肌电反馈治疗失眠症的临床实验与驻石家庄部队干休所老年人失眠状况调查
摘要
本论文的研究目的有二：一、探讨肌电反馈在治疗失眠症中的作用；二、调查驻石家庄部队干休所老年人的失眠状况。
本实验采用肌电反馈仪对失眠症患者进行治疗，在治疗前后对失眠症患者进行全夜多导睡眠图监测(PSG)，并填写抑郁自评量表(SDS)和焦虑自评量表(SAS)。结果表明：经过肌电反馈治疗后，睡眠效率提高，多导睡眠图显示实际睡眠时间延长，夜间觉醒次数减少，其中以快速眼动睡眠、三期、四期睡眠时间延长较为明显，而且，患者的焦虑症状也有明显改善。
本研究对驻石家庄部队干休所的115例失眠老年人进行了老年人失眠症问卷调查。结果表明：引起老年人失眠的因素中以心理因素为主；有半数患者伴有情绪障碍；失眠症严重影响了老年人正常的生活；在失眠老年人中女性比男性更积极采取治疗措施。
This paper aims to approach the effects of electromyography (EMG) feedback on insomnia and investigate the insomnia of the retired elders in the military resthome in Shijiazhuang .
For approaching the effect of the EMG feedback on insomnia, All-night polysomnography(PSG), Self-rating Depression Scale(SDS)
and Self-rating Anxiety Scale(SAS) were used to evaluate seven
e insomniacs before and after the electromyography(EMG) feedback.
Results: The electromyography(EMG) feedback had significant effects on the parameters of all-night polysomnography(PSG), including higher sleep efficiency, prolong total sleep time, decrease awake frequency, especially increased the time of stage REM, stage 3 and stage 4 obviously; Furthermore, the patient's anxious symptoms show obvious improvement.
An investigation on insomnia was conducted among 115 old people in the military resthome in Shijiazhuang. Results: most affected old people's insomnia was psychological factor; Half of the patients carried insomnia coupled with emotion disorder; Psychological or physiological discomfort resulting from the insomnia has produced a bad influence on the normal life of the elders and women usually took more positive measures than men among those old people who have suffered from the insomnia.
本实验采用肌电反馈仪对失眠症患者进行治疗，在治疗前后对失眠症患者进行全夜多导睡眠图监测(PSG)，并填写抑郁自评量表(SDS)和焦虑自评量表(SAS)。结果表明：经过肌电反馈治疗后，睡眠效率提高，多导睡眠图显示实际睡眠时间延长，夜间觉醒次数减少，其中以快速眼动睡眠、三期、四期睡眠时间延长较为明显，而且，患者的焦虑症状也有明显改善。
本研究对驻石家庄部队干休所的115例失眠老年人进行了老年人失眠症问卷调查。结果表明：引起老年人失眠的因素中以心理因素为主；有半数患者伴有情绪障碍；失眠症严重影响了老年人正常的生活；在失眠老年人中女性比男性更积极采取治疗措施。
This paper aims to approach the effects of electromyography (EMG) feedback on insomnia and investigate the insomnia of the retired elders in the military resthome in Shijiazhuang .
For approaching the effect of the EMG feedback on insomnia, All-night polysomnography(PSG), Self-rating Depression Scale(SDS)
and Self-rating Anxiety Scale(SAS) were used to evaluate seven
e insomniacs before and after the electromyography(EMG) feedback.
Results: The electromyography(EMG) feedback had significant effects on the parameters of all-night polysomnography(PSG), including higher sleep efficiency, prolong total sleep time, decrease awake frequency, especially increased the time of stage REM, stage 3 and stage 4 obviously; Furthermore, the patient's anxious symptoms show obvious improvement.
An investigation on insomnia was conducted among 115 old people in the military resthome in Shijiazhuang. Results: most affected old people's insomnia was psychological factor; Half of the patients carried insomnia coupled with emotion disorder; Psychological or physiological discomfort resulting from the insomnia has produced a bad influence on the normal life of the elders and women usually took more positive measures than men among those old people who have suffered from the insomnia.
引文
[1] 施建安，王焕林．失眠症的临床研究进展[J]．中华神经精神科杂志．1994，(27)1：52—54．
[2] Rosekind MR. The epidemiology and occurrence of insomnia[J]. Clin Psychiatry, 1992,53(6):4.
[3] Morin CM, Grayling SE. Sleep patterns and aging: comparison of older adults with and without insomnia complaints. Psychol Aging, 1989, 4: 290-294.
[4] Rorberts BE, Shema SJ, iaplan GA, et al. Sleep complaints and depression in an aging cohort: A prospective perspective. Psychiatry, 2000, 157: 81-88.
[5] Ohayon MM. Prevalence of DSM-Ⅳ diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. Psychiatr Res, 1997,31:333-346.
[6] 刘连启，刘贤臣，刘兆玺等．山东省城市老年入睡眠障碍患病率的现状调查[J]．中华精神科杂志，2002，35(3)：180-183．
[7] 王学军．失眠病人的生活质量对照研究[J]．健康心理学杂志，2003，11(3)：204-206．
[8] Bixler E, Kales A, Soldatos C, et al. Prevalence of sleep disorders in the losangeles metropolitan area. Psychiatry, 1979,136:1257-1262.
[9] Balter MB, Uhlenhuth Eft. New epidemiologic findings about insomnia and it treatment[J]. Clin Psychiatry, 1992, 53(12):34.
[10] Charles MM, Peter JH, Colin AE. Nonpharmacologic treatment of chronic insomnia[J]. Sleep, 1999, 22(8): 1134-1156.
[11] Stepanski E, Koshorek G, Zorick F. Characteristics of individuals who do or not seek treatment for chronic insomnia[J]. Sleep, 1989, 30(1): 421-427.
[12] 吴任钢，张春改，邓军．慢性失眠症患者的应对方式和睡眠行为特征的对照研究[J]．中国心理卫生杂志，2003，17(10)：716-718．
[13] Prisoni GB, De Leo 9, Rozzini R, et al. Psychic correlates of sleep symptoms in the elderly. Geriatric Psychiatry, 1992,7:891-898.
[14] Jenkins LD, Stanton BA, Niemeryrs SJ, et al. A search for the estimation of sleep problems in clinical research[J]. Cli Epidemiol, 1988,41(4):313-321.
[15] Morrison DN, Mcgee R, Stanton WR ET AL. Sleep problems in adolescence. Child Adolesc psychiatry. 1992:94-99.
[16] 肖南，柳超萍．大学生失眠及其相关因素探讨[J]．中国心理卫生杂志，2001，15(3)：211．
[17] 王雪笠．慢性失眠症的临床与多导睡眠图研究[D]．石家庄：白求恩国际和平医院2000：10-11．
[18] Ford DE, Kamerow DB. Epidemiological study of sleep disturbances and psychiatric disorders: an opportunity for prevention. JAMA, 1989, 262:1479-1484.
[19] 潘集阳，赵耕原，张晋碚等．原发性失眠症患者的焦虑抑郁状态研究．中国行为医学科学，2000，9：178-179．
[20] 贺旭，洪军，林建华．失眠患者睡眠质量与抑郁焦虑状态的相关性研究[J]．中华物理医学与康复杂志，2002，24(8)：500-501．
[21] 朱姝．高荣林，隋殿军．老年患者失眠相关因素分析[J]．中国中医基础医学杂志．2002，8(1)：43-44．
[22] 张时革，孙定人．镇静助眠药[J]．中国药房，2001，12(2)：125．
[23] Regestei QR, et al. Specific effects of sedative hypnotic drugs in the treatment of in capacitating chronic insomnia. Med, 1987,83:138-142.
[24] 王廷槐．生物反馈及其机理进展[J]．医学信息，2002，15(10)：610-614．
[25] Schwartz MS. Biofeedback: A Practitioner's Guide[M]. 2nd ed. New York, London: The Guilford Press, 1995.
[26] 郑延平．生物反馈的临床实践[M]．北京：高等教育出版社，2003：2-5．
[27] 孟斌．郑戈．肌电反馈治疗神经衰弱42例[J]．1997，40(3)：183．
[28] 张巧俊，向丽，张凤等．肌电图生物反馈疗法在神经科心身疾病治疗中的应用价值[J]．中国临床康复，2003，7(16)：2334-2335．
[29] 陈凤美，符静．生物反馈治疗30例心身疾病疗效分析[J]．河北医学，2000，6(5)：449．
[30] 凌继昌，李丕平，范俊英．生物反馈治疗焦虑性神经症9例分析．苏州医学院学报，1995，15(1)：147-148．
[31] 郑延平．生物反馈的临床实践[M]．北京：高等教育出版社，2003：61、110．
[32] 张翠兰，肖红，黄久荣．生物反馈治疗老年人顽固性失眠[J]．四川医学，1999，20(2)：204-205．
[33] 徐清华．李军艳，李玉玮．肌电生物反馈疗法结合中药治疗老年睡眠障碍临床观察[J]．
中华医药杂志．2004，4(2)：166．
[34] American Sleep Disorders Association. Practice parameter for the use of polysomnography in the evaluation of insomnia. Sleep, 1995, 18: 55-57.
[35] American Sleep Disorders Association. The indications for polysomnography and related rocedures. Sleep, 1997, 20: 423-487.
[36] Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stage of human subjects. Los Angeles: Brain Research Institute, University of California, 1977:1-12.
[37] 李冲，贾福军，杜郝瑞等．失眠患者的多导睡眠图研究[J]．中华神经精神科杂志．1999，(32)1：33—35．
[38] Besset A. Electroencephalogr[J]. Clin Neurophysiol. 1998, 107(2): 122～132 19、33
[39] 兰胜作，邓敏琼，朱贤苟等．控制睡眠行为配合放松训练治疗失眠症临床观察[J]．中国心理卫生杂志，2002，16(9)：625-627．
[40] 王雪笠，冯连元；贺银方等．慢性失眠的足底穴位按摩治疗及多导睡眠图分析[J]．按摩与导引，2001，17(6)：6-8．
[41] 江帆，张远惠，刘协和等．佐匹克隆及三唑仑对失眠症患者多导睡眠图影响的研究[J]．中华精神科杂志，2001，34(1)34-37．
[42] Smith S, Triuder J. The effect of arousals during sleep onset on estimates of sleep onset latency. Sleep Res, 2000,9:129.
[43] 王雪笠，贺银芳，冯连元等．慢性失眠者多道睡眠图的观察及定量分析[J]．临床神经电生理学杂志，2001，10(2)：92-94．
[44] 余海鹰，王宏，崔庶等．失眠症患者主客观睡眠状况分析[J]．临床精神医学杂志．2003，13(2)：75-76．
[45] Dorsey CM. Biol[J]. Psychiatry, 1997,41(2): 209～216.
[46] 世界卫生组织．ICD-10精神与行为障碍分类临床描述与诊断要点[M]．范肖冬，汪向东．于欣等译．北京：人民卫生出版社，1993：70-106．
[47] 中华医学会精神科学会，南京医科大学脑科医院．中国精神病分类和诊断标准(CCMD-2-R)[M]．南京：东南大学出版社，1994：56-74．
[48] 江帆，袁强．失眠症睡眠脑电的研究进展[J]．国外医学．精神病学分册，2000，27(2)：112-116．
[49] 李充，贾福军贾福，杜好瑞等．失眠症患者的多导睡眠图研究．中华精神科杂志，1999，32(1)：33-35．
[50] 郭卜乐．做梦是记忆过程的一部分[EB]．http://www.being.org.cn/webquest/dream/rdcl/mengyujiyi.htm.2002, 12, 6.
[51] Kajimura N, Kato M, Setimoto M, et al. A polysomno graphic study of sleep patterns in normal human with low-or-high-anxiety personality traits[J]. Psychiatry Clin Nerosci, 1998,52(3):317-320.
[52] 郑革，孟斌．肌电反馈治疗焦虑症30例临床分析[J]．中国民政医学杂志，1998，10(3)：189-190．
[53] 杨晓东，冯永萍．赵玉萍．老年人的睡眠及睡眠障碍．中国老年学杂志．2000．20(1)：58-60．
[54] 于守臣，张忠山．宋彦等．1072例睡眠障碍的流调资料分析[J]．中国临床心理学杂志，1994，2(3)：171-173．
[2] Rosekind MR. The epidemiology and occurrence of insomnia[J]. Clin Psychiatry, 1992,53(6):4.
[3] Morin CM, Grayling SE. Sleep patterns and aging: comparison of older adults with and without insomnia complaints. Psychol Aging, 1989, 4: 290-294.
[4] Rorberts BE, Shema SJ, iaplan GA, et al. Sleep complaints and depression in an aging cohort: A prospective perspective. Psychiatry, 2000, 157: 81-88.
[5] Ohayon MM. Prevalence of DSM-Ⅳ diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. Psychiatr Res, 1997,31:333-346.
[6] 刘连启，刘贤臣，刘兆玺等．山东省城市老年入睡眠障碍患病率的现状调查[J]．中华精神科杂志，2002，35(3)：180-183．
[7] 王学军．失眠病人的生活质量对照研究[J]．健康心理学杂志，2003，11(3)：204-206．
[8] Bixler E, Kales A, Soldatos C, et al. Prevalence of sleep disorders in the losangeles metropolitan area. Psychiatry, 1979,136:1257-1262.
[9] Balter MB, Uhlenhuth Eft. New epidemiologic findings about insomnia and it treatment[J]. Clin Psychiatry, 1992, 53(12):34.
[10] Charles MM, Peter JH, Colin AE. Nonpharmacologic treatment of chronic insomnia[J]. Sleep, 1999, 22(8): 1134-1156.
[11] Stepanski E, Koshorek G, Zorick F. Characteristics of individuals who do or not seek treatment for chronic insomnia[J]. Sleep, 1989, 30(1): 421-427.
[12] 吴任钢，张春改，邓军．慢性失眠症患者的应对方式和睡眠行为特征的对照研究[J]．中国心理卫生杂志，2003，17(10)：716-718．
[13] Prisoni GB, De Leo 9, Rozzini R, et al. Psychic correlates of sleep symptoms in the elderly. Geriatric Psychiatry, 1992,7:891-898.
[14] Jenkins LD, Stanton BA, Niemeryrs SJ, et al. A search for the estimation of sleep problems in clinical research[J]. Cli Epidemiol, 1988,41(4):313-321.
[15] Morrison DN, Mcgee R, Stanton WR ET AL. Sleep problems in adolescence. Child Adolesc psychiatry. 1992:94-99.
[16] 肖南，柳超萍．大学生失眠及其相关因素探讨[J]．中国心理卫生杂志，2001，15(3)：211．
[17] 王雪笠．慢性失眠症的临床与多导睡眠图研究[D]．石家庄：白求恩国际和平医院2000：10-11．
[18] Ford DE, Kamerow DB. Epidemiological study of sleep disturbances and psychiatric disorders: an opportunity for prevention. JAMA, 1989, 262:1479-1484.
[19] 潘集阳，赵耕原，张晋碚等．原发性失眠症患者的焦虑抑郁状态研究．中国行为医学科学，2000，9：178-179．
[20] 贺旭，洪军，林建华．失眠患者睡眠质量与抑郁焦虑状态的相关性研究[J]．中华物理医学与康复杂志，2002，24(8)：500-501．
[21] 朱姝．高荣林，隋殿军．老年患者失眠相关因素分析[J]．中国中医基础医学杂志．2002，8(1)：43-44．
[22] 张时革，孙定人．镇静助眠药[J]．中国药房，2001，12(2)：125．
[23] Regestei QR, et al. Specific effects of sedative hypnotic drugs in the treatment of in capacitating chronic insomnia. Med, 1987,83:138-142.
[24] 王廷槐．生物反馈及其机理进展[J]．医学信息，2002，15(10)：610-614．
[25] Schwartz MS. Biofeedback: A Practitioner's Guide[M]. 2nd ed. New York, London: The Guilford Press, 1995.
[26] 郑延平．生物反馈的临床实践[M]．北京：高等教育出版社，2003：2-5．
[27] 孟斌．郑戈．肌电反馈治疗神经衰弱42例[J]．1997，40(3)：183．
[28] 张巧俊，向丽，张凤等．肌电图生物反馈疗法在神经科心身疾病治疗中的应用价值[J]．中国临床康复，2003，7(16)：2334-2335．
[29] 陈凤美，符静．生物反馈治疗30例心身疾病疗效分析[J]．河北医学，2000，6(5)：449．
[30] 凌继昌，李丕平，范俊英．生物反馈治疗焦虑性神经症9例分析．苏州医学院学报，1995，15(1)：147-148．
[31] 郑延平．生物反馈的临床实践[M]．北京：高等教育出版社，2003：61、110．
[32] 张翠兰，肖红，黄久荣．生物反馈治疗老年人顽固性失眠[J]．四川医学，1999，20(2)：204-205．
[33] 徐清华．李军艳，李玉玮．肌电生物反馈疗法结合中药治疗老年睡眠障碍临床观察[J]．
中华医药杂志．2004，4(2)：166．
[34] American Sleep Disorders Association. Practice parameter for the use of polysomnography in the evaluation of insomnia. Sleep, 1995, 18: 55-57.
[35] American Sleep Disorders Association. The indications for polysomnography and related rocedures. Sleep, 1997, 20: 423-487.
[36] Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stage of human subjects. Los Angeles: Brain Research Institute, University of California, 1977:1-12.
[37] 李冲，贾福军，杜郝瑞等．失眠患者的多导睡眠图研究[J]．中华神经精神科杂志．1999，(32)1：33—35．
[38] Besset A. Electroencephalogr[J]. Clin Neurophysiol. 1998, 107(2): 122～132 19、33
[39] 兰胜作，邓敏琼，朱贤苟等．控制睡眠行为配合放松训练治疗失眠症临床观察[J]．中国心理卫生杂志，2002，16(9)：625-627．
[40] 王雪笠，冯连元；贺银方等．慢性失眠的足底穴位按摩治疗及多导睡眠图分析[J]．按摩与导引，2001，17(6)：6-8．
[41] 江帆，张远惠，刘协和等．佐匹克隆及三唑仑对失眠症患者多导睡眠图影响的研究[J]．中华精神科杂志，2001，34(1)34-37．
[42] Smith S, Triuder J. The effect of arousals during sleep onset on estimates of sleep onset latency. Sleep Res, 2000,9:129.
[43] 王雪笠，贺银芳，冯连元等．慢性失眠者多道睡眠图的观察及定量分析[J]．临床神经电生理学杂志，2001，10(2)：92-94．
[44] 余海鹰，王宏，崔庶等．失眠症患者主客观睡眠状况分析[J]．临床精神医学杂志．2003，13(2)：75-76．
[45] Dorsey CM. Biol[J]. Psychiatry, 1997,41(2): 209～216.
[46] 世界卫生组织．ICD-10精神与行为障碍分类临床描述与诊断要点[M]．范肖冬，汪向东．于欣等译．北京：人民卫生出版社，1993：70-106．
[47] 中华医学会精神科学会，南京医科大学脑科医院．中国精神病分类和诊断标准(CCMD-2-R)[M]．南京：东南大学出版社，1994：56-74．
[48] 江帆，袁强．失眠症睡眠脑电的研究进展[J]．国外医学．精神病学分册，2000，27(2)：112-116．
[49] 李充，贾福军贾福，杜好瑞等．失眠症患者的多导睡眠图研究．中华精神科杂志，1999，32(1)：33-35．
[50] 郭卜乐．做梦是记忆过程的一部分[EB]．http://www.being.org.cn/webquest/dream/rdcl/mengyujiyi.htm.2002, 12, 6.
[51] Kajimura N, Kato M, Setimoto M, et al. A polysomno graphic study of sleep patterns in normal human with low-or-high-anxiety personality traits[J]. Psychiatry Clin Nerosci, 1998,52(3):317-320.
[52] 郑革，孟斌．肌电反馈治疗焦虑症30例临床分析[J]．中国民政医学杂志，1998，10(3)：189-190．
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