248例男性缺血性脑卒中患者勃起功能及性生活状况的流行病学研究

发布时间：2018-05-11 00:33

本文选题：勃起功能障碍 + 缺血性脑卒中　；参考：《北京中医药大学》2017年硕士论文

【摘要】：随着人民生活水平的不断提高,人们对健康的关注度也与日俱增。对男性而言正常的性功能是男性健康的重要组成部分,也是维系满意性生活的必要条件。然而,勃起功能障碍(ErectiledysfunctionED)的发病率有逐年增加的趋势。ED的病因较多,但总体可以归为心理型和器质型两大类,并且来越多的研究表明器质型ED的比例逐渐升高。近年来,脑卒中已经成为影响人类健康的主要原因,在我国因脑卒中死亡的人数占第二位,仅次于肿瘤,并具有高发病率、高致死率和高致残率的特点。其中,缺血性脑卒中(Ischemic stroke IS)是最常见类型,占全部脑卒中的60%～80%。一些国外研究发现,IS除引起患者肢体运动、心理及认知障碍外,对患者的性功能也有重要影响,尤其表现在勃起功能、性生活频率、性欲、性兴奋度等方面。然而,当前关于我国男性IS患者勃起功能状况及性生活质量的临床研究报道较少,本研究将运用流行病学方法调查IS患者发病前后的勃起功能状况及性生活质量,进一步探讨两者的相关性,从而拓展勃起功能障碍的诊疗的思路。目的:了解男性缺血性脑卒中(IS)患者发病前后的勃起功能和性生活质量的变化及其可能的原因,探讨勃起功能障碍(ED)与IS之间的临床相关性,为提高恢复期患者性生活质量提供指导依据。方法:自2016年1月至2016年12月,采用连续抽样方法选择在北京中医药大学东直门医院脑病科就诊的缺血性卒中患者248例为研究对象(年龄≤65岁),采用自制量表,以面对面问卷形式进行调查。调查内容包括四个部分:第一部分为IS患者的一般情况,包括人口学资料、IS发病特点、既往史、用药史、个人史等;第二部分为IS患者发病前后勃起功能状况及性生活质量,包括IIEF-5评分、性欲、性交频率、射精情况、晨勃情况等;第三部分为IS患者中医证候、证素分布情况;第四部分为IS患者发病后情绪状态,辅助评价患者病情变化及勃起功能状况。调查开始前,获取相关科室及患者的知情同意,向调查对象承诺本调查不记名,所采集的信息严格保存,不公开、不泄露;将新发病(病程≤6个月)且尚未恢复性生活的患者,作为电话随访对象,在病程超过6个月后,通过电话随访,了解患者相关情况,完善调查资料,后期拒绝随访或电话有误者视为失访,予以剔除。资料收集截止在2016年12月。试验为自身前后对照,对所收集的数据,采用Excel软件录入,采用SPSS21.0作为统计学软件对本研究所有数据进行分析处理。结果:符合本研究要求的调查对象共272例,2例患者在随访过程中意外死亡、7例患者借故不愿意回答有关性生活方面的问题、10例患者因电话号码改变无法进行随访、5例患者中途改变决定,停止填写问卷,最终有248例完成本次调查,总回应率为91.18%。调查对象平均年龄为55.65±6.32岁,平均体重指数(BMI)为26.12±2.64。其中,诊断为脑血栓形成患者192例,脑栓塞患者8例,腔隙性脑梗死患者48例,临床NIHSS平均分为4.68±2.38分。45.56%的患者在发病前6个月伴有ED的情况,77.73%的患者发病后6个月伴有ED,差异有统计学意义(P0.01)。发病前伴有ED的98例患者中(已剔除病后无性生活者),IIEF-5 评分从 16.24 分(IQR:14.75-18)下降到 9.5 分(IQR:6.75-12);病后性欲普遍偏低;性交频率从发病前的3次(中位数,IQR:2-4)降低到发病后的1.25次(中位数,IQR:0.5-2),其差异具有统计学意义(P0.01);发病后射精潜伏期、射精快感、性生活整体满意度方面均有下降,结果有统计学差异(P0.01)。脑干区梗死患者ED的患病率为33/40(82.50%),基底节区为96/116(82.76%),侧脑室旁为 124/148(77.03%),顶叶为 79/103(76.70%),枕叶为 25/33(75.76%),颞叶为 20/27(74.07%),丘脑为 44/60(73.33%),额叶为 102/142(71.83%),小脑为 7/10(70%)。卒中病后患者整体抑郁患病率为168/248(67.74%),焦虑总患病率为162/248(65.32%),抑郁焦虑共患率为124/248(50.00%);病后未恢复性生活患者和伴有ED者PHQ-9平均分高于不伴有ED的患者,差异有统计学意义(P0.05);病后伴有ED的患者抑郁的患病率明显高于其他两种情况,差异有统计学意义(P0.01),病后伴有ED的患者抑郁焦虑共患率高于不伴有ED的患者,差异有统计学意义(P0.01)。IS患者中肝阳上亢证14/16(87.50%)、气虚血瘀证32/37(86.49%)、气血两虚证5/6(83.33%)、痰湿内蕴证10/12(83.33%)出现ED的频率最多。证素拆分统计为,病位证素中肝部位ED发病率最高(87.50%),病性证素气虚(88.37%)、血虚(83.33%)、湿(83.33%)导致的ED病发病率较高。结论:与中风前相比,IS男性患者的ED患病率及严重程度明显增高,患者在性欲、性生活频率、射精潜伏期、性高潮快感、性生活满意度等方面均有明显下降。其可能的原因是与调控勃起及其他性功能的中枢区域梗死有关,而中风后所产生的心理障碍(尤其是抑郁障碍)和广泛使用具有影响勃起功能的药物也是导致ED发生发展的重要因素。其他如年龄、体重指数、相关基础病数量可能是诱发ED的高危因素,但必须在更大样本的前瞻性研究中进一步证实。中风患者以痰瘀阻络、气虚血瘀和风痰阻络为多见证候,但并未见到肾虚类证候,其中痰瘀阻络和气虚血瘀是中风合并阳痿的主要证型;以治疗中风为目标的患者其勃起功能也有较为明显的改善,提示治疗中风的用药思路同样适用于治疗阳痿。
[Abstract]:With the improvement of the people's living standard, people's attention to health is also increasing. The normal sexual function for men is an important part of male health and a necessary condition for maintaining a satisfactory life. However, the incidence of erectile dysfunction (ErectiledysfunctionED) has an increasing trend of.ED in the cause of the incidence of erectile dysfunction (the incidence of erectile dysfunction). But in general, it can be classified as two major categories of psychological and organic type, and the more research shows that the proportion of organic ED is increasing. In recent years, cerebral apoplexy has become the main cause of human health. In our country, the number of deaths from stroke is second, second only to the tumor, and has high incidence, high mortality and high disability rate. Among them, ischemic stroke (Ischemic stroke IS) is the most common type, which accounts for 60% to 80%. of all cerebral apoplexy, and some foreign studies have found that IS has an important influence on the sexual function of the patient, especially in the aspects of erectile function, sexual frequency, sexual desire and sexual excitability. However, there are few clinical reports on the erectile function and the quality of life of the male IS patients in China. This study will use epidemiological methods to investigate the erectile function and the quality of life of the patients with IS before and after the onset of the disease, and further explore the correlation between the two, so as to expand the diagnosis and treatment of erectile dysfunction. The changes of erectile function and sexual quality of life before and after the onset of male ischemic stroke (IS) and its possible causes are discussed, and the clinical relevance between erectile dysfunction (ED) and IS is discussed, and the guidance for improving the quality of sexual life in the recovery period is provided. Methods: from January 2016 to December 2016, the continuous sampling method was selected in the north. 248 cases of ischemic stroke in the Department of encephalopathy in Dongzhimen Hospital of Beijing University of traditional Chinese medicine were studied (age less than 65 years old). A self-made questionnaire was used to investigate the form of face-to-face questionnaire. The content of the investigation included four parts: the first part was the general situation of IS patients, including demographic data, IS disease characteristics, past history, history of medication, individual The second part was the erectile function and the quality of life before and after the onset of IS, including IIEF-5 score, sexual desire, sexual frequency, ejaculation, morning and Bo situation, and the third part was the TCM syndrome of IS patients and the distribution of syndrome elements; the fourth part was the mood state after the onset of IS, and assistant evaluation of the patient's condition change and erectile function. Before the start of the investigation, the informed consent of the related departments and patients was obtained, and the survey was unregistered. The information collected was strictly preserved, not open and not disclosed; the patients with new disease (course of illness less than 6 months) had not been restored to sexual life, and were followed up for more than 6 months after the course of the disease, and the patients were followed up by telephone to understand the patient's phase. After closing the situation, perfecting the investigation data, the later refusal of follow-up or the telephone error is considered to be lost and eliminated. The data collection is in December 2016. The test is the control of itself, the data collected, the Excel software is recorded, and SPSS21.0 is used as the statistical software to analyze all the data of the research. The required subjects were 272 cases, 2 patients died in the follow-up process, 7 cases were not willing to answer questions about sexual life, 10 patients were unable to follow up due to telephone number change, 5 patients changed the decision, stopped filling out the questionnaire, and finally completed the survey, the total response rate was 91.18%. survey. The average age was 55.65 + 6.32 years, and the average body mass index (BMI) was 26.12 + 2.64.. The diagnosis was 192 patients with cerebral thrombosis, 8 cases of cerebral embolism, 48 cases of lacunar infarction, and 4.68 + 2.38.45.56% in clinical NIHSS, with ED in 6 months before the onset of the disease, and 77.73% patients with ED after the onset of the disease. The difference was poor. The difference was statistically significant (P0.01). In 98 patients with ED before the onset of the disease, the IIEF-5 score decreased from 16.24 (IQR:14.75-18) to 9.5 (IQR:6.75-12), and the sexual desire was generally low after the disease; the frequency of sexual intercourse decreased from 3 times before the onset (median, IQR:2-4) to 1.25 times after the onset (median, IQR:0.5-2), and the difference between them (median, IQR:0.5-2). The difference was statistically significant (P0.01); there was a decrease in ejaculatory latency, ejaculatory sensation, and overall sexual satisfaction (P0.01). The prevalence of ED in patients with brain stem infarction was 33/40 (82.50%), 96/116 (82.76%) in the basal ganglia, 124/148 (77.03%) beside the lateral ventricle, 79/103 (76.70%) in the parietal lobe, and 25/33 in the occipital lobe. (75.76%) the temporal lobe was 20/27 (74.07%), the thalamus was 44/60 (73.33%), the frontal lobe was 102/142 (71.83%), and the cerebellum was 7/10 (70%). The overall depression rate of the patients after the stroke was 168/248 (67.74%), the total anxiety prevalence rate was 162/248 (65.32%), the depression and anxiety codevelopment rate was 124/248 (50%), and the average height of PHQ-9 in the patients who were not restored to sex after the disease and the PHQ-9 average height of those with ED after the disease. The difference was statistically significant (P0.05) in patients without ED, and the incidence of depression in patients with ED was significantly higher than those of the other two cases, and the difference was statistically significant (P0.01). The incidence of depression and anxiety in patients with ED was higher than those without ED, and the difference was statistically significant (P0.01) in.IS patients with hyperactivity of liver Yang (87.5) 0%) Qi deficiency and blood stasis syndrome 32/37 (86.49%), Qi and blood two deficiency syndrome 5/6 (83.33%), phlegm dampness syndrome 10/12 (83.33%) of the most frequent occurrence of ED. The incidence of ED in the liver site is the highest (87.50%), disease syndrome factor Qi deficiency (88.37%), blood deficiency (83.33%), and wet (83.33%) caused by the higher incidence of ED disease. Conclusion: compared with before stroke, IS male The prevalence and severity of ED in sex patients were significantly higher, and the patients had a significant decrease in sexual desire, sexual frequency, ejaculation latency, orgasm pleasure, sexual satisfaction, and so on. The possible reason is that it is related to central regional infarction that regulates erection and other sexual functions, and the psychological disorder (especially depression) after stroke. And extensive use of drugs that affect erectile function is also an important factor in the development of ED. Other factors such as age, body mass index and the number of related basic diseases may be the high risk factors for inducing ED, but it must be further confirmed in a prospective study of larger samples. The syndrome of kidney deficiency was not seen, among which phlegm and stasis and Qi deficiency and blood stasis are the main syndromes of Apoplexy with impotence, and the erectile function of the patients with the target of treating stroke is also obviously improved, suggesting that the thought of treating apoplexy is also applicable to impotence.

【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】：R277.7;R277.5

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