心率变异生物反馈治疗广泛性焦虑障碍的研究

发布时间：2018-05-08 22:26

本文选题：广泛性焦虑障碍 + 心率变异性　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1、探讨广泛性焦虑障碍患者人格方面的特质。2、探讨心率变异生物反馈训练对心率变异性中频域指标、时域指标及心率的影响,心率变异生物反馈训练对广泛性焦虑障碍患者焦虑症状的缓解效果。3、探讨广泛性焦虑障碍患者心率变异性基线值与其状态特质焦虑量表、艾森克人格评分及心率之间的相关性分析。[方法]1、第一部分:本研究为病例对照研究,共纳入了 87例广泛性焦虑障碍患者,采用艾森克人格问卷进行评估,并与常模进行对照分析,探讨其人格方面的特征,然后服用舒肝解郁胶囊0. 72g每天2次、复方地西泮1片每天1次(舒肝解郁胶囊含有贯叶金丝桃和刺五加,主要有疏肝解郁和健脾安神的功效;复方地西泮虽不是治疗广泛性焦虑障碍的主药,但可以辅助改善广泛性焦虑障碍患者的焦虑症状,且未见有这两种药物影响HRV的相关报告);2、第二部分:采用从德国Biosign公司进口的心率变异生物反馈扫描分析仪(HRV-Scanner Professional)测定广泛性焦虑障碍患者的心率变异性(HRV),包括47例干预组广泛性焦虑障碍患者和40例对照组广泛性焦虑障碍患者,其中对干预组进行为期6周的心率变异生物反馈训练,观察6周前后患者的HRV指标变化情况,采用汉密尔顿焦虑量表(HAMA)量表和状态特质焦虑量表(STAI)评分对广泛性焦虑障碍患者的症状进行定量评估;3、第三部分:针对上述所有广泛性焦虑障碍患者,利用状态特质焦虑量表(STAI)评定,并进一步对患者状态特质焦虑、艾森克人格各维度及心率与心率变异性各指标进行相关性分析。[结果]第一部分:①通过对艾森克人格问卷中四个维度:E、P、N、L进行分析,并与常模进行比较,患者问卷中的N分显著高于常模[(16. 66±3. 78) vs (11. 6±4. 8),p0. 01],这表明广泛性焦虑障碍患者具有神经质的人格特质。第二部分:①在6周的随访中,干预组脱落4人,其中3人由于工作原因、1人由于交通原因不能按时随访,对照组脱落3人,3人全部由于交通原因不能按时随访。分别对广泛性焦虑障碍患者干预组与对照组的HRV中的频域指标、时域指标及心率进行6周前后两两比较分析,结果显示:干预组HRV频域指标中的低频(LF)成分降低[(2. 15±0. 43)ms2vs(1.99±0.43)ms2, p0.05],差异具有统计学意义;频域指标中的高频(HF)成份未见明显变化,差异无统计学意义,p0. 05;频域指标中 LF/HF 成份降低[1.54 (1. 65)vs 1. 17(1. 23), p0. 05],差异有统计学意义;频域指标中的极低频(VLF)成份未见明显变化,差异无统计学意义,p0. 05;频域指标中的总功率(TP)成份未见有明显变化,差异无统计学意义,p0.05。干预组反馈前后心率(HR)较前降低[(73.21±]0.80)次/min vs(63. 93±6. 18)次/min, p0. 05],差异有统计学意义。时域指标中SDNN和RMSSD均未见有明显变化,差异均无统计学意义,均p0.05。而对照组HRV中频域指标、时域指标及心率均未见明显变化,差异均无统计学意义,均p0. 05。②经过心率变异生物反馈训练后的广泛性焦虑障碍患者,STAI量表中SAI维度评分降低,差异有统计学意义[(60. 60 ±5. 90) vs (44. 79 ±5. 30),p0. 05];单纯药物治疗对照组也有所降低,差异亦有统计学意义[(59. 88±5. 83) vs (55. 51 ±4.38),p0.05],两组治疗前后的差值比较,差异有统计学意义[(-14. 40±4.66)vs(-10.00±3.91),p0.05],这说明干预组下降较对照组明显。干预组TAI评分在训练后评分下降,差异有统计学意义[(56. 13 ±4. 35) vs (52. 91 ±4. 36),p0. 05],但对照组TAI未见明显变化,P0. 05,两组治疗前后的差值比较,差异有统计学意义[(-3. 06±3. 07) vs (-1. 27± 1. 33),p0. 05]。干预组在训练后HAMA 评分下降,差异有统计学意义[(25. 51 ±2.66) vs (10. 33±1.82),p0. 05],对照组HAMA评分也下降,差异有统计学意义[(25. 53±2. 41) vs (15. 11 ±2. 77),p0.05],且两组治疗前后的差值比较差异有统计学意义[(-14.86 ±2. 88) vs (-10. 30±3. 66),p0. 05],这说明干预组下降较对照组明显。第三部分:广泛性焦虑障碍患者的HRV基线值中SDNN成份与HR呈负相关关系(r = -0. 464,P=0. 000), RMSSD 成份与 HR 呈负相关关系(r =-0.612,P=0. 000)。[结论]第一部分:①广泛性焦虑障碍患者具有神经质的人格特点,该类患者情绪的稳定性较正常人差。第二部分:①广泛性焦虑障碍患者经过心率变异生物反馈训练后,心率变异性中频域指标及心率有所变化,LF主要反映了交感神经的活性,频域指标中的LF成份降低,说明心率变异生物反馈训练可以降低交感神经的兴奋性;频域指标中的HF未见显著变化,HF主要映射了迷走神经的活性,说明迷走神经张力的调动可能需要更长的时间。频域指标中的LF/HF成份降低,而LF/HF反映了交感神经与迷走神经的平衡性,说明心率变异生物反馈可以改善交感神经系统与迷走神经系统之间的平衡状态,促进交感神经与迷走神经系统之间的相互平衡,可改善自主神经系统的平衡性。干预组中患者的心率明显下降,说明心率变异生物反馈训练可以降低患者的心率,可改善患者的心慌、心悸等心脏不适状况。干预组与对照组的SAI量表及HAMA评分均有所下降,但干预组下降较为明显,说明在相同药物治疗的基础上,心率变异生物反馈训练可以明显改善患者的焦虑症状。第三部分:干预组及对照组中所有广泛性焦虑障碍患者的HR与HRV时域指标中的SDNN成分呈负相关,HR与HRV时域指标中的RMSSD成分呈负相关,SDNN主要映射了交感神经与副交感神经总的张力大小,RMSSD主要映射了迷走神经的张力大小,这说明广泛性焦虑障碍个体的心率越高,交感神经与副交感神经总的张力越小,迷走神经的张力越小;在今后的临床实践中,可以对易感个体及疾病早期进行早期筛查与早期干预,为提高患者的预后及早期干预奠定一定的基础。
[Abstract]:[Objective]1 to explore the personality traits of patients with generalized anxiety disorder (.2), and to explore the effect of heart rate variation biofeedback training on the frequency domain index, time domain index and heart rate in heart rate variability. The effect of heart rate variation biofeedback training on anxiety symptoms in patients with generalized anxiety disorder (.3), and to explore the heart rate of patients with generalized anxiety disorder. The correlation between the variance baseline and the state trait anxiety scale, the Eysenck personality score and the heart rate. [method]1, Part 1: This study was a case-control study. A total of 87 patients with generalized anxiety disorders were evaluated by the Eysenck personality questionnaire and compared with the norm to explore their personality aspects. Features, and then take Shugan Jie Yu capsule 0. 72g 2 times a day, compound diazepam 1 tablets 1 times a day (Shugan Jie Yu capsule contains Hypericum Hypericum and acanthopanax, which mainly has the effect of dispersing liver and relieving depression and invigorating the spleen and amelioration; compound diazepam is not the main drug for the treatment of generalized anxiety disorder, but can assist in improving the focus of generalized anxiety disorder. " Symptoms were considered, and there were no related reports of the effects of these two drugs on HRV. 2, second: heart rate variability (HRV) in patients with generalized anxiety disorder (HRV) using heart rate variant biofeedback analyzer imported from German Biosign company (HRV-Scanner Professional), including 47 patients with generalized anxiety disorder and 40 controls In the group of patients with generalized anxiety disorder, the intervention group was trained for 6 weeks of heart rate variation biofeedback training, and the changes of HRV index were observed before and after 6 weeks. The Hamilton Anxiety Scale (HAMA) scale and the State Trait Anxiety Scale (STAI) score were used to evaluate the symptoms of the patients with generalized anxiety disorder (3, third). For all the patients with generalized anxiety disorder, the status trait anxiety scale (STAI) was used to evaluate the patient's state trait anxiety, Eysenck personality dimensions, heart rate and heart rate variability. [results] first part: (1) through the four dimensions of the Eysenck Personality Questionnaire: E, P, N, L. Analysis, and compared with the norm, the N score in the patient's questionnaire was significantly higher than that of the norm [(16.66 + 3.78) vs (11.6 + 4.8), p0. 01], which indicated that the patients with generalized anxiety disorder had neurotic personality traits. Second part: during the 6 week follow-up, the intervention group dropped 4 people, of which 3 were due to work reasons and 1 people were not on time due to traffic reasons. Following up, 3 people in the control group and 3 people were all unable to follow up due to traffic reasons. The frequency domain index, time domain index and heart rate of HRV in the intervention group and the control group were compared and analyzed 22 weeks before and after 6 weeks respectively. The results showed that the low frequency (2.15 + 0.43) ms2vs (2.15 + 0.43) ms2vs (1) in the intervention group was (2.15 + 0.43) ms2vs (1). .99 + 0.43) MS2, p0.05], the difference was statistically significant, the frequency domain index of the high frequency (HF) component did not change significantly, the difference was not statistically significant, p0. 05; the LF/HF component in the frequency domain index reduced [1.54 (1.65) vs 1.17 (1.23), p0. 05], the difference was statistically significant; the frequency domain index of the extreme low frequency (VLF) component did not change obviously, the difference was no Statistical significance, p0. 05, the total power (TP) component of the frequency domain index had no significant change, and the difference was not statistically significant. The heart rate (HR) before and after feedback in the p0.05. intervention group was lower than that of the former [(73.21 +]0.80) /min vs (63.93 + 6.18) /min, p0. 05], and there was no significant difference in both SDNN and RMSSD. No statistical significance, all p0.05. in the control group HRV in frequency domain index, time domain index and heart rate had no significant change, the difference was not statistically significant, all p0. 5 after the heart rate variant biological feedback training of patients with generalized anxiety disorder, STAI scale SAI dimension score lower, the difference was statistically significant [(60.60 + 5.90) vs (44.7) 9 + 5.30), p0. 05], the control group was also reduced, the difference was statistically significant [59.88 + 5.83) vs (55.51 + 4.38), p0.05], and the difference of the two groups before and after treatment was statistically significant [(-14. 40 + 4.66) vs (-10.00 + 3.91), p0.05], indicating that the intervention group was lower than the control group. The TAI score in the intervention group was in training. After training, the difference was statistically significant [(56.13 + 4.35) vs (52.91 + 4.36), p0. 05], but there was no significant change in the control group TAI, P0. 05, and two groups before and after treatment, the difference was statistically significant [(-3. 06 + 3.07) vs (-1. 27 + 1.33), p0. 05]. intervention group after training HAMA score decreased, the difference was statistically significant [(2] 5.51 + 2.66) vs (10.33 + 1.82), p0. 05], and the HAMA score in the control group also decreased, the difference was statistically significant [(25.53 + 2.41) vs (15.11 + 2.77), p0.05], and the difference of the two groups before and after treatment was statistically significant [(-14.86 + 2.88) vs (-10. 30 + 3.66), p0. 05], indicating that the intervention group was significantly lower than the control group. Third part: The SDNN component in HRV baseline values of patients with generalized anxiety disorder was negatively correlated with HR (r = -0. 464, P=0. 000), and the RMSSD component was negatively correlated with HR (R =-0.612, P=0. 000). [Conclusion] first part: (1) the patients with generalized anxiety disorder have neurotic personality characteristics, and the stability of this kind of patient is worse than that of the normal person. Second parts of the patients are less stable than the normal person. Scores: (1) after the heart rate variability biofeedback training in patients with generalized anxiety disorder, the frequency domain index and heart rate of heart rate variability have changed. LF mainly reflects the activity of sympathetic nerve, and the LF component in frequency domain index decreases. It shows that heart rate variation biofeedback training can lower the excitability of sympathetic nerve; HF in frequency domain index has not been found. HF mainly maps the activity of the vagus nerve, suggesting that the mobilization of the vagus nerve may take longer. The LF/HF component in the frequency domain index decreases, and LF/HF reflects the balance between the sympathetic and the vagus nerves, indicating that the heart rate variation biofeedback can improve the level of the sympathetic and vagus nerves. The balance between the sympathetic and the vagus nerve system can improve the balance of the autonomic nervous system. The heart rate of the patients in the intervention group decreases obviously, indicating that the heart rate variation biofeedback training can reduce the heart rate of the patient, and improve the heart discomfort, such as the patient's palpitation and palpitation, and the SAI quantity of the intervention group and the control group. The score of the table and HAMA decreased, but the decrease in the intervention group was more obvious. On the basis of the same drug treatment, the heart rate variation biofeedback training could obviously improve the anxiety symptoms of the patients. Third part: the HR of all the patients with generalized anxiety disorder in the intervention group and the control group was negatively correlated with the SDNN component in the time domain index of HRV, HR The RMSSD component in the HRV time domain index is negatively correlated. SDNN mainly maps the total tension of the sympathetic and parasympathetic nerves. RMSSD mainly maps the tension of the vagus nerve, which indicates that the higher the heart rate of the individuals with generalized anxiety disorder, the smaller the total tension of the sympathetic and parasympathetic nerves, the smaller the tension of the vagus nerve; the lower the tension of the vagus nerve; In the post clinical practice, early screening and early intervention can be carried out for susceptible individuals and early diseases, which will lay a foundation for improving the prognosis and early intervention of the patients.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.72

【参考文献】