發(fā)布時間：2018-03-24 22:32

  本文選題：慢性阻塞性肺病　切入點：抑郁　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.探索慢性阻塞性肺病合并抑郁的風(fēng)險因素。2.探討對于COPD合并抑郁患者,認(rèn)知行為療法(CBT)和在認(rèn)知行為療法的基礎(chǔ)上合并健康教育對患者抗抑郁效果,并比較兩組差異;分析比較兩種干預(yù)手段對于改善患者抑郁水平的早期療效和遠(yuǎn)期療效。3.探討對于COPD合并抑郁患者,除標(biāo)準(zhǔn)COPD治療外,增加單純CBT療法和CBT基礎(chǔ)上加入健康教育后,肺功能改善情況并比較兩組之間的差異。方法:1.研究對象:入選本研究的患者是處于COPD穩(wěn)定期的住院患者。慢阻肺病程可分為急性加重期和穩(wěn)定期。慢阻肺急性加重期(AECOPD)是指在疾病過程中,患者短期內(nèi)咳嗽、咳痰、喘息和(或)氣短癥狀其中至少一項加重,痰呈膿性或黏膿性,并且量增多,可伴發(fā)熱等炎癥明顯加重的表現(xiàn)。穩(wěn)定期則指患者咳嗽、咳痰、氣短等癥狀穩(wěn)定或癥狀輕微。剛?cè)朐旱幕颊叨酁榧毙约又仄?在規(guī)律應(yīng)用抗生素以及化痰、平喘、緩解氣道痙攣等治療藥物之后,患者進(jìn)入慢性阻塞性肺病穩(wěn)定期。本研究中納入的患者均處于穩(wěn)定期。2.慢性阻塞性肺病(COPD)的診斷:符合COPD臨床癥狀診斷標(biāo)準(zhǔn)且肺功能FEV1/FVC70%。3.抑郁的診斷標(biāo)準(zhǔn):根據(jù)ICD-10指南,由專門的精神科醫(yī)生做出診斷。抑郁的患者主要表現(xiàn)為沉默寡言、興趣減退、乏力、興趣下降、睡眠障礙等。本研究中符合COPD診斷標(biāo)準(zhǔn)的患者,首先對其用抑郁癥篩查量表(PHQ-9)進(jìn)行篩查,并對篩查分?jǐn)?shù)大于5分的患者進(jìn)行HAMD-17量表評分來評價其抑郁情況和程度。將HAMD-17量表分?jǐn)?shù)在7-17分之間的納入研究。分?jǐn)?shù)7考慮不符合抑郁,而17考慮為中重度抑郁。重度抑郁的患者不可通過單純的認(rèn)知行為療法進(jìn)行干預(yù),而應(yīng)該請示精神科醫(yī)生,必要時需要藥物治療,因此我們選入研究的患者為輕度抑郁患者。對于符合COPD診斷標(biāo)準(zhǔn)的患者的相關(guān)資料進(jìn)行收集,包括基本信息:患者姓名、性別、年齡、吸煙年數(shù)、每日吸煙數(shù)量、吸煙指數(shù)、身高、體重、BMI、COPD疾病年數(shù)、相關(guān)檢查肺功能包括第一秒用力呼氣量(FEV1)、第一秒用力肺活量與肺總量的比值(FEV1/FVC)、FEV1(%預(yù)計值);并對某些指標(biāo)如呼吸困難指數(shù)(mMRC)、COPD評定量表(CAT)進(jìn)行評估。對于符合COPD診斷標(biāo)準(zhǔn)同時符合輕度抑郁診斷標(biāo)準(zhǔn)的患者隨機分為兩組:實驗組和對照組。兩組患者都進(jìn)行標(biāo)準(zhǔn)的COPD規(guī)范治療,對照組在此基礎(chǔ)上給予認(rèn)知行為療法(CBT)進(jìn)行干預(yù),而實驗組的患者在進(jìn)行認(rèn)知行為療法的基礎(chǔ)上加入COPD健康教育,每個研究對象均行肺功能檢查。分別于2周、2月(一個完整的認(rèn)知行為療法周期)、及干預(yù)后二個月再次評估HAMD-17量表分?jǐn)?shù)及行肺功能檢查。比較兩組患者心理狀態(tài)(抑郁)情況及肺功能恢復(fù)情況。結(jié)果:1.COPD合并抑郁的風(fēng)險因素:COPD患者多有吸煙史,與非抑郁的患者相比,COPD合并抑郁的患者有更長的吸煙年數(shù)(P=0.005),且吸煙指數(shù)更大(P=0.022),病程更長(P0.05),FEV1(%預(yù)計值)越低(P=0.0410.05),呼吸困難指數(shù)越高(P0.05),COPD認(rèn)知程度越低即CAT分?jǐn)?shù)越高(P0.05),但是每日吸煙量(P=0.3210.05),FEV1(一秒量)(P=0.041)和FEV/FVC(一秒率)(P=0.827)在抑郁和非抑郁的患者之間并無明顯差異。2.兩組患者在研究前后的抑郁改善程度都較顯著,并且與單純的認(rèn)知行為療法相比(P0.05),在認(rèn)知行為療法的基礎(chǔ)上對患者進(jìn)行慢阻肺健康教育,患者抑郁改善程度較大(P=0.0290.05)。3.對于COPD患者合并抑郁患者來說,兩組患者在研究前后相比肺功能的改善都比較顯著,但兩組間差異不顯著(P=0.0770.05)。結(jié)論:1.在COPD患者中,吸煙年數(shù)長、吸煙指數(shù)高、COPD病程長、呼吸困難指數(shù)高、CAT值大、FEV1(%預(yù)計值)小等,是患者合并抑郁的風(fēng)險因素,而性別、年齡、體重指數(shù)、每日吸煙量、FEV1、FEV1/FVC與COPD患者合并抑郁的關(guān)系不顯著。2.認(rèn)知行為療法、慢阻肺健康教育對于COPD合并抑郁的患者的抑郁改善程度均有一定的意義。在CBT療法的基礎(chǔ)上加入慢阻肺健康宣教比單純的CBT療法更為顯著,尤其是對其抗抑郁的遠(yuǎn)期效果更為明顯。3.患者肺功能的改善程度兩組差別不顯著。
[Abstract]:Objective: To explore the risk factors of 1. patients with chronic obstructive pulmonary disease complicated with depression of.2. for COPD with depression, cognitive behavioral therapy (CBT) and on the basis of cognitive behavioral therapy on the consolidation of health education for patients with antidepressant effect, and compared the differences between the two groups; analysis and comparison of two kinds of interventions for early and long-term therapeutic effect of improved.3. study on COPD depression levels in patients with depression, in addition to the standard COPD treatment, increased CBT therapy alone and CBT added after the health education, improve lung function and compare the differences between the two groups. Methods: 1. subjects: the patients selected for this study in hospitalized patients with stable COPD COPD. Lung disease can be divided into acute exacerbation and stable stage. The acute exacerbation of chronic obstructive pulmonary disease (AECOPD) refers to the process in the short term, patients with cough, sputum, wheezing and shortness of breath (or at least one) Xiang Jiazhong is purulent sputum or sticky pus, and increased, accompanied by fever and inflammation significantly worse performance. Stable period refers to patients with cough, expectoration, shortness of breath and other symptoms or mild symptoms. Just stable patients admitted to hospital for acute exacerbation of asthma in the law application of antibiotics and phlegm, relieve the airway after. Spasm drug treatment, patients in the stable stage of chronic obstructive pulmonary disease. This study included patients who were in stable.2. patients with chronic obstructive pulmonary disease (COPD) diagnosis: according to COPD diagnosis standard and clinical symptoms of pulmonary function in FEV1/FVC70%.3. depression diagnosis standard: according to the ICD-10 guidelines, by specialized psychiatric doctors make a diagnosis of depression. The patients mainly manifested as appetite, fatigue, be scanty of words, decreased interest, sleep disorders. Meet the diagnostic criteria of COPD patients in the study, first on the Depression Scale (PHQ-9) for screening The investigation, and the screening scores greater than 5 of patients with HAMD-17 score to evaluate the situation and degree of depression. HAMD-17 scale will be included in the study scores between 7-17. Scores of 7 and 17 are not considered with depression, as in severe depression. Severe depression patients can not interfere with cognitive behavioral therapy simple, but should consult a psychiatrist when necessary medication, so we selected for study of patients with mild depression. The related data according to the diagnosis criteria of COPD patients were collected, including basic information, patient name, sex, age, years of smoking, daily smoking amount, smoking index height, weight, BMI, COPD, the number of years of disease, pulmonary function examination including the first second forced expiratory volume (FEV1), the ratio of the first second forced vital capacity and total lung (FEV1/FVC), FEV1 (% expected value); and some of the indicators such as breathing The difficulty index (mMRC), COPD Rating Scale (CAT) were evaluated. The patients were randomly divided into to meet the diagnostic criteria of COPD and meet the diagnostic criteria of mild depression into two groups: experimental group and control group. COPD treatment group two patients were the control group based on the given cognitive behavioral therapy (CBT) intervention, while the experimental group were enrolled in COPD health education based on cognitive behavioral therapy on each subject. Lung function tests were performed at 2 week, February (a complete cycle of cognitive behavioral therapy), and two months after the intervention the re evaluation of HAMD-17 scale scores and pulmonary function check. Compared two groups of patients with mental state (depression) and pulmonary function recovery. Results: the risk factors of 1.COPD with depression: COPD patients with a history of smoking, compared with non depression patients, COPD patients with depression had longer years of smoking The number (P=0.005), and the smoking index (P=0.022), the greater the longer duration (P0.05), FEV1 (% predicted) is low (P=0.0410.05), dyspnea index (P0.05), the higher the degree of cognitive COPD lower CAT score is higher (P0.05), but the amount of daily cigarette smoking (P=0.3210.05), FEV1 (a second volume) (P=0.041) and FEV/FVC (a second rate) (P=0.827) in patients with depression and non depression there is no significant difference between two groups of patients in the.2. study before and after the improvement of depression are obvious, and compared with the cognitive behavioral therapy alone (P0.05), on the basis of cognitive behavioral therapy on health education for patients with COPD patients with depression, improve the degree of large (P=0.0290.05).3. for COPD patients with depression, compared to the improvement in lung function are more significant in the patients of the two groups before and after the study, but the difference between the two groups was not significant (P=0.0770.05). Conclusion: 1. in patients with COPD, the long years of smoking smoking, The smoke index is high, COPD duration, dyspnea index, CAT value, FEV1 (% predicted) such as risk factors, patients with depression and gender, age, BMI, smoking, FEV1, FEV1/FVC and COPD were not significantly associated with depression.2. cognitive behavioral therapy. COPD health education has certain degree of significance for improving COPD and depression in patients with depression. With COPD health education than CBT therapy alone is more significant in CBT therapy, especially the improvement of the long-term antidepressant effect is more obvious pulmonary function in.3. patients is not the difference between the two groups significant.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R563.9;R749.4

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