慢性阻塞性肺病稳定期焦虑抑郁状态与病情的相关性研究

发布时间：2018-05-31 05:20

本文选题：慢性阻塞性肺疾病 + 焦虑　；参考：《广州中医药大学》2012年硕士论文

【摘要】：目的：阐述慢性阻塞性肺病(COPD)稳定期患者焦虑抑郁状态与病情的相关性,探讨焦虑抑郁水平对COPD稳定期患者病情的影响,了解COPD合并焦虑抑郁的常见证型,为临床综合诊治提供相应的指导。方法：纳入2011年2月到2012年4月于广东省中医院就诊的住院及门诊COPD稳定期分级为3-4级病人123例。应用Zung编制的焦虑自评量表(Self-Rating Anxiety ScaleSAS)和抑郁自评量表(Self-rating Depression Scale, SDS)以问卷的形式进行评估,并根据SDS和SAS的结果,将123例患者分为COPD无焦虑组、轻度焦虑组、中重度焦虑组,COPD无抑郁组、轻度抑郁组、中重度抑郁组。对组间性别、年龄、咳嗽病程、气促病程、中医症状计分、BODE指数、肺功能等基本情况进行统计分析。采多因素Logistic分析方法,分析COPD伴发焦虑抑郁状态的可能影响因素。并调查COPD伴发焦虑抑郁的中医证候分布。成果： 123例COPD患者中,无焦虑状态75例,占60.98%,有焦虑48例,占39.02%,其中轻度焦33例,占26.83%,中重度焦虑15例,占12.20%。患者中无抑郁状态66例,占53.66%,有抑郁57例,占46.34%,其中轻度抑郁35例,占28.46%,中重度抑郁22例,占17.89%。按SAS、SDS结果分组与调查结果进行分析得出各组COPD合并不同程度焦虑抑郁患者在咳嗽病程、气促病程、肺功能、中医症状计分、BODE指数、6MWD、BMI等各项间差异有统计学意义(P0.05),在年龄、性别两组间差异无统计学意义(P0.05)。以咳嗽病程、气促病程、中医症状计分、BODE指数4项为自变量,以有无焦虑或抑郁状态为因变量,进行Logistic多因素回归分析显示中医症状计分是COPD患者伴发抑郁状态的影响因素。COPD稳定期合并焦虑状态及合并抑郁不论病情的轻重,均以肺脾气虚,痰瘀阻肺为主,且在合并焦虑状态的患者中有33.33%合并肝气郁结,有20.83%合并心脾两虚；在合并抑郁状态的患者中有35.09%合并肝气郁结,有21.05%合并心脾两虚。结论： 123例COPD患者伴发焦虑抑郁状态的构成比高,合并焦虑患者占39.02%,合并抑郁的达46.34%,随着COPD患者的咳嗽气促病程延长、肺功能变差、6MWD、BMI下降、MMRC分级升高及中医症状计分升高,其合并焦虑抑郁情绪可能性越大。而焦虑抑郁等不良情绪的产生反过来又影响着患者整体的机能。在COPD合并焦虑抑郁患者治疗过程中要重视标本同治,同时应重视重视心理问题治疗。
[Abstract]:Objective: The relationship between anxiety and depression in stable patients with chronic obstructive pulmonary disease (COPD) was discussed. The influence of anxiety and depression on the condition of patients with stable COPD was discussed, and the common syndromes of COPD combined with anxiety and depression were understood. To provide the corresponding guidance for the clinical comprehensive diagnosis and treatment. Methods: From February 2011 to April 2012, 123 hospitalized and outpatient COPD patients were classified as 3-4 grade patients in Guangdong traditional Chinese Medicine Hospital. Self-Rating Anxiety scale SASs (developed by Zung) and Self-rating Depression Scale, SDS) (Self-rating Depression scale) were used to evaluate the patients. According to the results of SDS and SAS, 123 patients were divided into two groups: COPD without anxiety group and mild anxiety group. Moderate and severe anxiety group with COPD without depression group, mild depression group, moderate and severe depression group. Sex, age, course of cough, course of shortness of breath, TCM symptom score and bode index, pulmonary function were analyzed statistically. Multivariate Logistic analysis was used to analyze the possible influencing factors of anxiety and depression in COPD. To investigate the distribution of TCM syndromes of COPD with anxiety and depression. Outcome: Of the 123 patients with COPD, 75 (60.98) had no anxiety, 48 (39.02) had anxiety, 33 cases (26.83%) had mild coke, 15 cases (12.20%) had moderate and severe anxiety. There were 66 cases of non-depressive state (53.66%), 57 cases of depression (46.34%), 35 cases of mild depression (28.46%), 22 cases of moderate and severe depression (17.89%). According to the analysis of the results and the results of the investigation, it was found that there were significant differences in the course of cough, the course of shortness of breath, the pulmonary function, the score of bode index and the 6MW DBMI of the patients with COPD with different degree of anxiety and depression in each group. There was no significant difference between the two groups (P 0.05). According to the course of cough, the course of shortness of breath, the score of TCM symptom and bode index, 4 items were independent variables, and the dependent variables were whether there was anxiety or depression. Logistic multivariate regression analysis showed that TCM symptom score was the influencing factor of depression in COPD patients. Among the patients with anxiety, 33.33% were complicated with stagnation of liver-qi, 20.83% with deficiency of heart and spleen, 35.09% with stagnation of liver-qi and 21.05% with deficiency of heart and spleen. Conclusion: The compositional ratio of anxiety and depression in 123 patients with COPD was high, 39.02 in patients with anxiety and 46.34 in patients with depression. With the prolonged course of cough and shortness of breath in patients with COPD, the lung function decreased and the scores of MMRC and TCM symptoms increased. The more likely they are to be associated with anxiety and depression. Anxiety and depression and other adverse emotions in turn affect the overall function of patients. In the course of treatment of COPD patients with anxiety and depression, we should pay attention to the treatment of both specimen and psychological problems.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.9

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