本文選題：心力衰竭 + 情緒��； 參考：《北京協(xié)和醫(yī)學院》2017年碩士論文

【摘要】：背景:心力衰竭患者消化系統(tǒng)癥狀發(fā)生率較高,癥狀及癥狀掩蓋下的各種病理生理改變對機體造成了諸多不利影響。消化系統(tǒng)癥狀除受心功能影響外,還受抑郁、焦慮等情緒狀況的影響。對于心力衰竭患者,情緒對其消化系統(tǒng)癥狀的影響程度及機制如何,尚需深入研究。目的:(1)描述心力衰竭患者消化系統(tǒng)癥狀的發(fā)生情況及嚴重程度;(2)探討情緒對NYHA分級Ⅱ、Ⅲ和Ⅳ級心力衰竭患者消化系統(tǒng)癥狀的影響程度;(3)探討情緒對心力衰竭患者消化系統(tǒng)癥狀產(chǎn)生影響的機制。方法:采用便利抽樣法,選取2016年3月至2017年2月在北京市某三甲心血管病�？漆t(yī)院心力衰竭監(jiān)護病房住院的210例心力衰竭患者,用胃腸道癥狀分級評分量表(Gastrointestinal Symptom Rating Scale,GSRS)和簡式簡明心境量表(Profile of Mood States Short Form,POMS-SF)收集資料,同時測量研究對象24h竇性心搏R-R間期標準差、血清皮質(zhì)醇濃度和去甲腎上腺素濃度等。結(jié)果:(1)研究對象中發(fā)生率較高的消化系統(tǒng)癥狀為腹脹(60.48%)、排氣增多(44.76%)、惡心和嘔吐(44.29%)。消化系統(tǒng)癥狀嚴重程度評分1分、2分和3分(1=癥狀偶爾發(fā)生;2=癥狀持續(xù)時間延長,部分影響日�；顒�;3=癥狀持續(xù)存在,影響所有日常活動)研究對象所占比例:腹脹為46.19%、12.86%和31.43%;惡心和嘔吐為38.57%、5.71%和0.48%,排氣增多為37.71%、8.57%和0.00%。NYHA分級Ⅱ、Ⅲ和Ⅳ級研究對象:消化系統(tǒng)癥狀發(fā)生率分別為85.25%、96.39%和96.97%,存在統(tǒng)計學差異(P=0.011);消化系統(tǒng)癥狀嚴重程度評分M(Q1,Q3)分別為3(1,5)、5(4,8)和5(4,6),存在統(tǒng)計學差異(P0.01)。(2)以NYHA分級為控制變量進行回歸分析,發(fā)現(xiàn)情緒、NYHA分級及二者的交互作用對消化系統(tǒng)癥狀嚴重程度均存在影響(P0.01),標化回歸系數(shù)分別為1.234、0.390和-0.500;分層回歸分析結(jié)果顯示,情緒對NYHA分級Ⅱ、Ⅲ和Ⅳ級研究對象消化系統(tǒng)癥狀嚴重程度均存在影響(P0.01),標化回歸系數(shù)分別為0.890、0.819和0.939。(3)運用AMOS20.0進行路徑分析發(fā)現(xiàn):情緒對消化系統(tǒng)癥狀嚴重程度產(chǎn)生直接影響的效應系數(shù)為0.578,情緒通過24小時竇性心搏R-R間期標準差變化、血清皮質(zhì)醇濃度變化對消化系統(tǒng)癥狀嚴重程度產(chǎn)生影響的間接效應系數(shù)分別為0.039和0.060;NYHA分級對消化系統(tǒng)癥狀嚴重程度產(chǎn)生直接影響的效應系數(shù)不顯著(P0.05),NYHA分級通過24小時竇性心搏R-R間期標準差變化對消化系統(tǒng)癥狀嚴重程度產(chǎn)生影響的間接效應系數(shù)為0.023,NYHA分級通過情緒變化對消化系統(tǒng)癥狀嚴重程度產(chǎn)生影響的間接效應系數(shù)總和為0.133。情緒和NYHA分級通過血清去甲腎上腺素濃度變化對消化系統(tǒng)癥狀嚴重程度產(chǎn)生影響的效應系數(shù)不顯著(P0.05)。結(jié)論:情緒對NYHA分級IV級患者消化系統(tǒng)癥狀嚴重程度影響最大,其次為NYHA分級Ⅱ級和Ⅲ級患者。情緒可通過自主神經(jīng)系統(tǒng)、下丘腦-垂體-腎上腺皮質(zhì)軸的中介作用對心力衰竭患者消化系統(tǒng)癥狀嚴重程度產(chǎn)生影響。情緒對消化系統(tǒng)癥狀嚴重程度的影響程度強于心功能。研究結(jié)果有利于醫(yī)務工作者全面認識情緒和心功能對心力衰竭患者消化系統(tǒng)癥狀產(chǎn)生影響的程度及機制,對更好地控制心力衰竭患者消化系統(tǒng)癥狀有一定的指導。
[Abstract]:Background: the incidence of digestive system symptoms in patients with heart failure is high, and the various pathophysiological changes under the symptoms and symptoms are affected. The digestive system symptoms are influenced by the emotional state of depression and anxiety in addition to the influence of heart function. The influence of emotion on the digestive system symptoms of patients with heart failure. The extent and mechanism still need to be studied in depth. Objective: (1) to describe the occurrence and severity of digestive system symptoms in patients with heart failure; (2) to explore the influence of emotion on the digestive system symptoms in patients with NYHA grade II, III and IV heart failure; (3) to explore the mechanism of the influence of emotion on digestive system symptoms in patients with heart failure. Methods: 210 patients with heart failure hospitalized in the heart failure intensive care unit of a three a cardiovascular disease hospital in Beijing from March 2016 to February 2017 were selected by the convenient sampling method. The Gastrointestinal Symptom Rating Scale (GSRS) and the simple concise mood scale (Profile of Mood States Short Fo) were used. RM, POMS-SF) collected data and measured the standard deviation of R-R interval of 24h sinus heart, serum cortisol concentration and norepinephrine concentration. Results: (1) the high incidence of digestive system symptoms in the study subjects were abdominal distention (60.48%), exhaust increased (44.76%), nausea and vomiting (44.29%). The severity of digestive system symptoms was 1, 2 and 3 points (1= symptoms occasionally; duration of 2= symptoms prolonged, partial impact on daily activity; 3= symptoms persisting, affecting all daily activities) the proportion of subjects: abdominal distention to 46.19%, 12.86% and 31.43%; nausea and vomiting 38.57%, 5.71% and 0.48%, 8.57% and 0.00%.NYHA grade II, III and IV class II, III and IV studies Image: the incidence of digestive system symptoms was 85.25%, 96.39% and 96.97%, respectively (P=0.011); M (Q1, Q3) of digestive system symptom severity score was 3 (1,5), 5 (4,8) and 5 (4,6), and there was statistical difference (P0.01). (2) regression analysis was carried out with NYHA grade as control variable, and the interaction of emotion, NYHA classification and two were found. The severity of digestive system symptoms were all affected (P0.01), and the normalized regression coefficients were 1.234,0.390 and -0.500 respectively. The results of stratified regression analysis showed that there was an influence on the severity of digestive system symptoms of NYHA classification II, III and IV (P0.01), and the normalized regression coefficients were 0.890,0.819 and 0.939. (3) using AMOS20.0. It was found that the effect coefficient of emotion directly affected the severity of digestive system symptoms was 0.578. The indirect effect coefficient of serum cortisol concentration on the severity of digestive system symptoms was 0.039 and 0.060, respectively, with the change of the standard deviation of the R-R interval of 24 hours sinus heart, and the NYHA grading to the digestive system. The direct effect coefficient was not significant (P0.05), and the indirect effect coefficient of the NYHA classification through the 24 hour sinus R-R interval standard deviation on the severity of digestive system symptoms was 0.023. The indirect effect of NYHA classification through emotional changes on the severity of digestive system symptoms The effect coefficient of 0.133. emotion and NYHA classification through serum norepinephrine concentration changes has no significant effect on the severity of digestive system symptoms (P0.05). Conclusion: emotion has the greatest impact on the severity of digestive system symptoms in NYHA grade IV patients, followed by NYHA grade II and grade III patients. Emotion can be controlled by autonomy. The intermediary role of the nervous system, the hypothalamus pituitary adrenocortical axis has an influence on the severity of the digestive system symptoms in patients with heart failure. The influence of emotion on the severity of digestive system symptoms is stronger than that of the heart function. The results are beneficial to the medical workers to fully understand the digestive system of patients with heart failure. The degree and mechanism of the influence on the digestive system can help to better control the digestive system symptoms of patients with heart failure.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473.5

【參考文獻】

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本文編號：1915451