本文選題：慢性阻塞性肺疾病 + 焦慮　； 參考：《廣州中醫(yī)藥大學(xué)》2012年碩士論文

【摘要】：目的： 闡述慢性阻塞性肺病(COPD)穩(wěn)定期患者焦慮抑郁狀態(tài)與病情的相關(guān)性,探討焦慮抑郁水平對COPD穩(wěn)定期患者病情的影響,了解COPD合并焦慮抑郁的常見證型,為臨床綜合診治提供相應(yīng)的指導(dǎo)。 方法： 納入2011年2月到2012年4月于廣東省中醫(yī)院就診的住院及門診COPD穩(wěn)定期分級為3-4級病人123例。應(yīng)用Zung編制的焦慮自評量表(Self-Rating Anxiety ScaleSAS)和抑郁自評量表(Self-rating Depression Scale, SDS)以問卷的形式進(jìn)行評估,并根據(jù)SDS和SAS的結(jié)果,將123例患者分為COPD無焦慮組、輕度焦慮組、中重度焦慮組,COPD無抑郁組、輕度抑郁組、中重度抑郁組。對組間性別、年齡、咳嗽病程、氣促病程、中醫(yī)癥狀計(jì)分、BODE指數(shù)、肺功能等基本情況進(jìn)行統(tǒng)計(jì)分析。采多因素Logistic分析方法,分析COPD伴發(fā)焦慮抑郁狀態(tài)的可能影響因素。并調(diào)查COPD伴發(fā)焦慮抑郁的中醫(yī)證候分布。 成果： 123例COPD患者中,無焦慮狀態(tài)75例,占60.98%,有焦慮48例,占39.02%,其中輕度焦33例,占26.83%,中重度焦慮15例,占12.20%�；颊咧袩o抑郁狀態(tài)66例,占53.66%,有抑郁57例,占46.34%,其中輕度抑郁35例,占28.46%,中重度抑郁22例,占17.89%。按SAS、SDS結(jié)果分組與調(diào)查結(jié)果進(jìn)行分析得出各組COPD合并不同程度焦慮抑郁患者在咳嗽病程、氣促病程、肺功能、中醫(yī)癥狀計(jì)分、BODE指數(shù)、6MWD、BMI等各項(xiàng)間差異有統(tǒng)計(jì)學(xué)意義(P0.05),在年齡、性別兩組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。以咳嗽病程、氣促病程、中醫(yī)癥狀計(jì)分、BODE指數(shù)4項(xiàng)為自變量,以有無焦慮或抑郁狀態(tài)為因變量,進(jìn)行Logistic多因素回歸分析顯示中醫(yī)癥狀計(jì)分是COPD患者伴發(fā)抑郁狀態(tài)的影響因素。COPD穩(wěn)定期合并焦慮狀態(tài)及合并抑郁不論病情的輕重,均以肺脾氣虛,痰瘀阻肺為主,且在合并焦慮狀態(tài)的患者中有33.33%合并肝氣郁結(jié),有20.83%合并心脾兩虛；在合并抑郁狀態(tài)的患者中有35.09%合并肝氣郁結(jié),有21.05%合并心脾兩虛。 結(jié)論： 123例COPD患者伴發(fā)焦慮抑郁狀態(tài)的構(gòu)成比高,合并焦慮患者占39.02%,合并抑郁的達(dá)46.34%,隨著COPD患者的咳嗽氣促病程延長、肺功能變差、6MWD、BMI下降、MMRC分級升高及中醫(yī)癥狀計(jì)分升高,其合并焦慮抑郁情緒可能性越大。而焦慮抑郁等不良情緒的產(chǎn)生反過來又影響著患者整體的機(jī)能。在COPD合并焦慮抑郁患者治療過程中要重視標(biāo)本同治,同時(shí)應(yīng)重視重視心理問題治療。
[Abstract]:Objective: The relationship between anxiety and depression in stable patients with chronic obstructive pulmonary disease (COPD) was discussed. The influence of anxiety and depression on the condition of patients with stable COPD was discussed, and the common syndromes of COPD combined with anxiety and depression were understood. To provide the corresponding guidance for the clinical comprehensive diagnosis and treatment. Methods: From February 2011 to April 2012, 123 hospitalized and outpatient COPD patients were classified as 3-4 grade patients in Guangdong traditional Chinese Medicine Hospital. Self-Rating Anxiety scale SASs (developed by Zung) and Self-rating Depression Scale, SDS) (Self-rating Depression scale) were used to evaluate the patients. According to the results of SDS and SAS, 123 patients were divided into two groups: COPD without anxiety group and mild anxiety group. Moderate and severe anxiety group with COPD without depression group, mild depression group, moderate and severe depression group. Sex, age, course of cough, course of shortness of breath, TCM symptom score and bode index, pulmonary function were analyzed statistically. Multivariate Logistic analysis was used to analyze the possible influencing factors of anxiety and depression in COPD. To investigate the distribution of TCM syndromes of COPD with anxiety and depression. Outcome: Of the 123 patients with COPD, 75 (60.98) had no anxiety, 48 (39.02) had anxiety, 33 cases (26.83%) had mild coke, 15 cases (12.20%) had moderate and severe anxiety. There were 66 cases of non-depressive state (53.66%), 57 cases of depression (46.34%), 35 cases of mild depression (28.46%), 22 cases of moderate and severe depression (17.89%). According to the analysis of the results and the results of the investigation, it was found that there were significant differences in the course of cough, the course of shortness of breath, the pulmonary function, the score of bode index and the 6MW DBMI of the patients with COPD with different degree of anxiety and depression in each group. There was no significant difference between the two groups (P 0.05). According to the course of cough, the course of shortness of breath, the score of TCM symptom and bode index, 4 items were independent variables, and the dependent variables were whether there was anxiety or depression. Logistic multivariate regression analysis showed that TCM symptom score was the influencing factor of depression in COPD patients. Among the patients with anxiety, 33.33% were complicated with stagnation of liver-qi, 20.83% with deficiency of heart and spleen, 35.09% with stagnation of liver-qi and 21.05% with deficiency of heart and spleen. Conclusion: The compositional ratio of anxiety and depression in 123 patients with COPD was high, 39.02 in patients with anxiety and 46.34 in patients with depression. With the prolonged course of cough and shortness of breath in patients with COPD, the lung function decreased and the scores of MMRC and TCM symptoms increased. The more likely they are to be associated with anxiety and depression. Anxiety and depression and other adverse emotions in turn affect the overall function of patients. In the course of treatment of COPD patients with anxiety and depression, we should pay attention to the treatment of both specimen and psychological problems.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R563.9

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