中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2005年
12期
241-243
,共3页
偏头痛%行为疗法%评价研究
偏頭痛%行為療法%評價研究
편두통%행위요법%평개연구
背景:紧张、焦虑、抑郁是偏头痛的重要诱发因素,而紧张、焦虑、抑郁与患者不合理信念、不正确的应付策略密切相关.药物疗法是目前治疗偏头痛的主要方法,但其不能改变患者的不合理信念,从而减少头痛诱发因素的产生.目的:观察药物疗法和合理情绪行为疗法对偏头痛的近远期疗效,以期为偏头痛患者提供更为安全有效的干预措施,从而改善其远期生活质量.设计:以偏头痛患者为研究对象,健康人群为对照组的观察对比研究.单位:一所市级医院的心理咨询门诊(现已撤消).对象:研究对象为289医院心理咨询门诊1999-03/2001-10的偏头痛患者,共86例,其中男34例,女52例,年龄16～48岁,平均35岁,病程2～11年.采用查表法将86例患者随机分为合理情绪行为疗法组和药物组各43例,两组患者年龄、性别、病程、病情、文化程度差异无显著性意义.另设30例健康体检者作为对照组,其中男12例,女18例,平均36岁.方法:合理情绪行为疗法组采用合理情绪行为疗法;药物组给予阿米替林50～100 mg/d,尼莫地平60 mg/d,口服,治疗12周,观察24周.比较两组患者偏头痛效疗评分及治疗前后事件相关电位P300,90项症状自评量表评分.主要观察指标:两组患者偏头痛疗评分及治疗前后P300,90项症状自评量表评分比较.结果:两组患者90项症状自评量表总分明显高于对照组,差异具有显著性意义(P＜0.05);经治12周,两组患者偏头痛疗效评分、90项症状自评量表总分及主要因子分与治疗前相比均显著降低(P＜0 05),但两组间差异无显著性意义;停止治疗后第12周,合理情绪行为疗法组90项症状自评量表总分及主要因子分、偏头痛效疗评分、P300潜伏期与治疗12周时基本相同,P300波幅显著增高,而药物组90项症状自评量表总分及主要因子分、偏头痛疗效评分与治疗12周时相比差异具有显著性意义(P＜0.05),两组同期相比差异具有显著性意义(P＜0.05).结论:合理情绪行为疗法能减少偏头痛发作次数、降低偏头痛疗效评分,近期疗效与药物组相似;同时能够改善患者认知功能障碍、改变患者不合理信念、提高其应付策略,远期疗效明显优于药物治疗.
揹景:緊張、焦慮、抑鬱是偏頭痛的重要誘髮因素,而緊張、焦慮、抑鬱與患者不閤理信唸、不正確的應付策略密切相關.藥物療法是目前治療偏頭痛的主要方法,但其不能改變患者的不閤理信唸,從而減少頭痛誘髮因素的產生.目的:觀察藥物療法和閤理情緒行為療法對偏頭痛的近遠期療效,以期為偏頭痛患者提供更為安全有效的榦預措施,從而改善其遠期生活質量.設計:以偏頭痛患者為研究對象,健康人群為對照組的觀察對比研究.單位:一所市級醫院的心理咨詢門診(現已撤消).對象:研究對象為289醫院心理咨詢門診1999-03/2001-10的偏頭痛患者,共86例,其中男34例,女52例,年齡16～48歲,平均35歲,病程2～11年.採用查錶法將86例患者隨機分為閤理情緒行為療法組和藥物組各43例,兩組患者年齡、性彆、病程、病情、文化程度差異無顯著性意義.另設30例健康體檢者作為對照組,其中男12例,女18例,平均36歲.方法:閤理情緒行為療法組採用閤理情緒行為療法;藥物組給予阿米替林50～100 mg/d,尼莫地平60 mg/d,口服,治療12週,觀察24週.比較兩組患者偏頭痛效療評分及治療前後事件相關電位P300,90項癥狀自評量錶評分.主要觀察指標:兩組患者偏頭痛療評分及治療前後P300,90項癥狀自評量錶評分比較.結果:兩組患者90項癥狀自評量錶總分明顯高于對照組,差異具有顯著性意義(P＜0.05);經治12週,兩組患者偏頭痛療效評分、90項癥狀自評量錶總分及主要因子分與治療前相比均顯著降低(P＜0 05),但兩組間差異無顯著性意義;停止治療後第12週,閤理情緒行為療法組90項癥狀自評量錶總分及主要因子分、偏頭痛效療評分、P300潛伏期與治療12週時基本相同,P300波幅顯著增高,而藥物組90項癥狀自評量錶總分及主要因子分、偏頭痛療效評分與治療12週時相比差異具有顯著性意義(P＜0.05),兩組同期相比差異具有顯著性意義(P＜0.05).結論:閤理情緒行為療法能減少偏頭痛髮作次數、降低偏頭痛療效評分,近期療效與藥物組相似;同時能夠改善患者認知功能障礙、改變患者不閤理信唸、提高其應付策略,遠期療效明顯優于藥物治療.
배경:긴장、초필、억욱시편두통적중요유발인소,이긴장、초필、억욱여환자불합리신념、불정학적응부책략밀절상관.약물요법시목전치료편두통적주요방법,단기불능개변환자적불합리신념,종이감소두통유발인소적산생.목적:관찰약물요법화합리정서행위요법대편두통적근원기료효,이기위편두통환자제공경위안전유효적간예조시,종이개선기원기생활질량.설계:이편두통환자위연구대상,건강인군위대조조적관찰대비연구.단위:일소시급의원적심리자순문진(현이철소).대상:연구대상위289의원심리자순문진1999-03/2001-10적편두통환자,공86례,기중남34례,녀52례,년령16～48세,평균35세,병정2～11년.채용사표법장86례환자수궤분위합리정서행위요법조화약물조각43례,량조환자년령、성별、병정、병정、문화정도차이무현저성의의.령설30례건강체검자작위대조조,기중남12례,녀18례,평균36세.방법:합리정서행위요법조채용합리정서행위요법;약물조급여아미체림50～100 mg/d,니막지평60 mg/d,구복,치료12주,관찰24주.비교량조환자편두통효료평분급치료전후사건상관전위P300,90항증상자평량표평분.주요관찰지표:량조환자편두통료평분급치료전후P300,90항증상자평량표평분비교.결과:량조환자90항증상자평량표총분명현고우대조조,차이구유현저성의의(P＜0.05);경치12주,량조환자편두통료효평분、90항증상자평량표총분급주요인자분여치료전상비균현저강저(P＜0 05),단량조간차이무현저성의의;정지치료후제12주,합리정서행위요법조90항증상자평량표총분급주요인자분、편두통효료평분、P300잠복기여치료12주시기본상동,P300파폭현저증고,이약물조90항증상자평량표총분급주요인자분、편두통료효평분여치료12주시상비차이구유현저성의의(P＜0.05),량조동기상비차이구유현저성의의(P＜0.05).결론:합리정서행위요법능감소편두통발작차수、강저편두통료효평분,근기료효여약물조상사;동시능구개선환자인지공능장애、개변환자불합리신념、제고기응부책략,원기료효명현우우약물치료.
BACKGROUND: Nervousness, anxiety and depression are important inducing factors of migraine, while nervousness, anxiety and depression are closely correlated with the unreasonable belief and incorrect strategy. Medicine therapy is the principal method in the treatment of migraine at present, but it cannot change the unreasonable belief of the patients and thereby to reducethe occurrence of the inducing factors of headache.OBJECTIVE: To observe the near term and long term therapeutic effects of medicine therapy and rational emotional behavior therapy(REBT) to provide a safer and more effective intervention for the patients with migraine and thereby to improve their long term quality of life(QOL).DESIGN: An observatory comparative study based on patients with migraine as subjects and healthy population as controls.SETTING: A psychological consultation clinic of a municipal hospital(has been canceled now).PARTICIPANTS: Totally 86 cases of migraine including 34 males and 52females aged between 16 and 48 years old(means of 35 years old) with a course of disease between 2 and 11 years were selected from the Psychological Consultation Clinic of the 289 Hospital between March 1999 and October 2001. All 86 cases were randomly divided into REBT group and medicine group with 43 cases each. There was no significant difference of age, gender,course of the disease, situation of the disease, and education background between two groups. Another 30 healthy individuals including 12 males and 18 females with a mean age of 36 years old were selected in control group.METHODS: REBT was applied for patients in REBT group. Patients of medicine group received 50-100 mg/day of Amitriptyline and 60 mg/day of nimodipine through oral administration. Patients received 12 weeks of therapy followed by 24 weeks of observation.MAIN OUTCOME MEASURES: Therapeutic scale score on migraine (TSSM), before and after migraine-correlated potential(P300) and symptoms checklist 90 (SCL-90) scores were compared.RESULTS: SCL-90 total points of two groups of patients were significantly higher than that of control group( P ＜ 0.05); after 12 weeks of therapy,TSSM, SCL-90 total points and points of major factors of two groups of patients were significantly lower compared with the situations before therapy( P ＜ 0.05), but there was no significant difference between two therapy groups; on the 12th week after therapy, SCL-90 total points, points for major factors and TSSM, and P300 latency of REBT group were almost as the same as that after 12 weeks of therapy and the wave amplitude of P300 significantly elevated; owever, the differences in SCL-90 total points, points of major factors, and the TSSM in medicine group were significant compared with that after 12 weeks of therapy( P ＜ 0.05) . There was significant difference at the same period between two therapy groups ( P ＜ 0.05).CONCLUSION: REBT can reduce the attacks of migraine, decrease TSSM,and has similar therapeutic effects to medicine group. Simultaneously, it can ameliorate the cognitive disorder, change the unreasonable belief of the patients, and improve the strategy to cope with the disease; hence its long term therapeutic effect is better than medicine therapy.
