合并睡眠障礙患者與正常人有著不同的睡眠模式，兩者多導(dǎo)睡眠 圖多項(xiàng)指標(biāo)界常，其睡眠改變主要為覺(jué)醒次數(shù)、

13、rem睡眠時(shí)間顯箸延長(zhǎng)，總睡眠時(shí)間、睡眠 效率、慢波睡眠、rem睡眠潛伏期明顯縮短。目前，多數(shù)認(rèn)為rem睡眠潛伏期縮短、rem睡 眠時(shí)間延長(zhǎng)是抑郁癥睡眠結(jié)構(gòu)紊亂的特征性改變，serfritz等認(rèn)為這些特異性異?？赡?與5-ht/ne能神經(jīng)傳遞減少或膽堿能傳遞增加有關(guān)，而目前認(rèn)為5-ht卜降和膽堿能增加是 抑郁癥的原因。美抒玉是三ii坐毗噪類(lèi)衍生物，選擇性阻斷5jit再攝取，對(duì)5 iit2受體冇中等強(qiáng)度的拮 抗作用，臨床常川于抑郁合并睡眠障礙治療。本研究捉示，美抒玉能顯著增加睡眠時(shí)間、睡 眠效率、慢波睡眠時(shí)間，顯著降低覺(jué)醒次數(shù)，抑郁癥狀改善，自我評(píng)價(jià)睡眠質(zhì)量好轉(zhuǎn)，與 kaynak<3)等結(jié)

14、果一致，由于rem睡眠吋間及潛伏期治療前后無(wú)改善，睡眠好轉(zhuǎn)考慮與睡眠維 持率提高冇關(guān)，而saletu-zyhlarz等研究認(rèn)為美抒玉除了延長(zhǎng)rem睡眠潛伏期，s1時(shí)間亦 顯著延長(zhǎng)，結(jié)合5tit再攝取抑制劑、三壞類(lèi)、單胺氧化酶抑制劑等抗抑郁藥均減少rem睡 眠，因而認(rèn)為抗抑郁藥降低rem睡眠可能是它們改善睡眠的一個(gè)重要機(jī)制，但新型抗 抑郁藥復(fù)合物nofczodono和moclobcmide改善睡眠且增加rem睡眠就不好解釋?zhuān)渲羐iles 等對(duì)29名抑郁癥患者治療前后睡眠eeg監(jiān)測(cè)，大多數(shù)沒(méi)有改變。美抒玉顯著增加慢波睡眠時(shí)間，國(guó)外冇類(lèi)似報(bào)道，但抗抑郁藥對(duì)慢波睡眠作用是復(fù) 雜的，作用于5-hw 受

15、體阻斷劑增加慢波睡眠，5-iit再攝取抑制劑、單胺氧化酶抑制劑 降低慢波睡眠時(shí)間或無(wú)改變。美抒玉為鎮(zhèn)靜性抗抑郁藥，治療后患者抑郁癥狀改善，主觀(guān) 睡眠質(zhì)量好轉(zhuǎn)，美抒玉期一優(yōu)點(diǎn)是沒(méi)冇依賴(lài)性，可以治療藥物依賴(lài)戒端后的焦慮、抑郁 癥狀?？傊鄬?dǎo)睡眠圖可了解失眠的真實(shí)性和評(píng)估失眠程度，抑郁癥合并睡眠障礙可能有特 征性多導(dǎo)睡眠圖改變，但由于睡眠機(jī)制復(fù)雜，需要更大樣本研究才能進(jìn)一步明確。美抒玉能 改善失眠患者主、客觀(guān)指標(biāo)，對(duì)抑郁癥合并睡眠障礙的患者是一種較好的治療選擇。參考文獻(xiàn)1. saletzyhlarz gm, abbakr mh, anderer p,et al. insomnia in depre

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