文章摘要
右美托咪定鼻喷联合重复经颅磁刺激用于慢性失眠合并焦虑患者的治疗效果
Therapeutic effect of dexmedetomidine nasal spray combined with transcranial magnetic stimulation in patients with chronic insomnia and anxiety
  
DOI：10.12089/jca.2026.06.010
中文关键词: 右美托咪定鼻喷  重复经颅磁刺激  慢性失眠  焦虑
英文关键词: Dexmedetomidine nasal spray  Repetitive transcranial magnetic stimulation  Chronic insomnia  Anxiety
基金项目:河南省医学科技攻关省部共建项目(SBGJ202502086)；河南大学第一附属医院开放课题青年基金项目（KFQN24011）
作者单位E-mail
王威 475001,开封市,河南大学第一附属医院麻醉与围术期医学科  
杜青青 475001,开封市,河南大学第一附属医院麻醉与围术期医学科  
高亚乐 475001,开封市,河南大学第一附属医院麻醉与围术期医学科  
韩强强 475001,开封市,河南大学第一附属医院麻醉与围术期医学科  
陈勇 475001,开封市,河南大学第一附属医院麻醉与围术期医学科  
庞红利 475001,开封市,河南大学第一附属医院麻醉与围术期医学科 18237863159@163.com 
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中文摘要:
      
目的：探讨右美托咪定鼻喷联合重复经颅磁刺激（rTMS）对慢性失眠合并焦虑患者的临床治疗效果。
方法：选择麻醉与睡眠医学门诊收治的慢性失眠合并焦虑患者，年龄18～64岁，BMI 18.5～28.0 kg/m2。采用随机数字表法将患者分为三组：rTMS组（T组）、右美托咪定鼻喷组（D组）和右美托咪定鼻喷联合rTMS组（DT组）。三组均接受4周干预，T组给予右侧背外侧前额叶皮层（DLPFC）低频rTMS治疗并逐渐减少次数；D组睡前实施右美托咪定鼻喷并执行递减方案；DT组联用两种干预方案。主要指标为治疗结束时的总体治疗率。次要指标包括治疗前、治疗结束时、治疗后1、3个月的匹兹堡睡眠质量指数（PSQI）；治疗前、治疗2周、治疗结束时及治疗后1、3个月的汉密尔顿焦虑量表（HAMA）、毛氏躯体化症状自评量表（SSS）、睡眠总时间、睡眠潜伏期、睡眠效率、深睡眠占比、浅睡眠占比、快速眼动（REM）睡眠占比、镇静催眠药的使用情况（以地西泮等效剂量表示）。
结果：共纳入患者135例，T组42例，D组45例，DT组48例。与T组比较，DT组总体有效率明显升高（P＜0.05）。与T组比较，DT组治疗结束时、治疗后1、3个月PSQI评分明显降低，治疗2周、治疗结束时及治疗后1、3个月HAMA、SSS评分明显降低，治疗2周、治疗结束时及治疗后1、3个月睡眠总时间明显延长，睡眠效率明显升高，睡眠潜伏期明显缩短，浅睡眠占比明显降低，治疗结束时及治疗后1、3个月深睡眠占比明显升高，治疗2周、治疗结束时REM睡眠占比明显升高，治疗结束时及治疗后1、3个月服用地西泮等效剂量明显减少，停药比例明显升高（P＜0.05）。与D组比较，DT组治疗结束时、治疗后1、3个月PSQI评分明显降低，治疗2周、治疗结束时及治疗后1、3个月HAMA、SSS评分明显降低，治疗2周、治疗结束时及治疗后1、3个月的睡眠总时间明显延长，睡眠效率明显升高，睡眠潜伏期明显缩短，浅睡眠占比明显降低，治疗结束时及治疗后1、3个月深睡眠占比明显升高，治疗2周、治疗结束时REM睡眠占比明显升高，治疗结束时及治疗后1、3个月服用地西泮等效剂量明显减少，停药比例明显升高（P＜0.05）。
结论： 与单用右美托咪定鼻喷或rTMS比较，右美托咪定鼻喷联合rTMS可显著提高慢性失眠合并焦虑患者的总体治疗率，并在改善睡眠质量、缓解焦虑情绪及促进镇静催眠药物减停方面具有持续优势。
英文摘要:
      
Objective: To investigate the therapeutic effect of dexmedetomidine nasal spray combined with transcranial magnetic stimulation in patients with chronic insomnia and anxiety.
Methods: Patients with chronic insomnia combined with anxiety admitted to the anesthesiology and sleep medicine outpatient were selected, aged 18-64 years, BMI 18.5-28.0 kg/m2. Patients were divided into three groups by random number table method: rTMS group (group T), dexmedetomidine nasal spray group (group D), and dexmedetomidine nasal spray combined with rTMS group (group DT). All three groups received 4 weeks of intervention. Group T was given low-frequency rTMS treatment on the right dorsolateral prefrontal cortex (DLPFC) with gradual reduction in frequency, group D received dexmedetomidine nasal spray before bedtime with a tapering regimen, group DT received the combination of the two intervention regimens. The primary outcome was the overall treatment rate at the end of treatment. Secondary outcomes included the Pittsburgh sleep quality index (PSQI) before treatment, at the end of treatment, and at 1 and 3 months after treatment; the Hamilton anxiety scale (HAMA), Mao's somatization symptoms self-rating scale (SSS), total sleep time, sleep latency, sleep efficiency, proportion of deep sleep, proportion of light sleep, proportion of rapid eye movement (REM) sleep, and the use of sedative-hypnotics (expressed as diazepam equivalent dose) before treatment, at 2 weeks of treatment, at the end of treatment, and at 1 and 3 months after treatment.
Results: A total of 135 patients were enrolled, including 42 patients in group T, 45 patients in group D, and 48 patients in group DT. Compared with group T, the overall treatment rate in group DT was significantly higher (P < 0.05). Compared with group T, the PSQI scores in group DT were significantly lower at the end of treatment, 1 month and 3 months after treatment. The HAMA and SSS scores were significantly lower at 2 weeks after treatment, at the end of treatment, and 1 month, 3 months after treatment, the total sleep time was significantly prolonged, sleep efficiency was significantly increased, sleep latency was significantly shortened, the proportion of light sleep was significantly reduced, the proportion of deep sleep was significantly increased at the end of treatment and 1 month, 3 months after treatment, the proportion of REM sleep was significantly increased at 2 weeks after treatment and at the end of treatment. The equivalent dose of diazepam taken was significantly reduced at the end of treatment and 1 month, 3 months after treatment, and the discontinuation rate was significantly increased (P < 0.05). Compared with group D, the PSQI scores in group DT were significantly lower at the end of treatment, 1 month and 3 months after treatment, the HAMA and SSS scores were significantly lower at 2 weeks of treatment, at the end of treatment, and 1 month, 3 months after treatment, the total sleep time was significantly prolonged, sleep efficiency was significantly increased, sleep latency was significantly shortened, the proportion of light sleep was significantly reduced, the proportion of deep sleep was significantly increased at the end of treatment and 1 month, 3 months after treatment, the proportion of REM sleep was significantly increased at 2 weeks of treatment, at the end of treatment, and 1 month, 3 months after treatment, the equivalent dose of diazepam taken at the end of treatment and 1 month, 3 months after treatment was significantly reduced, and the discontinuation rate was significantly increased (P < 0.05).
Conclusion: Compared with using dexmedetomidine nasal spray alone or rTMS alone, dexmedetomidine nasal spray combined with rTMS can significantly improve the overall treatment rate of patients with chronic insomnia and comorbid anxiety, and has lasting benefits in improving sleep quality, relieving anxiety symptoms, and facilitating the reduction and discontinuation of sedative-hypnotic drugs.
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