朱永　　刘颖

[摘要] 目的 探討米氮平联合重复经颅磁刺激治疗老年焦虑症伴睡眠障碍的临床效果。 方法 选择2018年1月至2019年12月在我院诊断治疗的老年焦虑症伴睡眠障碍患者100例为研究对象，随机分为观察组与对照组各50例。两组均给予米氮平治疗，观察组在此基础上予重复经颅磁刺激治疗。比较两组治疗前后HAMA评分、PSQI评分以及临床疗效。 结果 （1）治疗后，观察组HAMA评分（13.0±2.5）分，对照组（18.1±1.8）分，两组均显著下降，与治疗前比较，差异有统计学意义（P<0.05）;HAMA评分治疗后观察组较对照组低，差异有统计学意义（P<0.05）。（2）治疗后，观察组PSQI评分（6.2±1.1）分，对照组（10.7±1.4）分，两组均显著下降，低于治疗前，差异有统计学意义（P<0.05）;观察组治疗后PSQI评分低于对照组，差异有统计学意义（P<0.05）。（3）临床痊愈率观察组32.0%，对照组为10.0%，观察组高于对照组，差异有统计学意义（P<0.05）。观察组总有效率100.0%，显著高于对照组，差异有统计学意义（P<0.05）。 结论 米氮平联合重复经颅磁刺激治疗老年焦虑症伴睡眠障碍可显著改善患者焦虑症状及睡眠障碍情况。

[关键词] 米氮平;重复经颅磁刺激;睡眠障碍;焦虑症;心理状态;睡眠指标

[中图分类号] R749.72          [文献标识码] A          [文章编号] 1673-9701（2021）12-0024-04

Analysis on the clinical efficacy of mirtazapine combined with repetitive transcranial magnetic stimulation in the treatment of senile anxiety disorder complicated with sleep disorder

ZHU Yong1   LIU Ying2

1.Ward VI， Jiamusi Mental Welfare Institution in Heilongjiang Province， Jiamusi   154002， China; 2.Department of Inpatient Pharmacy， Jiamusi Mental Welfare Institution in Heilongjiang Province， Jiamusi   154002， China

[Abstract] Objective To investigate the clinical efficacy of mirtazapine combined with repetitive transcranial magnetic stimulation（rTMS） in the treatment of senile anxiety complicated with sleep disorder. Methods A total of 100 senile patients with anxiety and sleep disorder diagnosed and treated in our hospital from January 2018 to December 2019 were selected as the objects， and they were randomly divided into the observation group（n=50） and the control group （n=50）. Both groups were treated with mirtazapine， while the observation group was treated with rTMS based on the control group. HAMA score， PSQI score and clinical efficacy were compared between the two groups before and after treatment. Results （1）After treatment， the HAMA score of the observation group was （13.0±2.5） points， and the control group was （18.1±1.8） points. HAMA scores of both groups were decreased significantly， and the difference was statistically significant compared with that before treatment（P<0.05）. After treatment， HAMA score of the observation group was lower than that of the control group， and the difference was statistically significant（P<0.05）. （2）After treatment， the PSQI score of the observation group was（6.2±1.1） points and the control group was（10.7±1.4） points， PSQI scores of both groups were significantly lower than those before treatment， and the differences were statistically significant（P<0.05）. After treatment， the PSQI score of the observation group was lower than that of the control group， and the difference was statistically significant（P<0.05）. （3） The clinical recovery rate of the observation group was 32.0%， which was higher than 10.0% of the control group， and the difference was statistically significant（P<0.05）. The total effective rate of the observation group was 100.0%， which was significantly higher than that of the control group， and the difference was statistically significant（P<0.05）. Conclusion Mirtazapine combined with rTMS can significantly relieve anxiety and sleep disorders in senile patients.

[Key words] Mirtazapine; Repetitive transcranial magnetic stimulation; Sleep disorder; Anxiety; Psychological state; Sleep indicator

老年焦慮症是精神科常见病，因老年人表现可能不典型，识别率较低，容易导致精神致残，具有较高的自杀率，患者可能表现为心烦意乱、坐卧不安、紧张恐惧等，患者很容易合并睡眠障碍，与焦虑症互为因果，导致病情加重[1]。米氮平的作用于中枢突触前α2受体，其可使肾上腺素能神经传导增强，与5-羟色胺受体相作用来调节5-羟色胺的功能，具有镇静作用，临床上可用于睡眠障碍的治疗[2]。经颅磁刺激（Transcranial Magnetic Stimulation， TMS）是通过线圈产生高磁通量磁场无衰减地穿过颅骨，对神经结构产生刺激作用，达到改善睡眠、焦虑障碍、抑郁等情况。本文联合米氮平与重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）治疗老年焦虑症伴睡眠障碍，分析其临床疗效，现报道如下。

1 对象与方法

1.1研究对象

2018年1月至2019年12月，选择100例老年焦虑症伴睡眠障碍的患者为研究对象。纳入标准[3]：年龄≥65岁，符合焦虑症诊断标准[4]，伴睡眠障碍[5]，对本次研究知情同意。……