冠心病患者PCI术后失眠情况及中医证型分布研究

发布时间：2018-04-21 06:43

本文选题：冠心病 + 介入手术　；参考：《北京中医药大学》2017年硕士论文

【摘要】：目的:本研究旨在调查冠心病PCI术后存在失眠的患者,其失眠同冠心病及PCI术相关性程度、失眠类型及中医证型的分布状况及生活质量情况,从而了解PCI术患者失眠的状况以及中医证型的比例。方法:本研究采用横断面调查研究的方式,纳入2016年8月至2017年4月于东直门医院心血管内科门诊部及住院部进行治疗的冠心病支架术后伴有失眠的患者40例,并纳入冠心病未行支架术伴有失眠的患者20例,非冠心病的心血管疾病伴有失眠的患者20例作为两个对照组通过调查问卷的方式收集患者的资料,采集患者的基本资料、病史及治疗情况、危险因素控制情况、失眠情况、焦虑抑郁情况、生活质量调查和中医症候诊断。建立数据库,采用SPSS17.0统计软件进行资料的统计分析,比照对照组的数据,分析研究对象失眠的原因、类型与中医症候分布与PCI的相关性。结果:1.基本情况:本次研究纳入患者80例,其中冠心病支架术后伴有失眠的患者40例,其中处于康复Ⅰ期患者3人,康复Ⅱ期患者4人,康复Ⅲ期患者33人;冠心病未行支架术伴有失眠的患者20例,非冠心病的心血管疾病伴有失眠的患者20例。全部患者中包括男性38人,女性42人;纳入80名患者的平均年龄为66.99±11.049岁,其中最小年龄为42岁,最大年龄为91岁。纳入全部患者的年龄分布差异具有统计学意义。三组间患者年龄分布无明显差异。冠心病男性患者的患病年龄明显小于女性患者的患病年龄。2.危险因素控制情况:本研究全部患者中61人(76.25%)确诊患有高血压病,全部患者中34人(42.5%)确诊患有糖尿病,全部患者中60人(75%)确诊患有高脂血症,支架术后患者、冠心病患者及高血压、心律失常患者的高血压及高脂血症的患病率均高于糖尿病患病率。本研究中PCI组有吸烟史的患者比例为42.5%,冠心病组为30%,非冠心病组的25%;有饮酒史的各组比例都在30%及以上。3.患病及治疗情况:PCI组32名患者术前有心绞痛发作;冠心病组9名患者曾有心绞痛发作的情况。统计学计算结果支持有心绞痛症状的冠心病患者行PCI术的几率明显高于无心绞痛症状的冠心病患者。60-69岁患者心绞痛发作几率最高。不同年龄层心绞痛的发作率不具有明显差异。PCI组患者单支病变者20人,双支病变者7人,三支病变者8人,不详者5人。4.伴发心律失常:非冠心病组6名患者患有心律失常;冠心病组10个患者伴有心律失常;PCI组7个患者伴有心律失常,总计23人伴有心律失常。三组心律失常发生率具有明显差异,PCI组的心律失常发生率明显低于冠心病组心律失常发生率。5.失眠情况:纳入患者80例开始出现失眠症状时的平均年龄为54.388± 16.044,其中最小患病年龄为13岁,最大患病年龄为86岁;年龄是患有失眠的影响因素在本研究中得到了统计学支持,不同年龄阶段失眠的发病率不同。患者在50-59岁年龄段更易发生失眠。冠心病男性患者失眠的发病年龄明显较女性患者失眠的发病年龄更低。纳入慢性失眠患者最多,占83.75%。80例失眠患者中症状表现为入睡困难者为62人,睡眠轻浅,容易惊醒者为62人,梦多者42人,起夜多者36人,醒后难以再次入睡者57人,睡眠较充足,醒后仍觉疲倦5人。三组在失眠症状上的差异具有统计学意义,PCI组入睡困难症状发生率高于其他两组,PCI术后失眠患者以入睡困难发生率最高,其次是醒后难以再次入睡。患者受躯体因素影响睡眠者少于受精神因素影响睡眠者。PCI组影响患者睡眠的最多的原因为思索家庭或工作琐事(42.50%)。80例患者中失眠有所改善者48例,没有改善者20例,改善较少者12例;失眠有所改善者以服用药物有效最多。PCI组术后出现失眠的患者为4人(10%),术后失眠较前更加严重者7人(17.5%),术后失眠较前减轻者3人(7.5%),失眠与之前无不同26人(65%)。65%患者的失眠情况在PCI术后无明显变化。6.睡眠评分:以PSQI测评患者的失眠严重程度,各组差异不具有统计学意义。男性患者的PSQI明显小于女性的匹茨堡评分。以AIS对80例患者进行失眠程度的测评,各组差异不具有统计学意义。以ISI进行失眠程度测评,全部患者中ISI评分女性明显高于男性。7.嗜睡程度及疲劳程度:以ESS对患者进行嗜睡程度评价。83.75%患者都属于正常范围内。以FSS评价80名患者疲劳程度,80名患者中属于疲劳范围68人,不属于疲劳范围12人。8.焦虑抑郁情况:以SAS对患者进行焦虑情况评价,80名患者中60名属于正常范围,16名患者轻度焦虑,4名患者中度焦虑。无患者属于重度焦虑。以SDS对患者进行抑郁情况评价,80名患者中7名属于正常范围,12名患者轻度抑郁,3名患者中度抑郁,1名患者属于重度抑郁。83.75%患者属于不达到抑郁程度,16.25%的患者处于抑郁状态。9.中医证型分布情况:对PCI组及冠心病组两组患者的中医证型分布具有明显差异。支架术后患者气虚血瘀证型最多,多于冠心病气虚血瘀证型患者,支架术后患者的证型分布以气虚血瘀最多,气虚血瘀痰阻心脉心血瘀阻阳气虚衰=阴寒凝滞气滞血瘀气阴两虚心肾阴虚,与冠心病患者的中医证型分布具有明显差异。PCI组的症状评分低于冠心病组症状评分。冠心病患者(无论是否行支架术)中男性的症状评分低于女性的症状评分。结论:1.PCI术后失眠患者症状分布同PCI术相关性得到统计学支持。PCI术后患者失眠的症状分布同冠心病未行PCI治疗患者,高血压或心律失常患者的失眠症状分布具有明显的差异。PCI术后患者以入睡困难最多,其次多见醒后难以再次入睡。2.65%患者的失眠情况在PCI术后无明显变化,PCI术导致或加重失眠者27.5%,PCI术后失眠减轻者仅有7.5%。3.以PSQI,AIS,ESS测评患者的失眠严重程度,PCI术后患者同冠心病患者,高血压或心律失常患者不具有明显差异。4.PCI术后患者及冠心病患者在中医证型分布上具有明显差异。支架术后患者的证型分布以气虚血瘀最多,气虚血瘀痰阻心脉心血瘀阻阳气虚衰=阴寒凝滞气滞血瘀气阴两虚心肾阴虚,与冠心病患者的中医证型分布具有明显差异。
[Abstract]:Objective: the purpose of this study was to investigate the relationship between insomnia, coronary heart disease and PCI, the type of insomnia, the distribution of TCM syndrome type and the quality of life, so as to understand the status of insomnia and the proportion of TCM syndrome in the patients with PCI. Methods: a cross-sectional study was used in this study. From August 2016 to April 2017, 40 patients with insomnia after coronary heart disease stenting in the outpatient department of cardiovascular medicine and inpatient department of Dongzhimen hospital were included, and 20 patients with coronary heart disease without stent and insomnia were included, and 20 cases of non coronary heart disease accompanied by insomnia were investigated as two control groups. The questionnaire was used to collect the patient's data, collect the patient's basic information, medical history and treatment, risk factors control, insomnia, anxiety and depression, quality of life survey and TCM syndrome diagnosis. Establish a database, use SPSS17.0 statistical software to carry out statistical analysis of data, compared with the control group data, analyze the research object. The causes and types of insomnia and the correlation of TCM Syndrome Distribution and PCI. Results: 1. basic conditions: This study included 80 patients, including 40 patients with insomnia after coronary stenting, 3 in rehabilitation stage I, 4 in rehabilitation stage II, 33 in stage III patients, and 20 in patients with coronary heart disease without stenting and insomnia. There were 20 patients with non coronary heart disease and insomnia. All the patients included 38 men and 42 women. The average age of 80 patients was 66.99 + 11.049 years old, the minimum age was 42 years and the maximum age was 91. The age distribution of all patients was statistically significant. The age distribution of the three groups was no more. The age of male patients with coronary heart disease was significantly less than the risk factor control of.2. in women: 61 (76.25%) of all patients in this study were diagnosed with hypertension, 34 (42.5%) of all patients were diagnosed with diabetes, 60 (75%) of all patients were diagnosed with hyperlipidemia, after stenting, crowns The prevalence rate of hypertension and hyperlipidemia in patients with heart disease and hypertension and arrhythmia was higher than that of diabetes. In this study, the proportion of patients with a history of smoking in the PCI group was 42.5%, the coronary heart disease group was 30%, and the non coronary heart disease group was 25%; the proportion of each group in the history of alcohol drinking was 30% and the condition of upper.3. and treatment: 32 patients in group PCI were preoperatively. Angina pectoris occurred in 9 patients with coronary heart disease. Statistical results showed that the risk of angina pectoris in patients with coronary heart disease with angina pectoris in patients with coronary heart disease (PCI) was higher than that of coronary heart disease without angina. The incidence of angina pectoris in different age groups was not significantly worse than that of.60-69 years old. In the group of.PCI, there were 20 patients with single lesion, 7 of double branch lesions, 8 in three diseased persons, 5 in unknown person, with arrhythmia in 6 patients in non coronary heart disease group; 10 patients in coronary heart disease group were accompanied by arrhythmia; 7 patients in group PCI were accompanied by arrhythmia, and 23 people were accompanied by arrhythmia. The incidence of arrhythmia in three groups was clear. The incidence of arrhythmia in group PCI was significantly lower than that of.5. insomnia in coronary heart disease group: the average age of 80 cases of insomnia was 54.388 + 16.044, the minimum age was 13 years and the maximum age was 86 years; age was the influence factor of insomnia in this study. Statistical support, the incidence of insomnia at different age stages is different. Patients are more prone to insomnia at the age of 50-59 years. The age of insomnia in male patients with coronary heart disease is significantly lower than that of women with insomnia. The majority of patients with chronic insomnia, accounting for the symptoms of insomnia in 83.75%.80 cases, are 62, sleeping. Sleepless and shallow, easy to wake up the 62 people, more than 42 people, more than 36 people, after waking up to sleep again 57 people, sleep more enough, and still feel tired after waking up 5. The three groups in the symptoms of insomnia have statistical significance, PCI group sleep difficulty symptoms are higher than the other two groups, PCI after the insomnia patients with the highest incidence of sleep difficulties, the highest incidence of insomnia, after PCI insomnia patients with difficulty falling asleep rate is the highest, insomnia patients. The second was that the body factors were difficult to fall asleep again. The patients were less affected by the physical factors than the mental factors. The most important reason for the sleep in the.PCI group was to think about the family or work Trivia (42.50%) 48 cases of insomnia improvement in the patients with.80, 20 cases without improvement, 12 cases with less improvement, and the improvement of insomnia. The patients with insomnia were 4 (10%) and 7 patients (17.5%) with insomnia more serious after operation, 3 (7.5%) after operation and 3 (7.5%) after operation, and insomnia and 26 (65%).65% patients with insomnia after PCI, and no significant change of.6. sleep score after PCI: the severity of insomnia was evaluated with PSQI, each of the severity of insomnia, each The PSQI of the male patients was obviously less than the Pittsburgh score of the female. The difference of the degree of insomnia was evaluated with AIS in 80 patients. The difference of each group was not statistically significant. The degree of insomnia was evaluated by ISI, and the ISI score in all the patients was significantly higher than the degree of male.7. drowsiness and the degree of fatigue: ESS The degree of somnolence evaluation of.83.75% patients was within the normal range. The degree of fatigue in 80 patients was evaluated with FSS, 68 in 80 patients and 68 in the range of fatigue, not 12 in the range of fatigue: SAS for anxiety and depression, 60 of 80 patients in the normal range, 16 patients with mild anxiety and 4 patients. Moderate anxiety. No patients belonged to severe anxiety. SDS was used to evaluate the depression of the patients. 7 of the 80 patients were in the normal range, 12 were mild depression, 3 were moderately depressed, 1 of the patients with severe depression.83.75% were not in the degree of depression, and 16.25% of the patients were in the depressive state of.9. syndrome type distribution: P The distribution of TCM syndrome type of the two groups in group CI and coronary heart disease group has obvious difference. The patients with Qi deficiency and blood stasis syndrome after stenting are most, more than patients with coronary heart disease, Qi deficiency and blood stasis syndrome. The syndrome distribution of patients after stenting is most with Qi deficiency and blood stasis, Qi deficiency and blood stasis phlegm stasis, blood stasis and blood stasis of Yang Qi deficiency = Yin cold stagnation of qi stagnation, blood stasis and blood stasis and two deficiency heart Deficiency of kidney yin, the distribution of TCM syndrome type in patients with coronary heart disease was significantly different from that of group.PCI, the symptom score of the patients with coronary heart disease was lower than that of the coronary heart disease group. The symptom score of the male in the patients with coronary heart disease (whether or not for stent) was lower than that of the female symptom score. Conclusion: the correlation between the symptom distribution of the patients with insomnia after 1.PCI and the PCI operation was statistically supported by.PCI The distribution of the symptoms of insomnia after the operation was similar to that of the patients who had not been treated with PCI for coronary heart disease. There was a significant difference in the distribution of insomnia in patients with hypertension or arrhythmia. The patients were most difficult to fall asleep after.PCI operation, and then the insomnia of.2.65% patients who were difficult to fall asleep again after waking up had no obvious change after PCI operation. PCI operation led to or aggravated insomniacs 2 7.5%, the patients with insomnia relieved after PCI had only 7.5%.3. to evaluate the severity of insomnia with PSQI, AIS, ESS, and there was no significant difference between patients with same coronary heart disease after PCI, hypertension or arrhythmia, and there was significant difference in the distribution of TCM syndrome in patients with coronary heart disease and coronary heart disease after.4.PCI operation. The syndrome distribution of patients after stenting was Qi deficiency. The blood stasis is the most, Qi deficiency and blood stasis obstructing the heart, blood stasis and yang qi deficiency. = Yin cold stagnation of qi stagnation and blood stasis Qi Yin Qi Yin deficiency of two heart kidney yin deficiency, and the distribution of TCM syndrome type of the patients with coronary heart disease is obviously different.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.23

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