认知行为疗法对于慢性阻塞性肺病合并抑郁的疗效的研究

发布时间：2018-03-24 22:32

本文选题：慢性阻塞性肺病　切入点：抑郁　出处：《天津医科大学》2017年硕士论文

【摘要】：目的:1.探索慢性阻塞性肺病合并抑郁的风险因素。2.探讨对于COPD合并抑郁患者,认知行为疗法(CBT)和在认知行为疗法的基础上合并健康教育对患者抗抑郁效果,并比较两组差异;分析比较两种干预手段对于改善患者抑郁水平的早期疗效和远期疗效。3.探讨对于COPD合并抑郁患者,除标准COPD治疗外,增加单纯CBT疗法和CBT基础上加入健康教育后,肺功能改善情况并比较两组之间的差异。方法:1.研究对象:入选本研究的患者是处于COPD稳定期的住院患者。慢阻肺病程可分为急性加重期和稳定期。慢阻肺急性加重期(AECOPD)是指在疾病过程中,患者短期内咳嗽、咳痰、喘息和(或)气短症状其中至少一项加重,痰呈脓性或黏脓性,并且量增多,可伴发热等炎症明显加重的表现。稳定期则指患者咳嗽、咳痰、气短等症状稳定或症状轻微。刚入院的患者多为急性加重期,在规律应用抗生素以及化痰、平喘、缓解气道痉挛等治疗药物之后,患者进入慢性阻塞性肺病稳定期。本研究中纳入的患者均处于稳定期。2.慢性阻塞性肺病(COPD)的诊断:符合COPD临床症状诊断标准且肺功能FEV1/FVC70%。3.抑郁的诊断标准:根据ICD-10指南,由专门的精神科医生做出诊断。抑郁的患者主要表现为沉默寡言、兴趣减退、乏力、兴趣下降、睡眠障碍等。本研究中符合COPD诊断标准的患者,首先对其用抑郁症筛查量表(PHQ-9)进行筛查,并对筛查分数大于5分的患者进行HAMD-17量表评分来评价其抑郁情况和程度。将HAMD-17量表分数在7-17分之间的纳入研究。分数7考虑不符合抑郁,而17考虑为中重度抑郁。重度抑郁的患者不可通过单纯的认知行为疗法进行干预,而应该请示精神科医生,必要时需要药物治疗,因此我们选入研究的患者为轻度抑郁患者。对于符合COPD诊断标准的患者的相关资料进行收集,包括基本信息:患者姓名、性别、年龄、吸烟年数、每日吸烟数量、吸烟指数、身高、体重、BMI、COPD疾病年数、相关检查肺功能包括第一秒用力呼气量(FEV1)、第一秒用力肺活量与肺总量的比值(FEV1/FVC)、FEV1(%预计值);并对某些指标如呼吸困难指数(mMRC)、COPD评定量表(CAT)进行评估。对于符合COPD诊断标准同时符合轻度抑郁诊断标准的患者随机分为两组:实验组和对照组。两组患者都进行标准的COPD规范治疗,对照组在此基础上给予认知行为疗法(CBT)进行干预,而实验组的患者在进行认知行为疗法的基础上加入COPD健康教育,每个研究对象均行肺功能检查。分别于2周、2月(一个完整的认知行为疗法周期)、及干预后二个月再次评估HAMD-17量表分数及行肺功能检查。比较两组患者心理状态(抑郁)情况及肺功能恢复情况。结果:1.COPD合并抑郁的风险因素:COPD患者多有吸烟史,与非抑郁的患者相比,COPD合并抑郁的患者有更长的吸烟年数(P=0.005),且吸烟指数更大(P=0.022),病程更长(P0.05),FEV1(%预计值)越低(P=0.0410.05),呼吸困难指数越高(P0.05),COPD认知程度越低即CAT分数越高(P0.05),但是每日吸烟量(P=0.3210.05),FEV1(一秒量)(P=0.041)和FEV/FVC(一秒率)(P=0.827)在抑郁和非抑郁的患者之间并无明显差异。2.两组患者在研究前后的抑郁改善程度都较显著,并且与单纯的认知行为疗法相比(P0.05),在认知行为疗法的基础上对患者进行慢阻肺健康教育,患者抑郁改善程度较大(P=0.0290.05)。3.对于COPD患者合并抑郁患者来说,两组患者在研究前后相比肺功能的改善都比较显著,但两组间差异不显著(P=0.0770.05)。结论:1.在COPD患者中,吸烟年数长、吸烟指数高、COPD病程长、呼吸困难指数高、CAT值大、FEV1(%预计值)小等,是患者合并抑郁的风险因素,而性别、年龄、体重指数、每日吸烟量、FEV1、FEV1/FVC与COPD患者合并抑郁的关系不显著。2.认知行为疗法、慢阻肺健康教育对于COPD合并抑郁的患者的抑郁改善程度均有一定的意义。在CBT疗法的基础上加入慢阻肺健康宣教比单纯的CBT疗法更为显著,尤其是对其抗抑郁的远期效果更为明显。3.患者肺功能的改善程度两组差别不显著。
[Abstract]:Objective: To explore the risk factors of 1. patients with chronic obstructive pulmonary disease complicated with depression of.2. for COPD with depression, cognitive behavioral therapy (CBT) and on the basis of cognitive behavioral therapy on the consolidation of health education for patients with antidepressant effect, and compared the differences between the two groups; analysis and comparison of two kinds of interventions for early and long-term therapeutic effect of improved.3. study on COPD depression levels in patients with depression, in addition to the standard COPD treatment, increased CBT therapy alone and CBT added after the health education, improve lung function and compare the differences between the two groups. Methods: 1. subjects: the patients selected for this study in hospitalized patients with stable COPD COPD. Lung disease can be divided into acute exacerbation and stable stage. The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) refers to the process in the short term, patients with cough, sputum, wheezing and shortness of breath (or at least one) Xiang Jiazhong is purulent sputum or sticky pus, and increased, accompanied by fever and inflammation significantly worse performance. Stable period refers to patients with cough, expectoration, shortness of breath and other symptoms or mild symptoms. Just stable patients admitted to hospital for acute exacerbation of asthma in the law application of antibiotics and phlegm, relieve the airway after. Spasm drug treatment, patients in the stable stage of chronic obstructive pulmonary disease. This study included patients who were in stable.2. patients with chronic obstructive pulmonary disease (COPD) diagnosis: according to COPD diagnosis standard and clinical symptoms of pulmonary function in FEV1/FVC70%.3. depression diagnosis standard: according to the ICD-10 guidelines, by specialized psychiatric doctors make a diagnosis of depression. The patients mainly manifested as appetite, fatigue, be scanty of words, decreased interest, sleep disorders. Meet the diagnostic criteria of COPD patients in the study, first on the Depression Scale (PHQ-9) for screening The investigation, and the screening scores greater than 5 of patients with HAMD-17 score to evaluate the situation and degree of depression. HAMD-17 scale will be included in the study scores between 7-17. Scores of 7 and 17 are not considered with depression, as in severe depression. Severe depression patients can not interfere with cognitive behavioral therapy simple, but should consult a psychiatrist when necessary medication, so we selected for study of patients with mild depression. The related data according to the diagnosis criteria of COPD patients were collected, including basic information, patient name, sex, age, years of smoking, daily smoking amount, smoking index height, weight, BMI, COPD, the number of years of disease, pulmonary function examination including the first second forced expiratory volume (FEV1), the ratio of the first second forced vital capacity and total lung (FEV1/FVC), FEV1 (% expected value); and some of the indicators such as breathing The difficulty index (mMRC), COPD Rating Scale (CAT) were evaluated. The patients were randomly divided into to meet the diagnostic criteria of COPD and meet the diagnostic criteria of mild depression into two groups: experimental group and control group. COPD treatment group two patients were the control group based on the given cognitive behavioral therapy (CBT) intervention, while the experimental group were enrolled in COPD health education based on cognitive behavioral therapy on each subject. Lung function tests were performed at 2 week, February (a complete cycle of cognitive behavioral therapy), and two months after the intervention the re evaluation of HAMD-17 scale scores and pulmonary function check. Compared two groups of patients with mental state (depression) and pulmonary function recovery. Results: the risk factors of 1.COPD with depression: COPD patients with a history of smoking, compared with non depression patients, COPD patients with depression had longer years of smoking The number (P=0.005), and the smoking index (P=0.022), the greater the longer duration (P0.05), FEV1 (% predicted) is low (P=0.0410.05), dyspnea index (P0.05), the higher the degree of cognitive COPD lower CAT score is higher (P0.05), but the amount of daily cigarette smoking (P=0.3210.05), FEV1 (a second volume) (P=0.041) and FEV/FVC (a second rate) (P=0.827) in patients with depression and non depression there is no significant difference between two groups of patients in the.2. study before and after the improvement of depression are obvious, and compared with the cognitive behavioral therapy alone (P0.05), on the basis of cognitive behavioral therapy on health education for patients with COPD patients with depression, improve the degree of large (P=0.0290.05).3. for COPD patients with depression, compared to the improvement in lung function are more significant in the patients of the two groups before and after the study, but the difference between the two groups was not significant (P=0.0770.05). Conclusion: 1. in patients with COPD, the long years of smoking smoking, The smoke index is high, COPD duration, dyspnea index, CAT value, FEV1 (% predicted) such as risk factors, patients with depression and gender, age, BMI, smoking, FEV1, FEV1/FVC and COPD were not significantly associated with depression.2. cognitive behavioral therapy. COPD health education has certain degree of significance for improving COPD and depression in patients with depression. With COPD health education than CBT therapy alone is more significant in CBT therapy, especially the improvement of the long-term antidepressant effect is more obvious pulmonary function in.3. patients is not the difference between the two groups significant.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.9;R749.4

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