本文選題：睡眠障礙 + 維持性血液透析　； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:評估廣安門醫(yī)院維持性血液透析(maintenance hemodialysis,MHD)患者的睡眠質(zhì)量、癥狀困擾情況及MHD伴睡眠障礙患者的中醫(yī)證候分布特點,分析影響維持性血液透析患者睡眠的相關(guān)因素、睡眠障礙與中醫(yī)證候、癥狀困擾的相關(guān)性,為維持性血液透析睡眠障礙方面的臨床及中醫(yī)證候方面的研究提供一定的依據(jù)。方法:運用橫斷面流行病學(xué)調(diào)查方法對MHD患者進(jìn)行一般情況、匹茲堡睡眠質(zhì)量指數(shù)量表(Pittsburgh sleep quality index,PSQI)、透析患者癥狀困擾量表及中醫(yī)證候辨證量表調(diào)查得出患者PSQI評分、癥狀困擾情況和中醫(yī)證候,收集患者臨床生化指標(biāo),應(yīng)用SPSS20.0統(tǒng)計分析MHD患者睡眠質(zhì)量與中醫(yī)證候、癥狀困擾的相關(guān)性。結(jié)果:廣安門醫(yī)院201例維持性血液透析患者PSQI評分總分范圍為:0～21分,平均值:9.23±4.88分,睡眠障礙發(fā)生率為47.26%。PSQI評分的總分及各因子得分顯著高于國內(nèi)常模,有統(tǒng)計學(xué)差異(P0.01)。MHD患者中醫(yī)證候本虛證的分布情況依次為:氣陰兩虛證(77例,占38.3%)、脾腎陽虛證(55例,占27.4%)、脾腎氣虛證(37例,占18.4%)、肝腎陰虛證(23例,占11.4%)、陰陽兩虛證(9例,占4.5%)。標(biāo)實證的分布情況依次為:濕濁證(74例,占36.8%)、濕熱證(69例,占34.3%)、血瘀證(33例,占16.4%)、風(fēng)動證(19例,占9.5%)、水氣證(6例,占3.0%);且本虛證、標(biāo)實證中各證候PSQI評分之間具有統(tǒng)計學(xué)差異(P0.05)。MHD患者睡眠障礙影響因素分析,在年齡、年齡分層、職業(yè)狀態(tài)、透析齡、是否發(fā)用安眠藥方面有統(tǒng)計學(xué)差異(P0.05),在性別、文化程度、婚姻狀況、家庭收入、透析頻率、醫(yī)療付費方式、原發(fā)病方面無統(tǒng)計學(xué)意義(P0.05)。多因素分析,在年齡有統(tǒng)計學(xué)差異(P0.05)。生化指標(biāo)在鈣磷乘積、血清鐵蛋白、血紅蛋白指標(biāo)上有統(tǒng)計學(xué)意義(P0.05),在鈣、磷、堿性磷酸酶、血清鐵、總鐵結(jié)合力,轉(zhuǎn)鐵蛋白、總蛋白、白蛋白、C反應(yīng)蛋白、甘油三酯、總膽固醇、尿酸、血肌酐、甲狀旁腺激素指標(biāo)上無統(tǒng)計學(xué)意義(P0.05)。中醫(yī)證候分布:伴與不伴睡眠障礙患者本虛證分布具有統(tǒng)計學(xué)意義(P0.05);標(biāo)實證分布具有統(tǒng)計學(xué)意義(P0.05)。伴睡眠障礙患者中醫(yī)證候:本虛證各證候之間PSQI評分具有統(tǒng)計學(xué)差異(P0.05);標(biāo)實證各證候的PSQI評分無統(tǒng)計學(xué)差異(P0.05)。在維持性血液透析癥狀困擾的調(diào)查中,30種癥狀發(fā)生率為9.95%～82.59%,癥狀平均發(fā)生數(shù)為11,其中發(fā)生率最高的五種癥狀分別為皮膚干燥(82.59%),乏力(66.67%),瘙癢(66.67%),口干(64.18%),易醒(61.69%),且這五個癥狀的困擾程度得分、癥狀發(fā)生頻率得分、嚴(yán)重程度得分也最高。MHD患者的PSQI各因子和總分與癥狀困擾中癥狀有無、癥狀嚴(yán)重程度、癥狀出現(xiàn)頻率、癥狀困擾程度相關(guān)性均有統(tǒng)計學(xué)差異(P005)。MHD伴睡眠障礙患者30種癥狀發(fā)生率在15%～87.37%之間,癥狀發(fā)生的平均數(shù)為14種,其皮膚干燥、入睡困難、乏力、易醒、口干癥狀有無得分、癥狀的困擾程度得分、癥狀出現(xiàn)頻率得分、癥狀嚴(yán)重程度得分均最高。兩組患者的癥狀發(fā)生率進(jìn)行比較,伴睡眠障礙患者癥狀發(fā)生的平均數(shù)為14種,不伴睡眠障礙患者癥狀發(fā)生的平均數(shù)為9種。30個癥狀有24種癥狀兩組間發(fā)生率比較有統(tǒng)計學(xué)意義(P0.05)。入睡困難、易醒、乏力、便秘、食欲減退、口干、不安腿、肌肉酸痛、頭暈、咳嗽、胸痛、感到焦慮、感到悲傷這13種癥狀上具有顯著的差異性(P0.01)。結(jié)論:1.睡眠障礙普遍存在于廣安門醫(yī)院MHD患者中,發(fā)生率高,影響患者的生活質(zhì)量,醫(yī)護(hù)人員應(yīng)多予以關(guān)注。2.MHD患者睡眠障礙的發(fā)生受多種因素的共同影響,其中年齡是睡眠障礙發(fā)生的危險因素,鈣磷乘積、血清鐵蛋白、血紅蛋白是影響睡眠質(zhì)量相關(guān)因素。臨床中應(yīng)對高齡患者更加關(guān)注,且加強鈣磷乘積、血清鐵蛋白、血紅蛋白臨床的監(jiān)測,采取適當(dāng)?shù)母深A(yù)措施,有助于改善患者的睡眠質(zhì)量。3.本研究中MHD患者本虛證氣陰兩虛證患者易發(fā)生睡眠障礙,標(biāo)實證濕熱證、水氣證患者易發(fā)生睡眠障礙。在MHD伴睡眠障礙的患者中陰陽兩虛證患者的睡眠障礙嚴(yán)重程度更重。4.MHD患者癥狀發(fā)生種類越多、癥狀困擾程度越重、癥狀出現(xiàn)的頻率越高、癥狀越嚴(yán)重,睡眠質(zhì)量越差。MHD伴睡眠障礙患者受癥狀困擾種類繁多,與不伴睡眠障礙患者癥狀有差異性。臨床中醫(yī)護(hù)人員應(yīng)該注重患者的整體癥狀的發(fā)生情況和癥狀發(fā)生的差異性,采取有效適當(dāng)?shù)母深A(yù)措施來改善患者的睡眠障礙。
[Abstract]:Objective: To evaluate the quality of sleep, symptoms and the characteristics of TCM Syndrome Distribution in patients with maintenance hemodialysis (MHD) in Guanganmen hospital, and to analyze the related factors affecting the sleep in the patients with maintenance hemodialysis, the correlation of sleep disorders and TCM syndromes and symptoms, so as to maintain the relationship between the symptoms and the symptoms. The clinical and TCM Syndromes of sexual hemodialysis sleep disorders provide a certain basis. Methods: the general situation of MHD patients, the Pittsburgh sleep quality index (Pittsburgh sleep quality index, PSQI), the symptom distress scale of the dialysis patients and the syndrome differentiation scale of TCM syndrome are carried out by the cross-sectional epidemiological survey method. The PSQI score, symptoms and TCM syndromes were investigated, and the clinical biochemical indexes were collected, and the correlation between the sleep quality of MHD patients and TCM syndrome and the symptoms was analyzed by SPSS20.0. Results: the total score of PSQI scores in 201 cases of maintenance hemodialysis patients in Guanganmen hospital was 0~21 points, the average value was 9.23 + 4.88 points, The total score of 47.26%.PSQI score and the scores of all factors were significantly higher than those of the domestic norm. The distribution of deficiency syndrome of TCM syndrome in.MHD patients (P0.01) was in turn: Qi Yin two deficiency syndrome (77 cases, 38.3%), spleen kidney yang deficiency syndrome (55 cases, 27.4%), spleen kidney qi deficiency syndrome (37 cases, 18.4%), liver kidney kidney yin deficiency syndrome (23 cases, 11.4). (%), yin and yang two deficiency syndrome (9 cases, accounting for 4.5%). The distribution of the standard evidence was in turn: wet turbid syndrome (74 cases, 36.8%), damp heat syndrome (69 cases, 34.3%), blood stasis syndrome (33 cases, 16.4%), pneumatic syndrome (19 cases, 9.5%), water and gas syndrome (6, 3%); and this deficiency syndrome, the PSQI score of each syndrome in the standard demonstration (P0.05).MHD patients sleep disorder shadow There were statistically significant differences (P0.05) in age, age stratification, career status, dialysis age, and the use of sleeping pills (P0.05). There was no statistically significant difference in gender, educational level, marital status, family income, dialysis frequency, medical pay, and primary disease (P0.05). Multivariate analysis (P0.05). The index of calcium, phosphorus, serum ferritin and hemoglobin was statistically significant (P0.05). There was no statistical significance in calcium, phosphorus, alkaline phosphatase, serum iron, total iron binding force, transferrin, total protein, albumin, C reactive protein, triglyceride, total cholesterol, uric acid, blood creatinine and parathyroid hormone (P0.05). The distribution of deficiency syndrome of the patients with and without sleep disorders was statistically significant (P0.05); the standard positive distribution was statistically significant (P0.05). The TCM syndromes with sleep disorders were statistically significant (P0.05), and there was no statistical difference (P0.05) in the PSQI score of the syndrome syndrome (P0.05). In the maintenance hemodialysis syndrome, the symptoms of the syndrome were not statistically different (P0.05). In the survey, the incidence of 30 symptoms was 9.95% to 82.59%, and the average number of symptoms was 11. The highest five symptoms were dry skin (82.59%), fatigue (66.67%), itching (66.67%), dry mouth (64.18%), and easy to wake (61.69%), and the scores of the symptoms, the frequency of symptoms, and the severity of the symptoms were also scored, and the severity scores were also scored. The PSQI factors and total score of the highest.MHD patients and symptoms plagued by symptoms, symptom severity, symptom frequency, and the correlation of symptoms were statistically different (P005) the incidence of 30 symptoms in.MHD with sleep disorders was between 15% and 87.37%, the average of the symptoms was 14, the skin was dry, the sleep was difficult, and the fatigue was weak. The symptoms of the two groups were compared, the average of the symptoms of the patients with sleep disorders was 14, the average of the symptoms of the patients without sleep disorders was 9.30 symptoms and 24 symptoms. The incidence of the two groups was statistically significant (P0.05). There were significant differences in the 13 symptoms (P0.01). Conclusion: 1. sleep disorders are commonly found in MHD patients in Guanganmen hospital. Health care workers should pay more attention to the quality of life in patients with.2.MHD patients, which are the risk factors for sleep disorders, of which age is a risk factor for sleep disorders. Calcium and phosphorus products, serum ferritin, hemoglobin are related factors affecting the quality of sleep. Phosphorus product, serum ferritin, hemoglobin clinical monitoring and appropriate intervention measures are helpful to improve the quality of sleep in patients with.3.. In this study, the patients with deficiency syndrome of Qi Yin and Qi Yin are prone to sleep disorder in this study of the deficiency syndrome of Qi Yin and two of MHD patients, marked by positive damp heat syndrome, and the patients with syndrome of water and gas are prone to sleep disorders. The deficiency of yin and Yang in the patients with MHD with sleep disorders is two deficiency syndrome. The severity of the patient's sleep disorder is more serious, the more types of.4.MHD patients are, the more serious the symptoms are, the higher the frequency of the symptoms, the more serious the symptoms, the worse the quality of sleep in the patients with.MHD and sleep disorders, and the difference between the symptoms and the symptoms of the patients without sleep disorder. The incidence of symptoms and the difference of symptoms were observed. Effective and appropriate intervention measures were taken to improve sleep disorders.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5

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