慢性阻塞性肺疾病特异性症状与抑郁之间相关因素的临床研究

发布时间：2018-03-05 13:29

  本文选题：慢性阻塞性肺疾病　切入点：抑郁　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本文通过对慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者合并抑郁发生的影响因素进行分析,并进一步探讨慢阻肺患者与抑郁状态产生的相关性因素,为今后慢阻肺合并抑郁的患者早期进行针对性的护理和治疗提供科学的评估依据,以期提高患者生活质量。方法选取2015年9月至2016年9月天津医科大学总医院高干科病房、呼吸内科病房成年(年龄大于50岁)COPD患者60例,其诊断均应符合中华医学会2013年“慢性阻塞性肺疾病诊断和治疗指南”的标准。入院后根据入选标准制成统一的病例观察单以记录临床所需要的基础数据,并采用以调查问卷形式以自评与他评相结合的方式对患者进行临床症状数据采集,应用汉密尔顿抑郁量表(HAMD)对患者进行抑郁症状的调查,对所收集的临床病例资料的数据进行相应的统计学分析,得到本地区慢性阻塞性肺疾病合并抑郁的发病率;分析慢阻肺合并抑郁与吸烟指数、BMI、肺功能等基础指标的相互影响性;得到抑郁与慢阻肺肺部的特异性症状如患者疲劳程度、呼吸困难指数、及自身的健康和每日生活质量的危险因素的相关程度并评价调查问卷的价值;通过SPSS 17.0统计学软件进行汇总并统计分析。数据结果以均数±标准差表示;组间计量资料的比较采用独立样本t检验进行分析;HAMD抑郁评分与临床问卷调查评分的关系采用双变量相关Spearman相关系数法,报道Spearman相关系数r值;采用二元logistic回归筛选COPD伴抑郁的独立影响因素。以P0.05为差异有统计学意义。结果1、入选的60例COPD患者其中男性31例,女性29例。男女比例为1.07:1,年龄58岁~89岁,平均年龄(73.45±6.93)岁,所有入选60例患者进行肺功能、MMRC问卷、HAMD问卷、简明疲劳量表BFI问卷,结果存在21例患者存在抑郁状态(HAMD评分≥7分),本次调查COPD伴抑郁的发病率为35%,COPD伴抑郁男性10例,COPD伴抑郁女性11例,男女比例为1:1.1。2、体重指数BMI、吸烟指数SI、慢阻肺病程是COPD伴抑郁的影响因素,P值分别为(0.021、0.018、0.001)差异有统计学意义。吸烟指数SI(OR值1.005、P值0.021、95%CI1.001~1.009)、慢阻肺病程(OR值1.534、P值0.001、95%CI 1.188~1.982)是COPD伴抑郁的独立影响因素。3、抑郁程度与慢阻肺患者的CAT评分、呼吸困难指数MMRC评分、疲劳指数BFI评分之间呈线性正相关(r=0.837、0.653、0.842,p0.001),差异有统计学意义。与肺功能FEV1预计值无明显关联(r=-0.139、P值0.291)差异无统计学意义。结论1、天津市地区的慢性阻塞性肺疾病合并抑郁的发病率较高。2、慢阻肺患者抑郁状态的产生与BMI、吸烟程度、慢阻肺病程等基础指标有关。3、COPD患者的CAT评分、疲劳程度、气短状态与抑郁具有相关性,肺功能FEV1预计值与抑郁关系不大。4、疲劳指数BFI为评估慢阻肺合并抑郁提供有效评估方法。
[Abstract]:Objective to analyze the influencing factors of depression in patients with chronic obstructive pulmonary disease (pulmonary), and to explore the correlation between chronic obstructive pulmonary disease (COPD) and depression. To provide scientific evaluation basis for early nursing and treatment of patients with chronic obstructive pulmonary disease (COPD) complicated with depression in order to improve the quality of life. Methods from September 2015 to September 2016, the department of high dry department of Tianjin Medical University General Hospital was selected. 60 adult COPD patients (over 50 years old) in respiratory ward, The diagnosis should be in accordance with the Chinese Medical Association's guidelines for the diagnosis and treatment of chronic obstructive Pulmonary Disease (COPD) of 2013. The data of clinical symptoms were collected by self-assessment and other assessment in the form of questionnaire, and the depression symptoms were investigated by Hamilton Depression scale (Hamd). The incidence of chronic obstructive pulmonary disease (COPD) combined with depression was obtained by statistical analysis of the data collected from clinical cases, and the interaction between COPD with depression and smoking index (BMI), pulmonary function and other basic indexes was analyzed. The specific symptoms of depression and COPD such as fatigue degree, dyspnea index, risk factors of their own health and quality of daily life were obtained and the value of questionnaire was evaluated. Statistical software SPSS 17.0 was used to summarize and analyze the data. The results were expressed as mean 卤standard deviation. The relationship between Hamd depression score and clinical questionnaire score was analyzed by independent sample t-test. The correlation coefficient of Spearman was reported by using bivariate correlation Spearman correlation coefficient method. The independent influencing factors of COPD with depression were screened by binary logistic regression. Results 1. Among the 60 COPD patients, 31 were male and 29 were female. The ratio of male to female was 1.07: 1. The average age was 73.45 卤6.93 years old, the age of 58 years old was 89 years old, the average age was 73.45 卤6.93 years old, the average age was 73.45 卤6.93 years old, the ratio of male to female was 1.07: 1. All 60 patients were investigated with MMRC questionnaire, Hamd questionnaire and BFI questionnaire. Results there were 21 patients with depression status and Hamd score 鈮，

本文编号：1570460