老年综合评估及干预在老年高血压合并焦虑状态患者中的应用效果评价

发布时间：2018-04-08 23:37

本文选题：老年高血压　切入点：焦虑　出处：《华北理工大学》2017年硕士论文

【摘要】：目的通过在老年高血压合并焦虑状态患者临床诊疗基础上应用老年综合评估(Comprehensive Geriatric Assessment CGA),在疾病、躯体功能、精神心理和社会环境等多个层面对患者进行全面评估以及合理干预,探讨其在减轻患者焦虑症状、提高服药依从性、控制血压及动态血压、改善自主神经功能及生存质量方面的作用,从而为进一步促进患者病情恢复提供一定的临床参考。方法收集2015年10月至2016年4月在华北理工大学附属医院入住老年病科的高血压合并焦虑状态患者,从中选取符合纳入标准者152人作为研究对象。诊断标准:1)原发性高血压的诊断依照《中国高血压防治指南(2010版)》的标准:在未服用降压药的情况下非同日3次诊室收缩压≥140mm Hg和(或)舒张压≥90mm Hg,或既往明确诊断过高血压,正在接受降压治疗;2)焦虑状态诊断:SAS焦虑自评量表评分(粗分)≥40分,且症状符合《中国精神疾病分类及诊断标准》中广泛性焦虑症的临床表现:经常或持续的无明确对象和固定内容的恐惧或提心吊胆,伴植物神经功能紊乱或运动性不安。纳入标准:1)年龄在≥60岁;2)意识清楚;3)住院时间超过72小时;4)入选对象均已表示自愿参与本次研究,并于研究前签订相关知情同意书。将入选患者随机分成干预组75例及对照组77例,研究前采集两组患者的一般资料,测量并记录患者的血压、动态血压及心率变异性指标(Heart Rate Variability HRV)。对所有入选患者在入院当天完成焦虑症状评估,入院3天内完成老年综合评估、服药依从性评估及生存质量评估。研究过程中两组患者均给予规范疾病治疗、结合心理科会诊给予心理安慰或抗焦虑药物治疗,干预组同时进行老年综合评估,针对评估过程中筛查的问题给予针对性的干预措施。干预时间为2个月零14天,在本次研究结束时进行第2次评估,并复查血压、动态血压及心率变异性指标。所有研究资料应用SPSS20.0进行结果分析,两组计数资料采用例数和百分数表示,组间比较采用χ2检验。计量资料采用均数±标准差(x±s)表示,进行正态性检验后,两组间比较采用两独立样本t检验,组内前后比较采用配对t检验。P0.05为差异具有统计学意义。结果1两组患者的性别、年龄、婚姻、文化程度、职业、烟酒史、合并冠心病及2型糖尿病情况、β受体阻滞剂服用情况、高血压病程年数、体质指数等一般资料及老年综合评估等基础资料比较,无统计学差异(P0.05)。2入院第1天,两组患者SAS评分比较,无明显差异(P0.05)。出院2个月后复测,两组患者SAS评分较前均有不同程度减低,且干预组焦虑症状缓解效果优于对照组(P0.01)。3入院后3天内完成患者服药依从性评估,两组评分相比,无明显差异(P0.05)。出院2个月后复测,两组患者服药依从性较前均有不同程度提高,且干预组评分显著高于对照组(P0.01),提示干预组患者服药依从性提高更加明显。4入院第1天两组患者偶测血压水平比较,无明显统计学差异(P0.05)。出院2个月后复查,两组患者的收缩压及舒张压水平较前均有不同程度下降,且干预组比对照组血压下降更加明显(P0.05)。5入院后两组患者动态血压水平相比,无明显差异(P0.05)。出院2个月后复查,与对照组相比,除夜间平均舒张压以外,干预组的其余5项指标水平均较低(P0.05),提示两组比较,干预组患者的动态血压平均水平改善程度较大。6入院后两组患者血压昼夜节律性呈杓型的人数相比,无明显统计学差异(P0.05)。出院2个月后复查,干预组血压昼夜节律性呈杓型的人数较对照组增多(P0.05),提示干预组患者血压昼夜节律性改善更加明显。7入院后比较两组患者HRV水平,无明显差异(P0.05);出院2个月后复查时两组患者各项HRV指标较前均有所提高P0.01),且干预组HRV指标明显比对照组较高(P0.05),提示干预组患者自主神经功能改善更加明显。8入院3天内完成两组患者生存质量评估,各项评分相比无统计学差异(P0.05);出院2个月后复测,两组患者生存质量各项评分均有所提高(P0.05),且两组患者评分相比,除生理职能以外,其他7项干预组评分结果较高(P0.05)。结论在老年高血压合并焦虑状态患者的常规治疗方案中引入CGA,并对筛查出的问题给予科学干预,可以有以下效果:1)有效缓解患者的焦虑症状。2)提高患者服药依从性,促进平稳降压,改善自主神经功能。3)使患者的生存质量得到明显提高。
[Abstract]:Objective through the application of comprehensive geriatric assessment in elderly hypertensive patients with anxiety in patients with clinical diagnosis and treatment on the basis of (Comprehensive Geriatric Assessment CGA), the disease, physical function, psychological and social environment and other aspects were comprehensive evaluation and reasonable intervention on the anxiety symptoms of patients, improve medication compliance, and ambulatory blood pressure control of blood pressure, improve autonomic nerve function and quality of life of the role, so as to provide clinical reference to further promote the recovery of patients. The anxiety state of patients with hypertension were collected from October 2015 to April 2016 in the North Polytechnic in the Affiliated Hospital of University, the selection criteria of 152 people from the diagnostic criteria as the research object.: 1) the diagnosis of primary hypertension in accordance with the "guidelines for prevention and treatment of hypertension Chinese (2010 Edition) > standard: without Under the condition of non use of antihypertensive drugs on the same day 3 times more than 140mm Hg and consulting room, systolic blood pressure, diastolic blood pressure below 90mm (or Hg), or previous diagnosis had hypertension, are receiving antihypertensive treatment; 2) anxiety diagnosis: SAS self rating Anxiety Scale score (divided) more than 40 points, and in line with clinical symptoms. The performance of classification and diagnostic criteria of mental disorders China > in generalized anxiety disorder: often persistent or no clear object and fixed content of fear or always on tenterhooks, with autonomic dysfunction or motor restlessness. Inclusion criteria: 1) at the age of more than 60 years old; 2) clear consciousness; 3) hospitalization more than 72 h; 4) subjects have said voluntarily participated in this study and signed informed consent to the study. The patients were randomly divided into intervention group and control group in 75 cases and 77 cases, the research collected before the general information of the two groups of patients, measure and record the patient's blood pressure, ambulatory blood pressure and Heart rate variability index (Heart Rate Variability HRV). All patients in the day of admission completed anxiety symptom assessment, admission within 3 days of the completion of comprehensive geriatric assessment, assessment of medication compliance and quality of life assessment. Two groups of patients during the study were given the treatment of the disease, the combination of psychological consultation to give comfort or anti anxiety drug treatment the psychological intervention group, while the comprehensive geriatric assessment, aiming at the problems in the process of screening assessment given targeted intervention. The intervention lasted 2 months and 14 days, second assessment in the end of the study, and review the blood pressure, ambulatory blood pressure and heart rate variability index. Analysis results of all application data SPSS20.0, two groups of count data expressed by the number of cases and percentage were compared by 2 test measurement data using the mean and standard deviation (x + s) said that the normality test after, The two groups were compared using two independent samples t test, within groups using paired t test.P0.05 was statistically significant difference. Results 1 patients of the two groups of gender, age, marriage, education, occupation, smoking history, coronary heart disease and type 2 diabetes, beta blocker use, duration of hypertension years comparison of body mass index, general information and comprehensive geriatric assessment data, no significant difference (P0.05).2 on the first day, SAS scores in the two groups had no significant difference (P0.05). 2 months after discharge retest, the SAS score of the two groups were different degrees of reduction, and the intervention group anxiety the remission of symptoms better than the control group (P0.01) to complete the assessment of compliance of patients with.3 within 3 days after admission, compared two groups score, no significant difference (P0.05). 2 months after discharge retest, two groups of patients with medication compliance were different. Is high, and the intervention group were significantly higher than those in control group (P0.01), suggesting that the intervention group patients with medication compliance were better improved.4 on the first day of two groups of patients measuring blood pressure level comparison, no statistically significant difference (P0.05). After 2 months of discharge, two groups of patients with systolic blood pressure and diastolic blood pressure than before have varying degrees of decline, and the intervention group than the control group obviously decreased blood pressure (P0.05) compared to the level of blood pressure in two groups of patients with dynamic.5 after admission, no significant difference (P0.05). After 2 months of discharge, compared with the control group, except the night diastolic blood pressure, the intervention group of the remaining 5 indicators were low (P0.05), suggesting that the two groups of patients in the intervention group improved the average ambulatory blood pressure greater.6 blood pressure after admission of patients in two groups were the number of dipper circadian rhythm compared no significant difference (P0.05). After 2 months after the intervention group The circadian rhythm of blood pressure was the number of dipper was more than that in control group (P0.05), suggesting that the intervention of blood pressure circadian rhythm of the patients obviously improved.7 after admission were compared between the two groups HRV levels, no significant difference (P0.05); 2 months after discharge follow-up of the two groups were compared to that before HRV increased P0.01), and the intervention group than the control group, HRV index was significantly higher (P0.05), suggesting that the intervention group improved more obviously in autonomic nerve function in patients with.8 hospitalized within 3 days of the completion of the two groups of patients quality of life assessment, the score had no statistical difference (P0.05); the 2 months after the retest, the quality of life of patients in the two groups score were improved (P0.05), and the two group were compared, in addition to the physical function outside, the other 7 intervention group scores were higher (P0.05). Conclusion CGA was introduced into the conventional treatment combined with anxiety state in elderly patients with hypertension, and screening Scientific intervention can bring the following effects: 1) effectively alleviate the patient's anxiety symptoms.2), improve patient compliance, promote stable blood pressure, improve autonomic nervous function.3, and improve the quality of life of patients.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R749.72

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