本文選題：乳腺癌術(shù)后　切入點：抑郁　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：本文主要分為文獻(xiàn)綜述與臨床研究兩個部分。第一部分是文獻(xiàn)綜述,分為兩篇綜述:綜述一分別闡述了中醫(yī)對乳腺癌和抑郁的認(rèn)識;綜述二闡述了現(xiàn)代醫(yī)學(xué)對乳腺癌術(shù)后抑郁的認(rèn)識及相關(guān)因素分析。第二部分是臨床研究,包括研究目的、方法、結(jié)果、討論等。研究目的本試驗的研究目的在于分析乳腺癌術(shù)后患者伴抑郁傾向的相關(guān)危險因素,對這些因素提前進(jìn)行干預(yù),從而改善患者的軀體癥狀及心理狀態(tài),提高其生活質(zhì)量,達(dá)到"治未病"的目的。同時,分析乳腺癌術(shù)后患者的中醫(yī)證候特點,為日后的臨床用藥及科研提供一定的參考依據(jù)。研究方法本研究納入于2016年5月至2017年1月在北京中醫(yī)藥大學(xué)東方醫(yī)院腫瘤科門診就診的同時符合納入與排除標(biāo)準(zhǔn)的乳腺癌術(shù)后患者145例,記錄入組患者的抑郁狀況、一般情況、臨床信息及中醫(yī)四診結(jié)果四個方面,運用SPSS 21.0統(tǒng)計軟件將所有數(shù)據(jù)信息進(jìn)行分析,探討乳腺癌術(shù)后患者出現(xiàn)抑郁傾向的相關(guān)危險因素及中醫(yī)證候特點。研究結(jié)果1、一般情況:研究結(jié)果顯示患者在工作狀態(tài)(x2=4.331,P=0.037)、家族史(x2=6.259,P=0.044)方面出現(xiàn)的抑郁傾向有差異�；颊叱霈F(xiàn)的抑郁傾向在年齡、婚姻狀況、文化程度方面無差異。根據(jù)Logistic回歸分析,僅認(rèn)為家族史(OR=0.221,P=0.026)與乳腺癌術(shù)后患者出現(xiàn)的抑郁傾向呈負(fù)相關(guān)關(guān)系,即無家族史的乳腺癌術(shù)后患者更容易出現(xiàn)抑郁傾向。2、臨床信息:研究結(jié)果顯示患者在遠(yuǎn)處轉(zhuǎn)移方面(x2=8.665,P=0.009)出現(xiàn)的抑郁傾向有差異,并根據(jù)Logistic回歸分析,認(rèn)為遠(yuǎn)處轉(zhuǎn)移(OR=5.099,P=0.005)與乳腺癌術(shù)后患者出現(xiàn)的抑郁傾向呈正相關(guān)關(guān)系,即有遠(yuǎn)處轉(zhuǎn)移的乳腺癌術(shù)后患者更容易出現(xiàn)抑郁傾向。但患者的治療方式不同,出現(xiàn)的抑郁傾向無明顯差異。3、乳腺癌術(shù)后伴抑郁傾向患者的中醫(yī)證候分布特點為:陽虛證39例(67.2%)、氣虛證33例(56.9%)、氣滯證16例(27.6%)、痰濕證16例(27.6%)、血瘀證19例(32.8%)、陰虛證9例(15.5%)、血虛證2例(3.4%)、痰熱證1例(1.7%),無熱毒證患者。無抑郁傾向患者的中醫(yī)證候特點:痰濕證29例(44.6%)、陽虛證28例(43.1%)、氣虛證 24 例(36.9%)、血瘀證 20 例(30.8%)、陰虛證 12 例(18.5%)、氣滯證12例(18.5%)、痰熱證3例(4.6%)、血虛證1例(1.5%),無熱毒證患者。4、乳腺癌術(shù)后患者出現(xiàn)的抑郁傾向在陽虛證(x2=7.519,P=0.0.023)和氣虛證(x2=9.260,P=0.0.01)兩個證型方面有差異。研究結(jié)論1、本研究顯示乳腺癌術(shù)后患者出現(xiàn)抑郁傾向的發(fā)生率為46.9%。由此可見,乳腺癌術(shù)后患者出現(xiàn)抑郁傾向的比例較高,抑郁癥對患者的危害較大,應(yīng)提前對伴抑郁傾向患者進(jìn)行心理甚或藥物干預(yù),減少抑郁癥的發(fā)生。2、根據(jù)本研究結(jié)果,認(rèn)為無工作患者、無家族史患者、有遠(yuǎn)處轉(zhuǎn)移患者更容易出現(xiàn)抑郁傾向。因此,我們應(yīng)多開展乳腺癌的宣講活動,增強(qiáng)患者對乳腺癌診治的認(rèn)知,減輕患者對乳腺癌的恐懼,對有遠(yuǎn)處轉(zhuǎn)移的患者多加以關(guān)懷及心理疏導(dǎo),盡量減輕患者的心理負(fù)擔(dān),同時,應(yīng)建議能工作的患者在病情穩(wěn)定后盡量外出工作,對于退休患者,則可多參加社區(qū)活動,加強(qiáng)對自我價值的肯定,增加抵抗病魔的信心。3、乳腺癌術(shù)后伴抑郁傾向患者的中醫(yī)證候中以陽虛、氣虛證為主,氣滯、痰濕、血瘀證次之。同時,本研究認(rèn)為乳腺癌術(shù)后陽虛、氣虛證患者相對更容易出現(xiàn)抑郁傾向,不能片面認(rèn)為乳腺癌術(shù)后抑郁患者多為氣滯證,為以后的臨床用藥及科研提供一定的參考。
[Abstract]:This paper is divided into two parts: literature review and clinical research. The first part is the literature review, divided into two review: a review illustrates the understanding of breast cancer and depression of TCM; review two describes the modern medical understanding of depression after breast cancer surgery and related factors analysis. The second part is clinical study, including the research purpose, methods, results, discussion and research purposes. The purpose of this study is to analyze the risk of postoperative breast cancer patients with depression factors, these factors for early intervention to improve the somatic symptoms and psychological status of patients, improve the quality of life, to achieve the purpose of "zhiweibing" at the same time, analysis of the characteristics of TCM syndrome in patients after breast cancer surgery, for the day after the clinical treatment and scientific research to provide some reference. Research methods included in this study from May 2016 to January 2017 in Beijing traditional Chinese Medicine At the same time the Oriental medicine university hospital outpatient clinic 145 patients met the inclusion and exclusion criteria of postoperative breast cancer, depression, record into the group of patients with general condition, clinical information and TCM diagnosis results of four aspects, using SPSS 21 statistical software to analyze all data information, the related risk factors of breast cancer postoperative depression and TCM syndrome characteristics. Results 1 general condition: the results showed that patients in the working state (x2=4.331, P=0.037), family history (x2=6.259, P=0.044) the emergence of depressive tendency differences. Marital status in patients with depression tendency, no differences in age, culture degree. According to Logistic regression analysis, only think of family history (OR=0.221, P=0.026) is negatively correlated with the appearance of postoperative breast cancer patients without depression symptoms, family history of breast cancer patients 瀹規(guī)槗鍑虹幇鎶戦儊鍊懼悜.2,涓村簥淇℃伅:鐮旂┒緇撴灉鏄劇ず鎮(zhèn)ｈ，

本文編號：1622452