本文選題：廣泛性焦慮障礙 + 心率變異性��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]1、探討廣泛性焦慮障礙患者人格方面的特質(zhì)。2、探討心率變異生物反饋訓(xùn)練對心率變異性中頻域指標(biāo)、時域指標(biāo)及心率的影響,心率變異生物反饋訓(xùn)練對廣泛性焦慮障礙患者焦慮癥狀的緩解效果。3、探討廣泛性焦慮障礙患者心率變異性基線值與其狀態(tài)特質(zhì)焦慮量表、艾森克人格評分及心率之間的相關(guān)性分析。[方法]1、第一部分:本研究為病例對照研究,共納入了 87例廣泛性焦慮障礙患者,采用艾森克人格問卷進(jìn)行評估,并與常模進(jìn)行對照分析,探討其人格方面的特征,然后服用舒肝解郁膠囊0. 72g每天2次、復(fù)方地西泮1片每天1次(舒肝解郁膠囊含有貫葉金絲桃和刺五加,主要有疏肝解郁和健脾安神的功效;復(fù)方地西泮雖不是治療廣泛性焦慮障礙的主藥,但可以輔助改善廣泛性焦慮障礙患者的焦慮癥狀,且未見有這兩種藥物影響HRV的相關(guān)報告);2、第二部分:采用從德國Biosign公司進(jìn)口的心率變異生物反饋掃描分析儀(HRV-Scanner Professional)測定廣泛性焦慮障礙患者的心率變異性(HRV),包括47例干預(yù)組廣泛性焦慮障礙患者和40例對照組廣泛性焦慮障礙患者,其中對干預(yù)組進(jìn)行為期6周的心率變異生物反饋訓(xùn)練,觀察6周前后患者的HRV指標(biāo)變化情況,采用漢密爾頓焦慮量表(HAMA)量表和狀態(tài)特質(zhì)焦慮量表(STAI)評分對廣泛性焦慮障礙患者的癥狀進(jìn)行定量評估;3、第三部分:針對上述所有廣泛性焦慮障礙患者,利用狀態(tài)特質(zhì)焦慮量表(STAI)評定,并進(jìn)一步對患者狀態(tài)特質(zhì)焦慮、艾森克人格各維度及心率與心率變異性各指標(biāo)進(jìn)行相關(guān)性分析。[結(jié)果]第一部分:①通過對艾森克人格問卷中四個維度:E、P、N、L進(jìn)行分析,并與常模進(jìn)行比較,患者問卷中的N分顯著高于常模[(16. 66±3. 78) vs (11. 6±4. 8),p0. 01],這表明廣泛性焦慮障礙患者具有神經(jīng)質(zhì)的人格特質(zhì)。第二部分:①在6周的隨訪中,干預(yù)組脫落4人,其中3人由于工作原因、1人由于交通原因不能按時隨訪,對照組脫落3人,3人全部由于交通原因不能按時隨訪。分別對廣泛性焦慮障礙患者干預(yù)組與對照組的HRV中的頻域指標(biāo)、時域指標(biāo)及心率進(jìn)行6周前后兩兩比較分析,結(jié)果顯示:干預(yù)組HRV頻域指標(biāo)中的低頻(LF)成分降低[(2. 15±0. 43)ms2vs(1.99±0.43)ms2, p0.05],差異具有統(tǒng)計學(xué)意義;頻域指標(biāo)中的高頻(HF)成份未見明顯變化,差異無統(tǒng)計學(xué)意義,p0. 05;頻域指標(biāo)中 LF/HF 成份降低[1.54 (1. 65)vs 1. 17(1. 23), p0. 05],差異有統(tǒng)計學(xué)意義;頻域指標(biāo)中的極低頻(VLF)成份未見明顯變化,差異無統(tǒng)計學(xué)意義,p0. 05;頻域指標(biāo)中的總功率(TP)成份未見有明顯變化,差異無統(tǒng)計學(xué)意義,p0.05。干預(yù)組反饋前后心率(HR)較前降低[(73.21±]0.80)次/min vs(63. 93±6. 18)次/min, p0. 05],差異有統(tǒng)計學(xué)意義。時域指標(biāo)中SDNN和RMSSD均未見有明顯變化,差異均無統(tǒng)計學(xué)意義,均p0.05。而對照組HRV中頻域指標(biāo)、時域指標(biāo)及心率均未見明顯變化,差異均無統(tǒng)計學(xué)意義,均p0. 05。②經(jīng)過心率變異生物反饋訓(xùn)練后的廣泛性焦慮障礙患者,STAI量表中SAI維度評分降低,差異有統(tǒng)計學(xué)意義[(60. 60 ±5. 90) vs (44. 79 ±5. 30),p0. 05];單純藥物治療對照組也有所降低,差異亦有統(tǒng)計學(xué)意義[(59. 88±5. 83) vs (55. 51 ±4.38),p0.05],兩組治療前后的差值比較,差異有統(tǒng)計學(xué)意義[(-14. 40±4.66)vs(-10.00±3.91),p0.05],這說明干預(yù)組下降較對照組明顯。干預(yù)組TAI評分在訓(xùn)練后評分下降,差異有統(tǒng)計學(xué)意義[(56. 13 ±4. 35) vs (52. 91 ±4. 36),p0. 05],但對照組TAI未見明顯變化,P0. 05,兩組治療前后的差值比較,差異有統(tǒng)計學(xué)意義[(-3. 06±3. 07) vs (-1. 27± 1. 33),p0. 05]。干預(yù)組在訓(xùn)練后HAMA 評分下降,差異有統(tǒng)計學(xué)意義[(25. 51 ±2.66) vs (10. 33±1.82),p0. 05],對照組HAMA評分也下降,差異有統(tǒng)計學(xué)意義[(25. 53±2. 41) vs (15. 11 ±2. 77),p0.05],且兩組治療前后的差值比較差異有統(tǒng)計學(xué)意義[(-14.86 ±2. 88) vs (-10. 30±3. 66),p0. 05],這說明干預(yù)組下降較對照組明顯。第三部分:廣泛性焦慮障礙患者的HRV基線值中SDNN成份與HR呈負(fù)相關(guān)關(guān)系(r = -0. 464,P=0. 000), RMSSD 成份與 HR 呈負(fù)相關(guān)關(guān)系(r =-0.612,P=0. 000)。[結(jié)論]第一部分:①廣泛性焦慮障礙患者具有神經(jīng)質(zhì)的人格特點,該類患者情緒的穩(wěn)定性較正常人差。第二部分:①廣泛性焦慮障礙患者經(jīng)過心率變異生物反饋訓(xùn)練后,心率變異性中頻域指標(biāo)及心率有所變化,LF主要反映了交感神經(jīng)的活性,頻域指標(biāo)中的LF成份降低,說明心率變異生物反饋訓(xùn)練可以降低交感神經(jīng)的興奮性;頻域指標(biāo)中的HF未見顯著變化,HF主要映射了迷走神經(jīng)的活性,說明迷走神經(jīng)張力的調(diào)動可能需要更長的時間。頻域指標(biāo)中的LF/HF成份降低,而LF/HF反映了交感神經(jīng)與迷走神經(jīng)的平衡性,說明心率變異生物反饋可以改善交感神經(jīng)系統(tǒng)與迷走神經(jīng)系統(tǒng)之間的平衡狀態(tài),促進(jìn)交感神經(jīng)與迷走神經(jīng)系統(tǒng)之間的相互平衡,可改善自主神經(jīng)系統(tǒng)的平衡性。干預(yù)組中患者的心率明顯下降,說明心率變異生物反饋訓(xùn)練可以降低患者的心率,可改善患者的心慌、心悸等心臟不適狀況。干預(yù)組與對照組的SAI量表及HAMA評分均有所下降,但干預(yù)組下降較為明顯,說明在相同藥物治療的基礎(chǔ)上,心率變異生物反饋訓(xùn)練可以明顯改善患者的焦慮癥狀。第三部分:干預(yù)組及對照組中所有廣泛性焦慮障礙患者的HR與HRV時域指標(biāo)中的SDNN成分呈負(fù)相關(guān),HR與HRV時域指標(biāo)中的RMSSD成分呈負(fù)相關(guān),SDNN主要映射了交感神經(jīng)與副交感神經(jīng)總的張力大小,RMSSD主要映射了迷走神經(jīng)的張力大小,這說明廣泛性焦慮障礙個體的心率越高,交感神經(jīng)與副交感神經(jīng)總的張力越小,迷走神經(jīng)的張力越小;在今后的臨床實踐中,可以對易感個體及疾病早期進(jìn)行早期篩查與早期干預(yù),為提高患者的預(yù)后及早期干預(yù)奠定一定的基礎(chǔ)。
[Abstract]:[Objective]1 to explore the personality traits of patients with generalized anxiety disorder (.2), and to explore the effect of heart rate variation biofeedback training on the frequency domain index, time domain index and heart rate in heart rate variability. The effect of heart rate variation biofeedback training on anxiety symptoms in patients with generalized anxiety disorder (.3), and to explore the heart rate of patients with generalized anxiety disorder. The correlation between the variance baseline and the state trait anxiety scale, the Eysenck personality score and the heart rate. [method]1, Part 1: This study was a case-control study. A total of 87 patients with generalized anxiety disorders were evaluated by the Eysenck personality questionnaire and compared with the norm to explore their personality aspects. Features, and then take Shugan Jie Yu capsule 0. 72g 2 times a day, compound diazepam 1 tablets 1 times a day (Shugan Jie Yu capsule contains Hypericum Hypericum and acanthopanax, which mainly has the effect of dispersing liver and relieving depression and invigorating the spleen and amelioration; compound diazepam is not the main drug for the treatment of generalized anxiety disorder, but can assist in improving the focus of generalized anxiety disorder. " Symptoms were considered, and there were no related reports of the effects of these two drugs on HRV. 2, second: heart rate variability (HRV) in patients with generalized anxiety disorder (HRV) using heart rate variant biofeedback analyzer imported from German Biosign company (HRV-Scanner Professional), including 47 patients with generalized anxiety disorder and 40 controls In the group of patients with generalized anxiety disorder, the intervention group was trained for 6 weeks of heart rate variation biofeedback training, and the changes of HRV index were observed before and after 6 weeks. The Hamilton Anxiety Scale (HAMA) scale and the State Trait Anxiety Scale (STAI) score were used to evaluate the symptoms of the patients with generalized anxiety disorder (3, third). For all the patients with generalized anxiety disorder, the status trait anxiety scale (STAI) was used to evaluate the patient's state trait anxiety, Eysenck personality dimensions, heart rate and heart rate variability. [results] first part: (1) through the four dimensions of the Eysenck Personality Questionnaire: E, P, N, L. Analysis, and compared with the norm, the N score in the patient's questionnaire was significantly higher than that of the norm [(16.66 + 3.78) vs (11.6 + 4.8), p0. 01], which indicated that the patients with generalized anxiety disorder had neurotic personality traits. Second part: during the 6 week follow-up, the intervention group dropped 4 people, of which 3 were due to work reasons and 1 people were not on time due to traffic reasons. Following up, 3 people in the control group and 3 people were all unable to follow up due to traffic reasons. The frequency domain index, time domain index and heart rate of HRV in the intervention group and the control group were compared and analyzed 22 weeks before and after 6 weeks respectively. The results showed that the low frequency (2.15 + 0.43) ms2vs (2.15 + 0.43) ms2vs (1) in the intervention group was (2.15 + 0.43) ms2vs (1). .99 + 0.43) MS2, p0.05], the difference was statistically significant, the frequency domain index of the high frequency (HF) component did not change significantly, the difference was not statistically significant, p0. 05; the LF/HF component in the frequency domain index reduced [1.54 (1.65) vs 1.17 (1.23), p0. 05], the difference was statistically significant; the frequency domain index of the extreme low frequency (VLF) component did not change obviously, the difference was no Statistical significance, p0. 05, the total power (TP) component of the frequency domain index had no significant change, and the difference was not statistically significant. The heart rate (HR) before and after feedback in the p0.05. intervention group was lower than that of the former [(73.21 +]0.80) /min vs (63.93 + 6.18) /min, p0. 05], and there was no significant difference in both SDNN and RMSSD. No statistical significance, all p0.05. in the control group HRV in frequency domain index, time domain index and heart rate had no significant change, the difference was not statistically significant, all p0. 5 after the heart rate variant biological feedback training of patients with generalized anxiety disorder, STAI scale SAI dimension score lower, the difference was statistically significant [(60.60 + 5.90) vs (44.7) 9 + 5.30), p0. 05], the control group was also reduced, the difference was statistically significant [59.88 + 5.83) vs (55.51 + 4.38), p0.05], and the difference of the two groups before and after treatment was statistically significant [(-14. 40 + 4.66) vs (-10.00 + 3.91), p0.05], indicating that the intervention group was lower than the control group. The TAI score in the intervention group was in training. After training, the difference was statistically significant [(56.13 + 4.35) vs (52.91 + 4.36), p0. 05], but there was no significant change in the control group TAI, P0. 05, and two groups before and after treatment, the difference was statistically significant [(-3. 06 + 3.07) vs (-1. 27 + 1.33), p0. 05]. intervention group after training HAMA score decreased, the difference was statistically significant [(2] 5.51 + 2.66) vs (10.33 + 1.82), p0. 05], and the HAMA score in the control group also decreased, the difference was statistically significant [(25.53 + 2.41) vs (15.11 + 2.77), p0.05], and the difference of the two groups before and after treatment was statistically significant [(-14.86 + 2.88) vs (-10. 30 + 3.66), p0. 05], indicating that the intervention group was significantly lower than the control group. Third part: The SDNN component in HRV baseline values of patients with generalized anxiety disorder was negatively correlated with HR (r = -0. 464, P=0. 000), and the RMSSD component was negatively correlated with HR (R =-0.612, P=0. 000). [Conclusion] first part: (1) the patients with generalized anxiety disorder have neurotic personality characteristics, and the stability of this kind of patient is worse than that of the normal person. Second parts of the patients are less stable than the normal person. Scores: (1) after the heart rate variability biofeedback training in patients with generalized anxiety disorder, the frequency domain index and heart rate of heart rate variability have changed. LF mainly reflects the activity of sympathetic nerve, and the LF component in frequency domain index decreases. It shows that heart rate variation biofeedback training can lower the excitability of sympathetic nerve; HF in frequency domain index has not been found. HF mainly maps the activity of the vagus nerve, suggesting that the mobilization of the vagus nerve may take longer. The LF/HF component in the frequency domain index decreases, and LF/HF reflects the balance between the sympathetic and the vagus nerves, indicating that the heart rate variation biofeedback can improve the level of the sympathetic and vagus nerves. The balance between the sympathetic and the vagus nerve system can improve the balance of the autonomic nervous system. The heart rate of the patients in the intervention group decreases obviously, indicating that the heart rate variation biofeedback training can reduce the heart rate of the patient, and improve the heart discomfort, such as the patient's palpitation and palpitation, and the SAI quantity of the intervention group and the control group. The score of the table and HAMA decreased, but the decrease in the intervention group was more obvious. On the basis of the same drug treatment, the heart rate variation biofeedback training could obviously improve the anxiety symptoms of the patients. Third part: the HR of all the patients with generalized anxiety disorder in the intervention group and the control group was negatively correlated with the SDNN component in the time domain index of HRV, HR The RMSSD component in the HRV time domain index is negatively correlated. SDNN mainly maps the total tension of the sympathetic and parasympathetic nerves. RMSSD mainly maps the tension of the vagus nerve, which indicates that the higher the heart rate of the individuals with generalized anxiety disorder, the smaller the total tension of the sympathetic and parasympathetic nerves, the smaller the tension of the vagus nerve; the lower the tension of the vagus nerve; In the post clinical practice, early screening and early intervention can be carried out for susceptible individuals and early diseases, which will lay a foundation for improving the prognosis and early intervention of the patients.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.72

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