發(fā)布時間：2018-03-05 13:29

  本文選題：慢性阻塞性肺疾病　切入點：抑郁　出處：《天津醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的本文通過對慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者合并抑郁發(fā)生的影響因素進行分析,并進一步探討慢阻肺患者與抑郁狀態(tài)產(chǎn)生的相關(guān)性因素,為今后慢阻肺合并抑郁的患者早期進行針對性的護理和治療提供科學的評估依據(jù),以期提高患者生活質(zhì)量。方法選取2015年9月至2016年9月天津醫(yī)科大學總醫(yī)院高干科病房、呼吸內(nèi)科病房成年(年齡大于50歲)COPD患者60例,其診斷均應(yīng)符合中華醫(yī)學會2013年“慢性阻塞性肺疾病診斷和治療指南”的標準。入院后根據(jù)入選標準制成統(tǒng)一的病例觀察單以記錄臨床所需要的基礎(chǔ)數(shù)據(jù),并采用以調(diào)查問卷形式以自評與他評相結(jié)合的方式對患者進行臨床癥狀數(shù)據(jù)采集,應(yīng)用漢密爾頓抑郁量表(HAMD)對患者進行抑郁癥狀的調(diào)查,對所收集的臨床病例資料的數(shù)據(jù)進行相應(yīng)的統(tǒng)計學分析,得到本地區(qū)慢性阻塞性肺疾病合并抑郁的發(fā)病率;分析慢阻肺合并抑郁與吸煙指數(shù)、BMI、肺功能等基礎(chǔ)指標的相互影響性;得到抑郁與慢阻肺肺部的特異性癥狀如患者疲勞程度、呼吸困難指數(shù)、及自身的健康和每日生活質(zhì)量的危險因素的相關(guān)程度并評價調(diào)查問卷的價值;通過SPSS 17.0統(tǒng)計學軟件進行匯總并統(tǒng)計分析。數(shù)據(jù)結(jié)果以均數(shù)±標準差表示;組間計量資料的比較采用獨立樣本t檢驗進行分析;HAMD抑郁評分與臨床問卷調(diào)查評分的關(guān)系采用雙變量相關(guān)Spearman相關(guān)系數(shù)法,報道Spearman相關(guān)系數(shù)r值;采用二元logistic回歸篩選COPD伴抑郁的獨立影響因素。以P0.05為差異有統(tǒng)計學意義。結(jié)果1、入選的60例COPD患者其中男性31例,女性29例。男女比例為1.07:1,年齡58歲~89歲,平均年齡(73.45±6.93)歲,所有入選60例患者進行肺功能、MMRC問卷、HAMD問卷、簡明疲勞量表BFI問卷,結(jié)果存在21例患者存在抑郁狀態(tài)(HAMD評分≥7分),本次調(diào)查COPD伴抑郁的發(fā)病率為35%,COPD伴抑郁男性10例,COPD伴抑郁女性11例,男女比例為1:1.1。2、體重指數(shù)BMI、吸煙指數(shù)SI、慢阻肺病程是COPD伴抑郁的影響因素,P值分別為(0.021、0.018、0.001)差異有統(tǒng)計學意義。吸煙指數(shù)SI(OR值1.005、P值0.021、95%CI1.001~1.009)、慢阻肺病程(OR值1.534、P值0.001、95%CI 1.188~1.982)是COPD伴抑郁的獨立影響因素。3、抑郁程度與慢阻肺患者的CAT評分、呼吸困難指數(shù)MMRC評分、疲勞指數(shù)BFI評分之間呈線性正相關(guān)(r=0.837、0.653、0.842,p0.001),差異有統(tǒng)計學意義。與肺功能FEV1預計值無明顯關(guān)聯(lián)(r=-0.139、P值0.291)差異無統(tǒng)計學意義。結(jié)論1、天津市地區(qū)的慢性阻塞性肺疾病合并抑郁的發(fā)病率較高。2、慢阻肺患者抑郁狀態(tài)的產(chǎn)生與BMI、吸煙程度、慢阻肺病程等基礎(chǔ)指標有關(guān)。3、COPD患者的CAT評分、疲勞程度、氣短狀態(tài)與抑郁具有相關(guān)性,肺功能FEV1預計值與抑郁關(guān)系不大。4、疲勞指數(shù)BFI為評估慢阻肺合并抑郁提供有效評估方法。
[Abstract]:Objective to analyze the influencing factors of depression in patients with chronic obstructive pulmonary disease (pulmonary), and to explore the correlation between chronic obstructive pulmonary disease (COPD) and depression. To provide scientific evaluation basis for early nursing and treatment of patients with chronic obstructive pulmonary disease (COPD) complicated with depression in order to improve the quality of life. Methods from September 2015 to September 2016, the department of high dry department of Tianjin Medical University General Hospital was selected. 60 adult COPD patients (over 50 years old) in respiratory ward, The diagnosis should be in accordance with the Chinese Medical Association's guidelines for the diagnosis and treatment of chronic obstructive Pulmonary Disease (COPD) of 2013. The data of clinical symptoms were collected by self-assessment and other assessment in the form of questionnaire, and the depression symptoms were investigated by Hamilton Depression scale (Hamd). The incidence of chronic obstructive pulmonary disease (COPD) combined with depression was obtained by statistical analysis of the data collected from clinical cases, and the interaction between COPD with depression and smoking index (BMI), pulmonary function and other basic indexes was analyzed. The specific symptoms of depression and COPD such as fatigue degree, dyspnea index, risk factors of their own health and quality of daily life were obtained and the value of questionnaire was evaluated. Statistical software SPSS 17.0 was used to summarize and analyze the data. The results were expressed as mean 鹵standard deviation. The relationship between Hamd depression score and clinical questionnaire score was analyzed by independent sample t-test. The correlation coefficient of Spearman was reported by using bivariate correlation Spearman correlation coefficient method. The independent influencing factors of COPD with depression were screened by binary logistic regression. Results 1. Among the 60 COPD patients, 31 were male and 29 were female. The ratio of male to female was 1.07: 1. The average age was 73.45 鹵6.93 years old, the age of 58 years old was 89 years old, the average age was 73.45 鹵6.93 years old, the average age was 73.45 鹵6.93 years old, the ratio of male to female was 1.07: 1. All 60 patients were investigated with MMRC questionnaire, Hamd questionnaire and BFI questionnaire. Results there were 21 patients with depression status and Hamd score 鈮，

本文編號：1570460