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语言诱导与古琴音乐对原发性失眠症患者疗效的比较研究
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摘要
1研究背景
     失眠症是常见的睡眠障碍,其发病率呈逐年上升趋势,并影响着人们的的生活质量,原发性失眠症是睡眠障碍的常见类型之一。原发性失眠症的中医治疗方法主要有非药物治疗、心理治疗、药物治疗、针灸治疗,然而西药治疗失眠见效虽快,但大多数催眠药物都存在耐受性和依赖性,长期服用会产生副反应,不但会影响造血功能、肝肾功能、心血管与神经系统功能,在一定程度上会影响认知功能。本文拟对非药物治疗的中医心理疗法、音乐治疗进行了对比的研究,为进一步探讨非药物治疗失眠症提供新思路与途径。
     2研究目的
     采用语言诱导和古琴音乐进行随机对照治疗前后观察研究,以期验证非药物疗法在原发性失眠的基础治疗上的临床效果。
     3研究方法
     3.1采用语言诱导、古琴音乐在香港怡仁中医保健中心失眠专科门诊招募原发性失眠症患者,通过招募志愿者随机选择失眠患者,本研究共入组患者120例,采集相关临床数据,录入并建立数据库。
     3.2采用医学统计学方法采用SAS统计软件,样本t检验、秩和检验和卡方检验,观察古琴音乐、语言诱导、语言诱导和古琴音乐、原发性失眠症的临床疗效。采用随机对照的研究设计,在专科门诊筛选出符合原发性失眠症条件的120例为研究对象。采用区组随机分组,应用SAS9.2统计软件PROC PLAN过程语句,产生120例受试者所接受处理(对照组30人、语言诱导30人、语言诱导和古琴音乐组31人、古琴音乐组29人)的随机分配表。登记相关信息并按随机分配表中的“入组序号”与患者就诊的先后顺序相对应,为患者分配随机号和治疗组别。
     3.3采用睡眠医学评价方法
     阿森斯失眠量表(AIS)和症状自评量表(SCL-90)入组后第0、2、4、8周观察记录各1次,患者前后的脑电图(EEG)、心率变异性生物反馈(HRV)入组后第0、4、8周观察记录各1次,进行治疗前和治疗后疗效的比较。
     4研究结果
     4.1非药物疗法对失眠的改善
     阿森斯失眠量表总分差值比较语言诱导组、古琴音乐组、语言诱导和古琴音乐组,相对于对照组,证明三种非药物疗法能够显着改善失眠较对照组为优。其中,语言诱导和古琴音乐组对失眠的改善优于其他治疗组。
     4.2非药物疗法对SCL-90中症状的改善
     与对照组相比,在第4周,三个治疗组在“恐怖”和“其它”因子上的平均差值有显著的下降;在第8周,三个治疗组在“强迫”、“恐怖”和“其它”因子上的平均差值有显著的下降。
     4.3非药物疗法对脑电图的改善
     脑电图指标差值比较,在第4、8周,语言诱导组、古琴音乐组、语言诱导和古琴音乐组、相对于对照组而言,Alpha和Theta波有显著的增多,表明Alpha和Theta波的改变可能是三种疗法起作用的机制之一。
     4.4非药物疗法对心率变异性生物反馈的改善
     语言诱导组、古琴音乐组、语言诱导和古琴音乐组、相对于对照组而言,VLFper、 LFper、LF/HF以及HR有显著的降低;而HFper有显著的升高,可认为三种治疗方法改善了失眠患者的心率变异性。
     4.5三种疗法治疗前后疗效指标的组内比较
     失眠量表、症状自评量表、脑电图、心率变异性生物反馈各疗效指标组内比较,语言诱导组、古琴音乐组、语言诱导和古琴音乐组,治疗前后组内比较均有显着统计学差异,证明每一种非药物疗法是有疗效的。
     5研究结论
     语言诱导、古琴音乐、语言诱导和古琴音乐,能够显著改善原发性失眠症患者的失眠以及严重程度,缓解与之相关的“强迫”、“恐怖”和“其它”等症状,同时改善心率变异性生物反馈指标,并提高了脑电中Alpha和Theta波。本研究应用我国的中医心理、古琴音乐治疗在治疗原发性失眠症上取得较好的疗效,其中,语言诱导和古琴音乐组的疗效是最好。古琴音乐可使失眠症患者身心进入和谐、安静、放松的状态,有效促进身心和谐、改善失眠,且古琴音乐在心率变异性的低频段所诱发的合一性,进一步促进身心和谐,以及缓解其心理紊乱等症状;语言诱导改变的是患者的内隐认知。所以,语言诱导和古琴音乐组是同时改变患者的情绪和认知。因此,将古琴音乐与中医心理养生结合起来,可促进音乐治疗在精神心理康复中的应用,广泛应用于临床治疗及养生保健,并可帮助失眠者缓减对安眠药的依赖性,从而提高失眠症患者的康复效果,为非药物治疗失眠症提供了新思路与路径。
1. Background:
     Insomnia is a common type of sleep disorder. Its tendency of gradual increase in recent years is causing negative impact on the quality of life. Of all kinds of sleep disorder, Primary Insomnia is one of the most common. At present, Primary Insomnia can be treated by TCM non-drug method, psychological method, Acupuncture, or medication. Westerm Drug medication is efficient in treating insomnia but most sleep-inducement drugs cause undesirable resistance and dependency. Long-term use of such drugs produces side effects, affecting not only the hematopoietic function, hepatic and renal function, cardiovascular function, but also the nervous system function, and to a certain extent, the cognitive function. This thesis seeked to give a contrastive study of non-drug approaches i.e.TCM Psychology and Music Therapy. It paved way for new possibilities of using non-drug treatment on basic treatment for Primary Insomnia.
     2. Research objectives:
     Patients suffering from Primary Insomnia were given treatments using Hypnotic Suggestion and Guqin Music. Observations and analysis were made about patients' progress before and after treatment. To ensure objectiveness, the collection of data was done in a random manner. It is hoped that this approach can verify the clinical effects of non-drug treatment on basic treatment of Primary Insomnia.
     3. Research Method:
     3.1Using Hypnotic Suggestion and Guqin Music:
     Patients of Primary Insomnia were recruited at Yee Yan TCM Healthcare Centre in Hong Kong.120volunteers were selected at random. Clinical data were collected, recorded and established as database.
     3.2Adoption of medical statistics methodology:
     Using SAS statistics software Sample test, Rank Test, X2test, observe different clinical effects on Primary Insomnia by treatments of Guqin music, Hypnotic suggestion, or Hypnotic suggestion combined with Guqin music therapy. Based on a system of random statistical cross-referencing,120patients with Primary Insomnia syndromes were selected for study. Application SAS9.2statistical software PROCLAN procedure statements were used to divide the120patients into groups randomly for different treatments (30in Control Group,30in Hypnotic Suggestion Group,31in Hypnotic Suggestion combined with Guqin Group,29in Guqin Group). Related data were recorded and a "Group item number" was assigned to match with the order of patients receiving treatment.
     3.3Adoption of assessment method in Sleep Medicine
     Athens insomnia scale and SCL-90were used to measure progress once in weeks0,2,4,8. Data of EEG, HRV were recorded once in weeks0,4th,8th, for comparisons of pre-and post-treatment efficacy.
     4. Research Results
     4.1. Improvements of non-drug treatment for insomnia scale
     When "Total Scores" on the Athens Insomnia scale were compared, a significant decline in the Hypnotic Suggestion Group, Guqin Music Group, combination of Hypnotic Suggestion with Guqin Music Group was indicated than the Control Group. This proved that the three non-drug therapies can significantly improve insomnia symptoms. Overall, The combination of Hypnotic Suggestion with Guqin Music Group was the best group comparing with the other groups.
     4.2Improvements of non-drug treatments in the self-reporting Inventory (SCL-90)
     When "Self-reporting Inventory" was compared in the4th weeks, the Hypnotic Suggestion Group, Guqin Music Group and combination of Hypnotic Suggestion with Guqin Music Group all indicated a bigger decline on the average value of "Terror" and "Others" than that of the Control Group. In the4th and8th weeks, the Hypnotic Suggestion Group, Guqin Music Group and combination of Hypnotic Suggestion with Guqin Music Group all indicated a bigger decline on the average value of "Obsessive-compulsive","Terror" and "Others" than that of the Control Group.
     4.3Improvement of non-drug treatments in EEG
     When EEG measurements were compared in the4th and8th weeks, the Hypnotic Suggestion Group, Guqin Music Group and combination of Hypnotic Suggestion with Guqin Music Group showed significant difference in Alpha and Theta waves from that of the Control Group. This result illustrated that significant increase of Alpha and Theta wave may be one of mechanism underlying effects of the three therapies.
     4.4Improvement of non-drug treatments in HRV
     When measurements of the HRV index were taken in the4th week, the Hypnotic Suggestion Group, Guqin Music Group and combination ofHypnotic Suggestion with Guqin Music Group showed significant decrease in Percentage Very Low Frequency (VLFper), Percentage Low Frequency (LFper), Low frequency/High frequency (LF/HF) and heart rate (HR) than that of the Control Group. However, Percentage High Frequency (HFper) significantly increased in the three therapy groups. This result proved that these three non-drug therapies can significantly improve some of the HRV index.
     4.5Group Comparison of treatment effects in the3groups using therapeutic methods
     When Athens insomnia scale (AIS), Self-reporting Inventory (SCL-90), EEG and HRV index were compared between the3groups using therapeutic methods, i.e. the Hypnotic Suggestion Group, Guqin Music Group and combination of Hypnotic Suggestion with Guqin Music Group, data from Pre and Post intervention showed statistical differences. These results indicated that each of the three therapies offered effective treatment for primary insomnia.
     5. Research Conclusions
     Hypnotic Suggestion, Guqin Music and combination of Hypnotic Suggestion with Guqin Music can improve primary insomnia symptoms and relieve associated "Obsessive-compulsive","Terror" and "Othef"symptoms. Moreover, some of the HRV indexes and Alpha and Theta wave in EEG were improved in the three therapies groups. Significant effect was observed applying TCM psychology(TIP Psychological treatment) and Guqin Music Therapy for primary insomnia. Meanwhile, the effect in combination of Hypnotic Suggestion with Guqin Music group was the best one. Guqin Music can make Insomnia patients'body and mind into a state of harmonious, quiet and relaxation, which can effectively promote the harmony of body and mind, so as to improve the insomnia symptom. At the same time, Guqin Music can caused a kind of unique of the low frequency heart rate variability, to further promote the harmony of body and mind, and relieve the psychological disorders as well as other symptoms; The purpose of language is to change patients implicit cognition, so combination of Hypnotic Suggestion with Guqin Music group is changed in the emotion and cognition at the same time. Therefore, to combine Guqin Music with TCM psychological health therapy, can promote the application of music therapy on mental rehabilitation, be widely used in clinical treatment and health care, and ease reliance on sleeping pills, so as to improve the rehabilitation effect of patients with insomnia, provide new idea and method for non-drug treatments of primary insomnia.
引文
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