失眠患者临床特征及叙事医学中医平行病历构建

发布时间：2018-01-02 16:29

  本文关键词：失眠患者临床特征及叙事医学中医平行病历构建　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 失眠 临床特征 叙事医学 平行病历

【摘要】：研究目的通过对失眠患者临床的采集及统计分析探讨失眠患者临床特征,根据生物学以外临床特征的重要性,提出全面了解疾病背后的故事,构建中医平行病历的必要性。研究方法自2015年10月至2017年2月就诊于导师门诊的符合标准的95名失眠患者,进行调查统计,收集记录患者的临床基本资料,采用匹兹堡睡眠质量指数量表(PSQI)进行睡眠评价,汉密尔顿焦虑量表(HAMA)进行焦虑水平的评估。根据所收集资料建立相关数据库,采用SPSS20.0统计分析软件对所采集资料进行描述性统计、相关分析、卡方检验、t检验及非参数检验等方法进行数据分析。自2015年至2017年邀请本院不同科室五位副高级以上专家对患者进行床旁访谈并进行回顾性思考。通过录音的方式,记录并整理成文,共积累访谈案例10篇。研究结果通过对近两年,东直门医院脑病科门诊失眠患者的信息采集及整理,发现失眠伴焦虑状态人群(66.32%)与非焦虑人群(33.68%)的比例为1:1.97,提示失眠患者常伴随焦虑状态。PSCI及HAMA评分进行描述性统计分析,得到PSQI评分最低为7分,最高为20分,平均分12.58±3.528。HAMA评分最低分为3分,最高为44分,平均分19.14±9.122。非焦虑状态与伴焦虑状态失眠患者的PSQI评分分别10.50(6)和13.33±3.943,P值0.05,提示焦虑与否的PSQI评分有差异,其中非焦虑组与焦虑组秩均值分别为37.83和53.17,说明焦虑患者的PSQI评分较非焦虑组高。HAMA分组对PSQI各成分影响的统计结果显示,HAMA分组对PSQI总分、睡眠质量(习惯性睡眠效率)、入睡时间(睡眠潜伏期)、睡眠障碍(主观睡眠质量)、日间功能障碍(白天功能紊乱)的评分有影响,且此5项r值均0,P值0.05,可以认为焦虑分组与PSQI各成分正相关,r值的绝对值比较显示:焦虑与否对入睡时间和日间功能的影响最显著,其次是PSQI评分,然后为睡眠障碍,最末为睡眠质量。非焦虑与焦虑组失眠患者的男女比例分别为1:2.2与1:2.94。可见在失眠患者中女性比例高于男性。年龄方面最高为40-59岁中老年人群(41.05%),其次为20-39岁的青中年人群(36.84%),最末为60-80岁老年人群(22.11%)。失眠患者中脑力劳动与体力劳动的比值为4:1,,单纯失眠患者组比值为4.3:1;伴焦虑状态组中比值为3.85:1。每组人群均可发现从事脑力劳动的失眠人数明显高于体力劳动的,而单纯失眠人群中的差异更明显。文化程度方面,小学文化2例(占2.11%)初中文化共17例(占17.89%),高中或中专文化28例(占29.47%),大学文化41例(占43.16%),研究生文化7例(占7.37%)。一般资料中频数描述可见性别、年龄、职业、文化程度对失眠均有显著影响,但并未得到统计学差异(P0.05)。主要临床特征:失眠的主要特征分别为入睡困难84例(88.42%)、多梦83例(87.37%)、易醒83例(87.37%)、醒后疲乏78例(82.11%)和早醒73例(76.84%)。并且发现非焦虑组睡不实、易醒27例(占84.38%),早醒23例(占71.88%)。焦虑组睡不实、易醒56例(占88.89%),早醒50例(占79.37%)。失眠伴焦虑患者更易出现睡不实、易醒的临床特征。次要临床特征:将性格特点与生活工作方式各项与HAMA分组进行卡方检验,按α=0.05的标准,发现只有性格特点中的爱操心与HAAMA分组存在统计学意义,其余各项P值0.05。但根据频数描述结果可知,爱操心70例(73.68%)、急脾气61例(64.21%)、爱生气58例(61.11%)、追求完美53例(55.79%)、承担过多41例(43.16%)等性格特点及工作压力大32例(占33.68%),视频作业56例(占58.95%),长期一个姿势36例(占37.89%)等生活方式均与失眠密切相关。通过对失眠患者临床特征的总结,揭示次要特征与失眠密切相关,明确生物学以外临床特征的重要性。尝试将叙事医学理论引入临床,邀请5位副高级以上专家对病人进行床旁访谈,并整理成文。为中医平行病历的构建提供经验以及参考。研究结论1.性别、年龄、职业、文化水平、病程时间及性格特点、工作生活方式均与失眠相关;2.女性、高知分子、中青年、脑力劳动者,病程时间长;急脾气、爱生气,爱操心;工作压力大、生活应激事件,起居不规律等非生物学特征均为失眠次要临床特征;3.通过临床访谈与写作,进行将叙事医学引入中医临床的探索,构建中医平行病历。
[Abstract]:Objective to explore the clinical features of patients with insomnia collection and statistical analysis of clinical insomnia patients, according to the importance of outside biology clinical features, put forward a comprehensive understanding of the disease and the story behind the necessity of the construction of Chinese parallel medical records from October 2015 to February 2017. The method of treatment in the outpatient department supervisor meets the standard of 95 patients with insomnia, investigation statistics collect, record the basic clinical data of patients, the Pittsburgh sleep quality index (PSQI) for sleep quality evaluation, Hamilton Anxiety Scale (HAMA) assessment of anxiety level. According to the data collected by the establishment of the database, using SPSS20.0 statistical analysis software for descriptive statistics, the collected data correlation analysis, chi square test. T test and non parametric test methods for data analysis. From 2015 to 2017 in Our Hospital Department invited different five vice senior The above expert bedside interviews with patients and the retrospective thinking. By recording, recorded and documented, a total of 10 cases of interviews accumulation. The results of the past two years, the information collection and collation of insomnia patients with encephalopathy outpatient hospital in Dongzhimen, found that insomnia associated with anxiety group and non anxiety group (66.32%) (33.68%) the ratio of 1:1.97, suggesting that patients with insomnia often accompanied by anxiety.PSCI and HAMA scores of descriptive statistical analysis, get the lowest PSQI score was 7 points, up 20 points, an average of 12.58 + 3.528.HAMA score lowest score was 3 points, up 44 points, an average of 19.14 + 9.122. and non anxiety with PSQI anxiety insomnia scores were 10.50 (6) and 13.33 + 3.943, P = 0.05, suggesting that anxiety and not PSQI score differences among non anxiety group and anxiety group rank mean were 37.83 and 53.17, indicating anxiety Patients with PSQI score than the non anxiety group statistical impact of high.HAMA grouping of components of PSQI showed that the HAMA groups of PSQI score, sleep quality (habitual sleep efficiency), sleep time (sleep latency), sleep disorders (subjective sleep quality), daytime dysfunction (daytime dysfunction) affect the score, and the 5 R value was 0, P value 0.05, can be considered as anxiety group and PSQI of each component is related to the absolute value of the R value of the comparison shows that the most significant anxiety of sleep time and daytime function, followed by the PSQI score, and sleep disorders, in the end for non anxiety and sleep quality. The proportion of male and female patients with insomnia anxiety group were 1:2.2 and 1:2.94. in patients with insomnia in women than men. The highest age for the elderly people at the age of 40-59 (41.05%), followed by the young and middle-aged population aged 20-39 (36.84%), the last for 60-80 years old people Group (22.11%). The ratio of insomnia in patients with mental and manual labor is 4:1, ratio of 4.3:1 group simple insomnia patients with anxiety; group 3.85:1. ratio of each group can be found that the number of insomnia engaged in mental work was higher than that of manual labor, and simply lost sleep in the crowd is more obvious differences. Cultural degree 2 cases of primary school, culture (2.11%) junior high school a total of 17 cases (17.89%), high school or secondary school culture in 28 cases (29.47%), 41 cases of university culture (43.16%), 7 cases of culture (7.37%). The frequency of visible description in the general information of gender, age, occupation, cultural degree have significant effects on insomnia, but did not get a statistically significant difference (P0.05). The main clinical features: the main features of insomnia were difficult to fall asleep in 84 cases (88.42%), 83 cases (87.37%), dreaminess, easy to wake up in 83 cases (87.37%), 78 cases of fatigue after waking (82.11%) and 73 cases (76.84%) wake up early and. 鍙戠幇闈炵劍铏戠粍鐫′笉瀹，

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