情绪对心力衰竭患者消化系统症状的影响及机制研究

发布时间：2018-05-20 16:46

本文选题：心力衰竭 + 情绪　；参考：《北京协和医学院》2017年硕士论文

【摘要】：背景:心力衰竭患者消化系统症状发生率较高,症状及症状掩盖下的各种病理生理改变对机体造成了诸多不利影响。消化系统症状除受心功能影响外,还受抑郁、焦虑等情绪状况的影响。对于心力衰竭患者,情绪对其消化系统症状的影响程度及机制如何,尚需深入研究。目的:(1)描述心力衰竭患者消化系统症状的发生情况及严重程度;(2)探讨情绪对NYHA分级Ⅱ、Ⅲ和Ⅳ级心力衰竭患者消化系统症状的影响程度;(3)探讨情绪对心力衰竭患者消化系统症状产生影响的机制。方法:采用便利抽样法,选取2016年3月至2017年2月在北京市某三甲心血管病专科医院心力衰竭监护病房住院的210例心力衰竭患者,用胃肠道症状分级评分量表(Gastrointestinal Symptom Rating Scale,GSRS)和简式简明心境量表(Profile of Mood States Short Form,POMS-SF)收集资料,同时测量研究对象24h窦性心搏R-R间期标准差、血清皮质醇浓度和去甲肾上腺素浓度等。结果:(1)研究对象中发生率较高的消化系统症状为腹胀(60.48%)、排气增多(44.76%)、恶心和呕吐(44.29%)。消化系统症状严重程度评分1分、2分和3分(1=症状偶尔发生;2=症状持续时间延长,部分影响日常活动;3=症状持续存在,影响所有日常活动)研究对象所占比例:腹胀为46.19%、12.86%和31.43%;恶心和呕吐为38.57%、5.71%和0.48%,排气增多为37.71%、8.57%和0.00%。NYHA分级Ⅱ、Ⅲ和Ⅳ级研究对象:消化系统症状发生率分别为85.25%、96.39%和96.97%,存在统计学差异(P=0.011);消化系统症状严重程度评分M(Q1,Q3)分别为3(1,5)、5(4,8)和5(4,6),存在统计学差异(P0.01)。(2)以NYHA分级为控制变量进行回归分析,发现情绪、NYHA分级及二者的交互作用对消化系统症状严重程度均存在影响(P0.01),标化回归系数分别为1.234、0.390和-0.500;分层回归分析结果显示,情绪对NYHA分级Ⅱ、Ⅲ和Ⅳ级研究对象消化系统症状严重程度均存在影响(P0.01),标化回归系数分别为0.890、0.819和0.939。(3)运用AMOS20.0进行路径分析发现:情绪对消化系统症状严重程度产生直接影响的效应系数为0.578,情绪通过24小时窦性心搏R-R间期标准差变化、血清皮质醇浓度变化对消化系统症状严重程度产生影响的间接效应系数分别为0.039和0.060;NYHA分级对消化系统症状严重程度产生直接影响的效应系数不显著(P0.05),NYHA分级通过24小时窦性心搏R-R间期标准差变化对消化系统症状严重程度产生影响的间接效应系数为0.023,NYHA分级通过情绪变化对消化系统症状严重程度产生影响的间接效应系数总和为0.133。情绪和NYHA分级通过血清去甲肾上腺素浓度变化对消化系统症状严重程度产生影响的效应系数不显著(P0.05)。结论:情绪对NYHA分级IV级患者消化系统症状严重程度影响最大,其次为NYHA分级Ⅱ级和Ⅲ级患者。情绪可通过自主神经系统、下丘脑-垂体-肾上腺皮质轴的中介作用对心力衰竭患者消化系统症状严重程度产生影响。情绪对消化系统症状严重程度的影响程度强于心功能。研究结果有利于医务工作者全面认识情绪和心功能对心力衰竭患者消化系统症状产生影响的程度及机制,对更好地控制心力衰竭患者消化系统症状有一定的指导。
[Abstract]:Background: the incidence of digestive system symptoms in patients with heart failure is high, and the various pathophysiological changes under the symptoms and symptoms are affected. The digestive system symptoms are influenced by the emotional state of depression and anxiety in addition to the influence of heart function. The influence of emotion on the digestive system symptoms of patients with heart failure. The extent and mechanism still need to be studied in depth. Objective: (1) to describe the occurrence and severity of digestive system symptoms in patients with heart failure; (2) to explore the influence of emotion on the digestive system symptoms in patients with NYHA grade II, III and IV heart failure; (3) to explore the mechanism of the influence of emotion on digestive system symptoms in patients with heart failure. Methods: 210 patients with heart failure hospitalized in the heart failure intensive care unit of a three a cardiovascular disease hospital in Beijing from March 2016 to February 2017 were selected by the convenient sampling method. The Gastrointestinal Symptom Rating Scale (GSRS) and the simple concise mood scale (Profile of Mood States Short Fo) were used. RM, POMS-SF) collected data and measured the standard deviation of R-R interval of 24h sinus heart, serum cortisol concentration and norepinephrine concentration. Results: (1) the high incidence of digestive system symptoms in the study subjects were abdominal distention (60.48%), exhaust increased (44.76%), nausea and vomiting (44.29%). The severity of digestive system symptoms was 1, 2 and 3 points (1= symptoms occasionally; duration of 2= symptoms prolonged, partial impact on daily activity; 3= symptoms persisting, affecting all daily activities) the proportion of subjects: abdominal distention to 46.19%, 12.86% and 31.43%; nausea and vomiting 38.57%, 5.71% and 0.48%, 8.57% and 0.00%.NYHA grade II, III and IV class II, III and IV studies Image: the incidence of digestive system symptoms was 85.25%, 96.39% and 96.97%, respectively (P=0.011); M (Q1, Q3) of digestive system symptom severity score was 3 (1,5), 5 (4,8) and 5 (4,6), and there was statistical difference (P0.01). (2) regression analysis was carried out with NYHA grade as control variable, and the interaction of emotion, NYHA classification and two were found. The severity of digestive system symptoms were all affected (P0.01), and the normalized regression coefficients were 1.234,0.390 and -0.500 respectively. The results of stratified regression analysis showed that there was an influence on the severity of digestive system symptoms of NYHA classification II, III and IV (P0.01), and the normalized regression coefficients were 0.890,0.819 and 0.939. (3) using AMOS20.0. It was found that the effect coefficient of emotion directly affected the severity of digestive system symptoms was 0.578. The indirect effect coefficient of serum cortisol concentration on the severity of digestive system symptoms was 0.039 and 0.060, respectively, with the change of the standard deviation of the R-R interval of 24 hours sinus heart, and the NYHA grading to the digestive system. The direct effect coefficient was not significant (P0.05), and the indirect effect coefficient of the NYHA classification through the 24 hour sinus R-R interval standard deviation on the severity of digestive system symptoms was 0.023. The indirect effect of NYHA classification through emotional changes on the severity of digestive system symptoms The effect coefficient of 0.133. emotion and NYHA classification through serum norepinephrine concentration changes has no significant effect on the severity of digestive system symptoms (P0.05). Conclusion: emotion has the greatest impact on the severity of digestive system symptoms in NYHA grade IV patients, followed by NYHA grade II and grade III patients. Emotion can be controlled by autonomy. The intermediary role of the nervous system, the hypothalamus pituitary adrenocortical axis has an influence on the severity of the digestive system symptoms in patients with heart failure. The influence of emotion on the severity of digestive system symptoms is stronger than that of the heart function. The results are beneficial to the medical workers to fully understand the digestive system of patients with heart failure. The degree and mechanism of the influence on the digestive system can help to better control the digestive system symptoms of patients with heart failure.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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