维持性血液透析患者睡眠障碍与中医证候、症状困扰相关性研究

发布时间：2018-05-19 16:41

本文选题：睡眠障碍 + 维持性血液透析　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:评估广安门医院维持性血液透析(maintenance hemodialysis,MHD)患者的睡眠质量、症状困扰情况及MHD伴睡眠障碍患者的中医证候分布特点,分析影响维持性血液透析患者睡眠的相关因素、睡眠障碍与中医证候、症状困扰的相关性,为维持性血液透析睡眠障碍方面的临床及中医证候方面的研究提供一定的依据。方法:运用横断面流行病学调查方法对MHD患者进行一般情况、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)、透析患者症状困扰量表及中医证候辨证量表调查得出患者PSQI评分、症状困扰情况和中医证候,收集患者临床生化指标,应用SPSS20.0统计分析MHD患者睡眠质量与中医证候、症状困扰的相关性。结果:广安门医院201例维持性血液透析患者PSQI评分总分范围为:0～21分,平均值:9.23±4.88分,睡眠障碍发生率为47.26%。PSQI评分的总分及各因子得分显著高于国内常模,有统计学差异(P0.01)。MHD患者中医证候本虚证的分布情况依次为:气阴两虚证(77例,占38.3%)、脾肾阳虚证(55例,占27.4%)、脾肾气虚证(37例,占18.4%)、肝肾阴虚证(23例,占11.4%)、阴阳两虚证(9例,占4.5%)。标实证的分布情况依次为:湿浊证(74例,占36.8%)、湿热证(69例,占34.3%)、血瘀证(33例,占16.4%)、风动证(19例,占9.5%)、水气证(6例,占3.0%);且本虚证、标实证中各证候PSQI评分之间具有统计学差异(P0.05)。MHD患者睡眠障碍影响因素分析,在年龄、年龄分层、职业状态、透析龄、是否发用安眠药方面有统计学差异(P0.05),在性别、文化程度、婚姻状况、家庭收入、透析频率、医疗付费方式、原发病方面无统计学意义(P0.05)。多因素分析,在年龄有统计学差异(P0.05)。生化指标在钙磷乘积、血清铁蛋白、血红蛋白指标上有统计学意义(P0.05),在钙、磷、碱性磷酸酶、血清铁、总铁结合力,转铁蛋白、总蛋白、白蛋白、C反应蛋白、甘油三酯、总胆固醇、尿酸、血肌酐、甲状旁腺激素指标上无统计学意义(P0.05)。中医证候分布:伴与不伴睡眠障碍患者本虚证分布具有统计学意义(P0.05);标实证分布具有统计学意义(P0.05)。伴睡眠障碍患者中医证候:本虚证各证候之间PSQI评分具有统计学差异(P0.05);标实证各证候的PSQI评分无统计学差异(P0.05)。在维持性血液透析症状困扰的调查中,30种症状发生率为9.95%～82.59%,症状平均发生数为11,其中发生率最高的五种症状分别为皮肤干燥(82.59%),乏力(66.67%),瘙痒(66.67%),口干(64.18%),易醒(61.69%),且这五个症状的困扰程度得分、症状发生频率得分、严重程度得分也最高。MHD患者的PSQI各因子和总分与症状困扰中症状有无、症状严重程度、症状出现频率、症状困扰程度相关性均有统计学差异(P005)。MHD伴睡眠障碍患者30种症状发生率在15%～87.37%之间,症状发生的平均数为14种,其皮肤干燥、入睡困难、乏力、易醒、口干症状有无得分、症状的困扰程度得分、症状出现频率得分、症状严重程度得分均最高。两组患者的症状发生率进行比较,伴睡眠障碍患者症状发生的平均数为14种,不伴睡眠障碍患者症状发生的平均数为9种。30个症状有24种症状两组间发生率比较有统计学意义(P0.05)。入睡困难、易醒、乏力、便秘、食欲减退、口干、不安腿、肌肉酸痛、头晕、咳嗽、胸痛、感到焦虑、感到悲伤这13种症状上具有显著的差异性(P0.01)。结论:1.睡眠障碍普遍存在于广安门医院MHD患者中,发生率高,影响患者的生活质量,医护人员应多予以关注。2.MHD患者睡眠障碍的发生受多种因素的共同影响,其中年龄是睡眠障碍发生的危险因素,钙磷乘积、血清铁蛋白、血红蛋白是影响睡眠质量相关因素。临床中应对高龄患者更加关注,且加强钙磷乘积、血清铁蛋白、血红蛋白临床的监测,采取适当的干预措施,有助于改善患者的睡眠质量。3.本研究中MHD患者本虚证气阴两虚证患者易发生睡眠障碍,标实证湿热证、水气证患者易发生睡眠障碍。在MHD伴睡眠障碍的患者中阴阳两虚证患者的睡眠障碍严重程度更重。4.MHD患者症状发生种类越多、症状困扰程度越重、症状出现的频率越高、症状越严重,睡眠质量越差。MHD伴睡眠障碍患者受症状困扰种类繁多,与不伴睡眠障碍患者症状有差异性。临床中医护人员应该注重患者的整体症状的发生情况和症状发生的差异性,采取有效适当的干预措施来改善患者的睡眠障碍。
[Abstract]:Objective: To evaluate the quality of sleep, symptoms and the characteristics of TCM Syndrome Distribution in patients with maintenance hemodialysis (MHD) in Guanganmen hospital, and to analyze the related factors affecting the sleep in the patients with maintenance hemodialysis, the correlation of sleep disorders and TCM syndromes and symptoms, so as to maintain the relationship between the symptoms and the symptoms. The clinical and TCM Syndromes of sexual hemodialysis sleep disorders provide a certain basis. Methods: the general situation of MHD patients, the Pittsburgh sleep quality index (Pittsburgh sleep quality index, PSQI), the symptom distress scale of the dialysis patients and the syndrome differentiation scale of TCM syndrome are carried out by the cross-sectional epidemiological survey method. The PSQI score, symptoms and TCM syndromes were investigated, and the clinical biochemical indexes were collected, and the correlation between the sleep quality of MHD patients and TCM syndrome and the symptoms was analyzed by SPSS20.0. Results: the total score of PSQI scores in 201 cases of maintenance hemodialysis patients in Guanganmen hospital was 0~21 points, the average value was 9.23 + 4.88 points, The total score of 47.26%.PSQI score and the scores of all factors were significantly higher than those of the domestic norm. The distribution of deficiency syndrome of TCM syndrome in.MHD patients (P0.01) was in turn: Qi Yin two deficiency syndrome (77 cases, 38.3%), spleen kidney yang deficiency syndrome (55 cases, 27.4%), spleen kidney qi deficiency syndrome (37 cases, 18.4%), liver kidney kidney yin deficiency syndrome (23 cases, 11.4). (%), yin and yang two deficiency syndrome (9 cases, accounting for 4.5%). The distribution of the standard evidence was in turn: wet turbid syndrome (74 cases, 36.8%), damp heat syndrome (69 cases, 34.3%), blood stasis syndrome (33 cases, 16.4%), pneumatic syndrome (19 cases, 9.5%), water and gas syndrome (6, 3%); and this deficiency syndrome, the PSQI score of each syndrome in the standard demonstration (P0.05).MHD patients sleep disorder shadow There were statistically significant differences (P0.05) in age, age stratification, career status, dialysis age, and the use of sleeping pills (P0.05). There was no statistically significant difference in gender, educational level, marital status, family income, dialysis frequency, medical pay, and primary disease (P0.05). Multivariate analysis (P0.05). The index of calcium, phosphorus, serum ferritin and hemoglobin was statistically significant (P0.05). There was no statistical significance in calcium, phosphorus, alkaline phosphatase, serum iron, total iron binding force, transferrin, total protein, albumin, C reactive protein, triglyceride, total cholesterol, uric acid, blood creatinine and parathyroid hormone (P0.05). The distribution of deficiency syndrome of the patients with and without sleep disorders was statistically significant (P0.05); the standard positive distribution was statistically significant (P0.05). The TCM syndromes with sleep disorders were statistically significant (P0.05), and there was no statistical difference (P0.05) in the PSQI score of the syndrome syndrome (P0.05). In the maintenance hemodialysis syndrome, the symptoms of the syndrome were not statistically different (P0.05). In the survey, the incidence of 30 symptoms was 9.95% to 82.59%, and the average number of symptoms was 11. The highest five symptoms were dry skin (82.59%), fatigue (66.67%), itching (66.67%), dry mouth (64.18%), and easy to wake (61.69%), and the scores of the symptoms, the frequency of symptoms, and the severity of the symptoms were also scored, and the severity scores were also scored. The PSQI factors and total score of the highest.MHD patients and symptoms plagued by symptoms, symptom severity, symptom frequency, and the correlation of symptoms were statistically different (P005) the incidence of 30 symptoms in.MHD with sleep disorders was between 15% and 87.37%, the average of the symptoms was 14, the skin was dry, the sleep was difficult, and the fatigue was weak. The symptoms of the two groups were compared, the average of the symptoms of the patients with sleep disorders was 14, the average of the symptoms of the patients without sleep disorders was 9.30 symptoms and 24 symptoms. The incidence of the two groups was statistically significant (P0.05). There were significant differences in the 13 symptoms (P0.01). Conclusion: 1. sleep disorders are commonly found in MHD patients in Guanganmen hospital. Health care workers should pay more attention to the quality of life in patients with.2.MHD patients, which are the risk factors for sleep disorders, of which age is a risk factor for sleep disorders. Calcium and phosphorus products, serum ferritin, hemoglobin are related factors affecting the quality of sleep. Phosphorus product, serum ferritin, hemoglobin clinical monitoring and appropriate intervention measures are helpful to improve the quality of sleep in patients with.3.. In this study, the patients with deficiency syndrome of Qi Yin and Qi Yin are prone to sleep disorder in this study of the deficiency syndrome of Qi Yin and two of MHD patients, marked by positive damp heat syndrome, and the patients with syndrome of water and gas are prone to sleep disorders. The deficiency of yin and Yang in the patients with MHD with sleep disorders is two deficiency syndrome. The severity of the patient's sleep disorder is more serious, the more types of.4.MHD patients are, the more serious the symptoms are, the higher the frequency of the symptoms, the more serious the symptoms, the worse the quality of sleep in the patients with.MHD and sleep disorders, and the difference between the symptoms and the symptoms of the patients without sleep disorder. The incidence of symptoms and the difference of symptoms were observed. Effective and appropriate intervention measures were taken to improve sleep disorders.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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