脑电生物反馈放松疗法对特发性耳鸣患者睡眠质量的影响
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摘要
目的探讨脑电生物反馈放松疗法对特发性耳鸣患者睡眠质量的影响。方法采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表调查148例特发性耳鸣患者的睡眠状况,将其中有睡眠障碍的60例患者随机分为对照组和试验组,每组30例,对照组单纯给予药物治疗(艾司唑仑片1mg,每晚睡前30min口服)8周;试验组在口服相同药物治疗的基础上,每周进行脑电生物反馈放松治疗3次,每次治疗约30min,治疗8周。所有患者在治疗前后均行PSQI量表、症状自评量表(symptom check list 90,SCL-90)评估,并收集治疗前后脑电Alpha波频率的平均值。结果 (1)148例特发性耳鸣患者PSQI的平均分为9.37±2.69分,>7分者共60人,失眠检出率为40.54%(60/148);治疗后,对照组PSQI>7分者22例,试验组PSQI>7分者13例,试验组低于对照组;(2)治疗前,两组患者间PSQI得分和脑电Alpha频率差异无统计学意义(t_(PSQI)=0.09,t_(Alpha波)=-0.83,P>0.05);对照组治疗后PSQI得分较治疗前降低,差异有统计学意义(t_(PSQI)=6.81,P<0.05),但治疗前后脑电Alpha波频率比较差异无统计学意义(t_(Alpha波)=-1.94,P>0.05);试验组治疗后PSQI得分和脑电Alpha波频率均较治疗前降低,差异均有统计学意义(t_(PSQI)=14.43,t_(Alpha波)=9.69,P<0.05),且试验组治疗后较对照组降低,差异有统计学意义(t_(PSQI)=-3.73,t_(Alpha波)=-7.58,P<0.05)。(3)试验组的SCL-90总分、躯体化、人际关系、抑郁、焦虑得分都显著低于对照组,差异有统计学意义(P<0.05);(4)特发性耳鸣患者的脑电Alpha波频率、SCL-90总分及其各因子得分均与PSQI得分呈显著正相关(P<0.001)。结论脑电生物反馈放松疗法能有效改善特发性耳鸣患者的心理状态,引导其放松,从而改善其睡眠质量。
Objective To investigate the clinical efficacy of elcetrocerebral biofeedback relaxation therapy on sleep quality of patients with idiopathic tinnitus.Methods At total of 148 idiopathic tinnitus patients were tested by Pittsburgh sleep quality index(PSQI),and 60 patients' scores were more than seven.30 patients were given Betahistine tablets and Mecobalamin tablets as an experimental group,at the same time they received elcetrocerebtal biofeedback relaxation therapy three times a week for two months.30 patients were given Betahistine tablets and Mecobalamin tablets as a control group,waiting for the elcetrocerebral biofeedback relaxation therapy when the experimental group over.All idiopathic tinnitus patients were tested with symptom checklist 90(SCL-90)and PSQI,and marked the points of Alpha.Results The average score of PSQI was 9.37±2.69 and 60 patients' scores were more than seven.The proportion of insomnia was 40.5%.After intervention,the scores of PSQI and Alpha were significantly different between experimental group and control group(P<0.05).After intervention,the scores of somatic,interpersonal sensitive,depression,anxiety were significantly different between experimental group and control group(P<0.05).The total points of SCL-90 and factors scores of tinnitus patient were positively correlative with PSQI(P<0.001).The points of Alpha were positively correlative with PSQI(P<0.001).Conclusion The relaxation therapy on tinnitus patient had significant effects on improving the quality of sleep and falling bad influence of the negative mental characteristics of tinnitus.
Objective To investigate the clinical efficacy of elcetrocerebral biofeedback relaxation therapy on sleep quality of patients with idiopathic tinnitus.Methods At total of 148 idiopathic tinnitus patients were tested by Pittsburgh sleep quality index(PSQI),and 60 patients' scores were more than seven.30 patients were given Betahistine tablets and Mecobalamin tablets as an experimental group,at the same time they received elcetrocerebtal biofeedback relaxation therapy three times a week for two months.30 patients were given Betahistine tablets and Mecobalamin tablets as a control group,waiting for the elcetrocerebral biofeedback relaxation therapy when the experimental group over.All idiopathic tinnitus patients were tested with symptom checklist 90(SCL-90)and PSQI,and marked the points of Alpha.Results The average score of PSQI was 9.37±2.69 and 60 patients' scores were more than seven.The proportion of insomnia was 40.5%.After intervention,the scores of PSQI and Alpha were significantly different between experimental group and control group(P<0.05).After intervention,the scores of somatic,interpersonal sensitive,depression,anxiety were significantly different between experimental group and control group(P<0.05).The total points of SCL-90 and factors scores of tinnitus patient were positively correlative with PSQI(P<0.001).The points of Alpha were positively correlative with PSQI(P<0.001).Conclusion The relaxation therapy on tinnitus patient had significant effects on improving the quality of sleep and falling bad influence of the negative mental characteristics of tinnitus.
引文
1中华耳鼻咽喉头颈外科杂志编辑委员会耳科专业组.2012耳鸣专家共识及解读[J].中华耳鼻咽喉头颈外科杂志,2012,47:709.
2 AAO-HNSF.Clinical practice guideline:tinnitus[J].Otolaryngology Head Neck Surgery,2014,151(2Suppl):S1.
3 吴洪军,徐丽萍,杨惠君,等.脑电生物反馈治疗失眠疗效评价[J].临床心身疾病杂志,2009,15:1.
4 刘光明,景璐石,彭华,等.生物反馈放松训练治疗医学生失眠症的试验研究[J].中华临床医师杂志,2012,6:5717.
5 邓小鹏,周丽芳,郭伟,等.脑电生物反馈辅助治疗老年失眠症的疗效观察[J].精神医学杂志,2014,2:110.
6 Hammer BU,Colbert AP,Brown KA,et al.Neurofeedback for insomnia:apilot study of Z-score SMR and individualized protocols[J].Appl Psychophysiol Biofeedback,2011,36:251.
7 Aydin S,Saraoglu HM,Kara S.Singular spectrum analysis of sleep EEG in insomnia[J].J Med Syst,2011,35:457.
8 Buysse DJ,Reynolds CF,Monk TH,et a1.The Pittsburgh sleep quality index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28:193.
9 刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29:103.
10 王征宇.症状自评量表(SCL~90)[J].上海精神医学,1984,2:68.
11 张永芬,白淑珍,高波.应用放松疗法改善耳鸣患者睡眠质量的对照性研究[J].中国健康心理学杂志,2012,20:1026.
12 齐思涵,秦兆冰,陈秀兰,等.影响慢性主观性耳鸣严重程度的相关因素分析[J].听力学及言语疾病杂志,2014,22:367.
13 韩艳艳,布荣霞,李芳.思诺思治疗合并睡眠障碍的主观性耳鸣疗效分析[J].听力学及言语疾病杂志,2016,24:457.
14 贾若,孙凤新,刘博.耳鸣与情绪认知的相关性分析[J].中华耳科学杂志,2016,14:158.
15 郑延平.生物反馈治疗的临床实践[M].北京:高等教育出版社,2003.6~81.
2 AAO-HNSF.Clinical practice guideline:tinnitus[J].Otolaryngology Head Neck Surgery,2014,151(2Suppl):S1.
3 吴洪军,徐丽萍,杨惠君,等.脑电生物反馈治疗失眠疗效评价[J].临床心身疾病杂志,2009,15:1.
4 刘光明,景璐石,彭华,等.生物反馈放松训练治疗医学生失眠症的试验研究[J].中华临床医师杂志,2012,6:5717.
5 邓小鹏,周丽芳,郭伟,等.脑电生物反馈辅助治疗老年失眠症的疗效观察[J].精神医学杂志,2014,2:110.
6 Hammer BU,Colbert AP,Brown KA,et al.Neurofeedback for insomnia:apilot study of Z-score SMR and individualized protocols[J].Appl Psychophysiol Biofeedback,2011,36:251.
7 Aydin S,Saraoglu HM,Kara S.Singular spectrum analysis of sleep EEG in insomnia[J].J Med Syst,2011,35:457.
8 Buysse DJ,Reynolds CF,Monk TH,et a1.The Pittsburgh sleep quality index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28:193.
9 刘贤臣,唐茂芹,胡蕾,等.匹兹堡睡眠质量指数的信度和效度研究[J].中华精神科杂志,1996,29:103.
10 王征宇.症状自评量表(SCL~90)[J].上海精神医学,1984,2:68.
11 张永芬,白淑珍,高波.应用放松疗法改善耳鸣患者睡眠质量的对照性研究[J].中国健康心理学杂志,2012,20:1026.
12 齐思涵,秦兆冰,陈秀兰,等.影响慢性主观性耳鸣严重程度的相关因素分析[J].听力学及言语疾病杂志,2014,22:367.
13 韩艳艳,布荣霞,李芳.思诺思治疗合并睡眠障碍的主观性耳鸣疗效分析[J].听力学及言语疾病杂志,2016,24:457.
14 贾若,孙凤新,刘博.耳鸣与情绪认知的相关性分析[J].中华耳科学杂志,2016,14:158.
15 郑延平.生物反馈治疗的临床实践[M].北京:高等教育出版社,2003.6~81.