ICD患者心理障碍及其处理对策

发布时间：2018-04-21 08:46

本文选题：埋藏式心律转复除颤器 + 心理障碍　；参考：《昆明医学院》2008年硕士论文

【摘要】： 目的了解埋藏式心律转复除颤器(ICD)患者中心理障碍的发病率,探讨心理障碍的病因与发病学机制,评价标准心理干预项目与综合治疗即“拼盘治疗”的疗效。方法选取从1998年～2007年12月在昆明医学院第一附属医院行ICD/CRT-D植入术的患者以及在外院植入而到本院随访的患者88人(男78人,女10人,平均年龄60.8岁),所有患者均接受中国生活事件量表(LES)、适应不良自评量表、防御方式问卷(DSQ)、症状自评量表(SCL-90)、社会支持评定量表(SSRS)、ICD与回避行为问卷、汉密尔顿抑郁量表(HRSD)和汉密尔顿焦虑量表(HAMA)进行心理状态评估,并选取昆明医学院部分在校研究生51例作为正常对照组(健康人群),采用相同量表进行心理状态评估,与ICD患者进行对比分析。选取2006年8月～2007年8月进行手术的病人分为两组,一组仅予以简单的健康教育,另一组予以ICD相关信息的全面健康教育;所有手术病人于术前1周和术后1周、1月、3月、6月及9月分别采用上述量表进行心理状态评估。对于除外上述提及的手术患者中未接受ICD放电的随访病例,发现存在心理障碍的患者予以综合治疗即“拼盘治疗”并在治疗后1周、2周、4周、6周和10周再次进行心理状态评估,与此同时采用病情严重程度(SI)与疗效总评(GI)两项指标进行疾病严重程度和疗效评价。病例追踪随访采用门诊复查、住院观察、电话随访及上门随访等方式进行,患者心理评估采用观察法、问卷法及半结构式晤谈法进行。结果本研究过程中失访两例,均为男性死亡病例(具体死因不详),总共完成随访292例次。研究发现ICD患者的心理健康状况较差其中42%存在心理障碍,明显高于健康对照组差异具有显著统计学意义(P＜0.01),其中以焦虑(包括惊恐发作和广泛性焦虑)、睡眠障碍、适应不良和抑郁为主要表现。本研究表明以SCL-90作为ICD患者是否出现心理障碍的衡量指标,其中以躯体化、焦虑与恐怖是最有意义的预测因子;应用HARD作为抑郁的评判指标,ICD患者抑郁状态以焦虑/躯体化、绝望感、睡眠障碍、迟缓和认知障碍作为预测指标;应用HAMA作为焦虑的评判指标,ICD患者焦虑状态中精神性与躯体性症状具有同等重要的意义,均是其发生的有力预测因素。在手术组患者的对照研究中采用SCL-90、HAMA、HRSD作为评价指标,实施经验心理健康教育干预组的患者术后心理障碍程度明显重于标准心理健康干预组的患者,心理障碍恢复时间也明显长于后者,两组患者之间的差异具有统计学意义(P＜0.05);标准干预组心理障碍发作高峰明显提前,严重程度也有所减轻;并且两组患者均表现出心理障碍会随时间消退的趋势。在应用综合治疗疗法治疗ICD患者心理障碍的研究中,治疗前后以适应不良自评量表、SCL-90、HAMA、HRSD、SI和GI作为评价指标,结果证明该疗法能够明显改善患者心理障碍的严重程度(P＜0.05),并在患者接受治疗的第二周开始显现疗效(P＜0.05)。本研究发现ICD放电与心理防御方式是ICD患者心理障碍的强烈预测因素。由本研究揭示的心理障碍病因及其他研究的成果推论ICD患者心理障碍发病的可能潜在机制为经典条件反射理论、学习无助理论和认知评价理论所解释。结论1.ICD患者心理障碍的发病率显著高于健康人群,不仅严重损害了患者的生活质量,甚至降低了患者的生存率,并且长期未受到应有重视。2.ICD患者心理障碍的症状随时间呈现山峦状消退趋势。3.本研究发现ICD患者心理障碍发病高危预测因素为:ICD放电、心理防御方式。4.ICD患者心理障碍发病的潜在机制可能为经典条件反射理论、学习无助理论和认知评价理论所解释。5.标准心理健康教育干预措施能够最大限度地减少ICD患者心理障碍症状的发生,减轻心理障碍的严重程度,更快的恢复到正常生活。6.综合治疗即“拼盘治疗”对存在心理障碍的ICD患者能够发挥上佳的治疗效果,并在治疗第二周开始发挥疗效。7.ICD患者的常规随访中应定期进行心理状态评估和心理咨询,及时对ICD患者的心理障碍发挥早发现、早治疗的一、二级预防作用。
[Abstract]:Objective to understand the incidence of psychological disorders in patients with buried cardiac arrhythmias (ICD), to explore the etiology and pathogenesis of psychological disorders, and to evaluate the therapeutic effect of standard psychological intervention and integrated treatment ("chicooy").
Methods from 1998 to December 2007, 88 patients (78 men, 10 women, 60.8 years old) were followed up in the First Affiliated Hospital of Kunming Medical University (78 men, 10 women, 60.8 years old). All the patients accepted the Chinese life event scale (DSQ), the Defense Style Questionnaire (DSQ), and the disease. Self rating scale (SCL-90), social support rating scale (SSRS), ICD and avoidance behavior questionnaire, Hamilton Depression Scale (HRSD) and Hamilton Anxiety Scale (HAMA) were used to evaluate the psychological status, and 51 postgraduates from Kunming Medical University were selected as the normal control group (healthy population), and the psychological state assessment was carried out by the same scale. The patients were compared with the ICD patients. The patients from August 2006 to August 2007 were divided into two groups. One group was only given a simple health education, the other was given a comprehensive health education with ICD related information. All the patients were evaluated by the above scale for mental state assessment in the 1 weeks before operation and 1 weeks after the operation, January, March, June and September, respectively. For a follow-up case that had not received ICD discharge in the patients with the exception of the above mentioned above, it was found that the patients with mental disorders were treated with a combination of "chawing therapy" and another psychological assessment for 1 weeks, 2 weeks, 4 weeks, 6 and 10 weeks after treatment, while two indexes of the disease severity (SI) and the total effect assessment (GI) were used. The severity and efficacy of the disease were evaluated. The follow-up follow-up was carried out by outpatient review, in-patient observation, telephone follow-up and follow-up. The patient's psychological assessment was observed by observation, questionnaire and semi structural discussion.
Results in this study, two cases were lost, all of which were male deaths (specific causes of death), and a total of 292 cases were followed up. The psychological health status of ICD patients was poor, and 42% of them had mental disorders, which were significantly higher than those of the healthy control group (P < 0.01). Generalized anxiety), sleep disorders, maladaptation and depression were the main manifestations. This study showed that SCL-90 was used as a measure of mental disorders in ICD patients, in which somatization, anxiety and terror were the most significant predictors; the use of HARD as a criterion for depression, and the depression of ICD patients with anxiety / somatization, despair, Sleep disorders, retardation, and cognitive impairment were used as predictors. Using HAMA as a marker of anxiety, the mental and physical symptoms of ICD patients were of the same importance, all of which were powerful predictors of their occurrence. In the control study of the operation group, SCL-90, HAMA, and HRSD were used as evaluation indicators to implement the experience. The psychological disorder of the patients in the health education intervention group was significantly higher than that in the standard mental health intervention group, and the recovery time of the mental disorder was also significantly longer than the latter. The difference between the two groups was statistically significant (P < 0.05); the peak of the mental disorder in the standard intervention group was obviously ahead of time and the severity was also reduced. The two groups of patients showed the tendency to decline with time. In the study of the treatment of psychological disorders in ICD patients with comprehensive treatment therapy, before and after treatment, SCL-90, HAMA, HRSD, SI and GI were used as evaluation indicators. The results showed that the therapy could significantly improve the severity of mental disorders in patients (P < 0.05). The effect of the second weeks of treatment was observed (P < 0.05). This study found that ICD discharge and psychological defense were a strong predictor of psychological disorders in ICD patients. The possible underlying mechanism of psychological disorders in ICD patients was deduced from the causes of psychological disorders and other research results revealed in this study. On the theory of learning helplessness and the theory of cognitive evaluation.
Conclusion the incidence of mental disorders in 1.ICD patients is significantly higher than that in healthy people, not only seriously damaging the quality of life of the patients, even reducing the survival rate of the patients, and the symptoms of the mental disorder of the patients with.2.ICD are not due to the trend of mountain range decline with time.3.. This study found the risk of psychological disorder in ICD patients. The test factors are: ICD discharge, psychological defense mode.4.ICD patients' psychological disorder may be the underlying mechanism of the classical conditioned reflex theory, learning helplessness theory and cognitive evaluation theory explained that.5. standard mental health education intervention measures can minimize the occurrence of psychological disorders in ICD patients and reduce the severity of psychological disorders. Degree, faster recovery to normal life,.6. comprehensive treatment is "platter therapy" for ICD patients with mental disorders, and the psychological status assessment and psychological counseling should be carried out regularly during the second week treatment of patients with therapeutic.7.ICD, and psychological disorders in ICD patients should be played in time. Early discovery, early treatment of one, two stage preventive effect.

【学位授予单位】：昆明医学院
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R395

【共引文献】