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Objective:To investigate the efficacy and safety of internet-based cognitive behavioral therapy for insomnia(iCBT-I) combined with estazolam for patients with chronic insomnia.Methods:Patients with chronic insomnia were randomly assigned to treatment group which were intervened with iCBFI combined with estazolam( n=46) and control group which were intervened with estazolam ( n=43) for 8 weeks according to random number table.Pittsburgh sleep quality index (PSQI) and state-trait anxiety inventory (STAI) were used to measure the anxious state, anxious trait and sleep quality at three time points: before intervention(T1), after one month(T2) and two months(T3). Treatment emergent symptom scale (TESS), blood routine, urine routine, liver and renal function and electrocardiogram were used to measure the safety.The dosage of estazolam was compared between the two groups after two months.χ 2 test and repeated measurement analysis of variance were performed by SPSS 19.0. Results:The PSQI scores of control group and treatment group were (10.41±2.48) vs (9.98±2.96) at T2 and (9.97±2.13) vs (7.82±1.57) at T3.The state anxiety scores of control group and treatment group were (57.27±2.74) vs (56.27±2.89) at T2 and (45.67±2.62) vs (42.67±2.97) at T3.The data of T2 and T3 were statistically significant compared with those before intervention(all P<0.05). Compared with the control group, the treatment group was better on treatment efficiency(86.96% vs 69.77%) at T3( P<0.05). PSQI score, subjective sleep quality, sleep efficiency, sleep disorders, sleep drugs, daytime dysfunction, drug maintenance and adverse reaction were significantly different between the two groups at T3 ( P<0.05). Conclusions:Internet-based cognitive behavioral therapy combined estazolam for insomnia can improve sleep quality, anxious state and trait for chronic insomnia patients.Good safety was improved, as well as reducing the need of drug.So it's worthy of clinic application.
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Objective To evaluate the efficacy of general anesthesia combined with ultrasoundguided epidural block for laparoscopic surgery in neonates.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ neonates,aged 20-60 days,scheduled for elective radical operation for Hirschsprung's disease,were divided into 2 groups (n=30 each) using a random number table:general anesthesia group (group Ⅰ) and general anesthesia combined with ultrasound-guided epidural block group (group Ⅱ).Anesthesia was induced by inhaling 8％ sevoflurane.Anesthesia was maintained with Ⅳ sufentanil 0.2 μg/kg,cisatracurium 0.1 mg/kg and then with additional sufentanil 0.1 μg/kg and cisatracurium 0.05 mg/kg every hour and 2％-3％ sevoflurane was simultaneously inhaled in group Ⅰ.In group Ⅱ,anesthesia was maintained by inhaling 2％-3％ sevoflurane,epidural block was performed at L1.2 interspace,the catheter was caudally advanced into the epidural space under ultrasound guidance,0.8％ lidocaine was injected at a loading dose of 6 mg/kg,the local anesthetic diffusion in the epidural space was observed,and additional 0.8％ lidocaine 3 mg/kg was given every 30 min.Heart rate and mean arterial pressure were recorded at 5 min before pneumoperitoneum,during pneumoperitoneum,at extubation and after extubation.The extubation time,duration of recovery room stay and development of assisted ventilation after extubation were recorded.Pain was assessed and scored at 5 min before discharge from recovery room.The development of epidural block-related complications was recorded in group Ⅱ.Results Operation was smoothly completed with stable anesthesia in two groups.Compared with group Ⅰ,the mean arterial pressure was significantly decreased during pneumoperitoneum and after extubation,the extubation time and duration of recovery room stay were shortened,and the requirement for assisted ventilation after extubation and pain scores were decreased in group Ⅱ (P＜0.05 or 0.01).No epidural block-related complications were found in group Ⅱ.Conclusion General anesthesia combined with ultrasound-guided epidural block is safe and effective for laparoscopic surgery and is helpful for postoperative recovery in neonates.