乳腺癌术后患者伴抑郁倾向的相关因素分析及中医证候特点研究

发布时间：2018-03-17 01:04

  本文选题：乳腺癌术后　切入点：抑郁　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：本文主要分为文献综述与临床研究两个部分。第一部分是文献综述,分为两篇综述:综述一分别阐述了中医对乳腺癌和抑郁的认识;综述二阐述了现代医学对乳腺癌术后抑郁的认识及相关因素分析。第二部分是临床研究,包括研究目的、方法、结果、讨论等。研究目的本试验的研究目的在于分析乳腺癌术后患者伴抑郁倾向的相关危险因素,对这些因素提前进行干预,从而改善患者的躯体症状及心理状态,提高其生活质量,达到"治未病"的目的。同时,分析乳腺癌术后患者的中医证候特点,为日后的临床用药及科研提供一定的参考依据。研究方法本研究纳入于2016年5月至2017年1月在北京中医药大学东方医院肿瘤科门诊就诊的同时符合纳入与排除标准的乳腺癌术后患者145例,记录入组患者的抑郁状况、一般情况、临床信息及中医四诊结果四个方面,运用SPSS 21.0统计软件将所有数据信息进行分析,探讨乳腺癌术后患者出现抑郁倾向的相关危险因素及中医证候特点。研究结果1、一般情况:研究结果显示患者在工作状态(x2=4.331,P=0.037)、家族史(x2=6.259,P=0.044)方面出现的抑郁倾向有差异。患者出现的抑郁倾向在年龄、婚姻状况、文化程度方面无差异。根据Logistic回归分析,仅认为家族史(OR=0.221,P=0.026)与乳腺癌术后患者出现的抑郁倾向呈负相关关系,即无家族史的乳腺癌术后患者更容易出现抑郁倾向。2、临床信息:研究结果显示患者在远处转移方面(x2=8.665,P=0.009)出现的抑郁倾向有差异,并根据Logistic回归分析,认为远处转移(OR=5.099,P=0.005)与乳腺癌术后患者出现的抑郁倾向呈正相关关系,即有远处转移的乳腺癌术后患者更容易出现抑郁倾向。但患者的治疗方式不同,出现的抑郁倾向无明显差异。3、乳腺癌术后伴抑郁倾向患者的中医证候分布特点为:阳虚证39例(67.2%)、气虚证33例(56.9%)、气滞证16例(27.6%)、痰湿证16例(27.6%)、血瘀证19例(32.8%)、阴虚证9例(15.5%)、血虚证2例(3.4%)、痰热证1例(1.7%),无热毒证患者。无抑郁倾向患者的中医证候特点:痰湿证29例(44.6%)、阳虚证28例(43.1%)、气虚证 24 例(36.9%)、血瘀证 20 例(30.8%)、阴虚证 12 例(18.5%)、气滞证12例(18.5%)、痰热证3例(4.6%)、血虚证1例(1.5%),无热毒证患者。4、乳腺癌术后患者出现的抑郁倾向在阳虚证(x2=7.519,P=0.0.023)和气虚证(x2=9.260,P=0.0.01)两个证型方面有差异。研究结论1、本研究显示乳腺癌术后患者出现抑郁倾向的发生率为46.9%。由此可见,乳腺癌术后患者出现抑郁倾向的比例较高,抑郁症对患者的危害较大,应提前对伴抑郁倾向患者进行心理甚或药物干预,减少抑郁症的发生。2、根据本研究结果,认为无工作患者、无家族史患者、有远处转移患者更容易出现抑郁倾向。因此,我们应多开展乳腺癌的宣讲活动,增强患者对乳腺癌诊治的认知,减轻患者对乳腺癌的恐惧,对有远处转移的患者多加以关怀及心理疏导,尽量减轻患者的心理负担,同时,应建议能工作的患者在病情稳定后尽量外出工作,对于退休患者,则可多参加社区活动,加强对自我价值的肯定,增加抵抗病魔的信心。3、乳腺癌术后伴抑郁倾向患者的中医证候中以阳虚、气虚证为主,气滞、痰湿、血瘀证次之。同时,本研究认为乳腺癌术后阳虚、气虚证患者相对更容易出现抑郁倾向,不能片面认为乳腺癌术后抑郁患者多为气滞证,为以后的临床用药及科研提供一定的参考。
[Abstract]:This paper is divided into two parts: literature review and clinical research. The first part is the literature review, divided into two review: a review illustrates the understanding of breast cancer and depression of TCM; review two describes the modern medical understanding of depression after breast cancer surgery and related factors analysis. The second part is clinical study, including the research purpose, methods, results, discussion and research purposes. The purpose of this study is to analyze the risk of postoperative breast cancer patients with depression factors, these factors for early intervention to improve the somatic symptoms and psychological status of patients, improve the quality of life, to achieve the purpose of "zhiweibing" at the same time, analysis of the characteristics of TCM syndrome in patients after breast cancer surgery, for the day after the clinical treatment and scientific research to provide some reference. Research methods included in this study from May 2016 to January 2017 in Beijing traditional Chinese Medicine At the same time the Oriental medicine university hospital outpatient clinic 145 patients met the inclusion and exclusion criteria of postoperative breast cancer, depression, record into the group of patients with general condition, clinical information and TCM diagnosis results of four aspects, using SPSS 21 statistical software to analyze all data information, the related risk factors of breast cancer postoperative depression and TCM syndrome characteristics. Results 1 general condition: the results showed that patients in the working state (x2=4.331, P=0.037), family history (x2=6.259, P=0.044) the emergence of depressive tendency differences. Marital status in patients with depression tendency, no differences in age, culture degree. According to Logistic regression analysis, only think of family history (OR=0.221, P=0.026) is negatively correlated with the appearance of postoperative breast cancer patients without depression symptoms, family history of breast cancer patients 瀹规槗鍑虹幇鎶戦儊鍊惧悜.2,涓村簥淇℃伅:鐮旂┒缁撴灉鏄剧ず鎮ｈ，

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