本文選題：神經(jīng)癥性障礙 + 綜合醫(yī)院　； 參考：《第四軍醫(yī)大學》2012年碩士論文

【摘要】：研究背景：隨著社會壓力的增加，神經(jīng)癥性障礙患病率呈逐年上升的趨勢，是門診中較常見的一種精神障礙，嚴重影響患者的生活質(zhì)量。我國神經(jīng)癥患者很少去精神科診治，多反復就診于各級綜合醫(yī)院，延誤診治，浪費醫(yī)療資源，給患者及社會造成極大的經(jīng)濟負擔。我國對神經(jīng)癥的流行病學調(diào)查主要人群集中在社區(qū)居民和學生，對綜合醫(yī)院神經(jīng)癥患者的求助方式研究較多，對非精神科門診患者神經(jīng)癥性障礙的患病率、分布特征以及醫(yī)護患三類人員對神經(jīng)癥性障礙的“知、信、行”研究較少。西安市作為陜西省省會以及西北五省的樞紐，匯集了西北各省以及全國各地的就診患者，各級綜合醫(yī)院醫(yī)務人員能否早期正確識別和診治神經(jīng)癥性障礙患者，使得更有效地控制和減少神經(jīng)癥性障礙的危害，具有重要的意義。 目的：①探索西安市綜合醫(yī)院門診患者神經(jīng)癥性障礙的患病率、分布特征及相關(guān)影響因素；②了解綜合醫(yī)院門診患者和醫(yī)務人員神經(jīng)癥的“知、信、行”，為綜合醫(yī)院門診患者神經(jīng)癥性障礙的早期干預提供基線數(shù)據(jù)。 方法：①方便抽取西安市有代表性的一級、二級、三級綜合醫(yī)院各一家，隨機抽取門診就診患者，選用世界衛(wèi)生組織推薦的復合性國際診斷交談表(CIDI-3.0)中文版對其進行神經(jīng)癥性障礙的流行病學調(diào)查，神經(jīng)癥性障礙按照國際疾病分類ICD-10診斷標準；②應用自制問卷對綜合醫(yī)院醫(yī)務人員和門診患者進行神經(jīng)癥“知、信、行”調(diào)查。采用SPSS17.0軟件包對調(diào)查資料進行統(tǒng)計分析，率的比較運用2檢驗，多因素分析采用非條件Logistic回歸分析，并計算OR值和OR值的95%可信區(qū)間。取檢驗水準(α)為雙側(cè)0.05，即P＜0.05為有統(tǒng)計學差異。 結(jié)果： 1、西安市綜合醫(yī)院門診患者神經(jīng)癥性障礙的流行病學特征西安市綜合醫(yī)院門診患者總的神經(jīng)癥性障礙患病率為10.75%，其中，，社交恐怖癥占1.34%，特殊恐怖癥占5.65%，驚恐障礙占1.08%，強迫障礙占3.76%，廣泛性焦慮為0，廣場恐怖癥占0.81%。Logistic回歸分析結(jié)果顯示：年齡＜40歲(OR=4.442,95%CI=2.050～9.624)、內(nèi)科就診患者(OR=6.545,95%CI=1.509～28.383)、受教育年限在6年以下(OR=4.189,95%CI=1.792～9.790)、女性(OR=2.253,95%CI=1.136～4.469)與神經(jīng)癥性障礙的發(fā)生相關(guān)。 2、綜合醫(yī)院醫(yī)務人員、門診患者神經(jīng)癥的“知、信、行”70%以上的醫(yī)生聽說過神經(jīng)癥以及各亞型；45.6%～69.0%的醫(yī)生能列舉出神經(jīng)癥各亞型的臨床表現(xiàn)；能對神經(jīng)癥做出診斷和治療的醫(yī)生分別為37.7%、32.1%，能列舉出治療神經(jīng)癥藥物的醫(yī)生為41.0%；三級醫(yī)院的醫(yī)生對神經(jīng)癥防治知識知曉率高于二級和一級綜合醫(yī)院，回答正確率的差異具有統(tǒng)計學意義(P＜0.01)。綜合醫(yī)院護士對神經(jīng)癥知曉情況參差不齊，總體呈現(xiàn)隨著醫(yī)院級別的升高認知水平增高的趨勢；90.0%的護士認為神經(jīng)癥會行為失控危及自身和他人安全，94.4%的護士對神經(jīng)癥不會導致精神分裂癥存在錯誤認識。有70%以上的護士聽說過神經(jīng)癥及各亞型，不同級別綜合醫(yī)院護士對神經(jīng)癥知識回答正確率的差異無統(tǒng)計學意義(P＞0.05)。對神經(jīng)癥可以用心理和藥物治療不同級別綜合醫(yī)院護士回答正確率的差異具有統(tǒng)計學意義(P＜0.05)。 綜合醫(yī)院門診患者對神經(jīng)癥知曉率較低。24.2%的患者清楚神經(jīng)癥的主要表現(xiàn)；認為神經(jīng)癥可以用藥物、心理治療的患者分別占32.3%、33.6%；有44.4%的患者認為如果出現(xiàn)神經(jīng)癥相關(guān)癥狀時，選擇去綜合醫(yī)院的心理科進行治療，24.2%的患者選擇去綜合醫(yī)院神經(jīng)內(nèi)科治療，不同級別醫(yī)院患者對神經(jīng)癥尋求幫助途徑之間的差異有統(tǒng)計學意義(P＜0.05)；45.2%的患者想咨詢/了解神經(jīng)癥有關(guān)知識的途徑，30.1%的患者想去相關(guān)機構(gòu)檢查是否患有神經(jīng)癥，46.5%的患者認為如果發(fā)現(xiàn)周圍人得神經(jīng)癥會督促其就診，不同級別醫(yī)院患者對神經(jīng)癥相關(guān)行為回答的正確率的差異有統(tǒng)計學意義(P＜0.05)。 門診患者、醫(yī)務人員獲得神經(jīng)癥知識的主要途徑是廣播、電視或錄像、報紙、雜志、講座和宣傳資料；患者傾向于從親戚、同事和朋友處獲得相關(guān)信息，醫(yī)務人員更傾向于通過講座或宣傳資料獲得。 結(jié)論：①西安市綜合醫(yī)院神經(jīng)癥性障礙患病率處于較高水平，其總患病率為10.75%；②門診患者神經(jīng)癥性障礙的危險因素包括：內(nèi)科、年齡小于40歲、女性和小學文化程度者。③門診患者、醫(yī)務人員對神經(jīng)癥防治知識的知曉率較低，應通過電視、廣播和錄像、報紙、雜志、講座和宣傳資料等途徑，提高門診患者對神經(jīng)癥的正確認識和就醫(yī)行為，減少綜合醫(yī)院醫(yī)務人員對神經(jīng)癥性障礙的漏診和誤診。
[Abstract]:Background: with the increase of social pressure, the prevalence of neurotic disorders is increasing year by year. It is a more common mental disorder in the outpatient department, which seriously affects the quality of life of the patients. The main population of the epidemiologic survey of neurosis in our country is concentrated in community residents and students, and there are more ways to help patients with neurosis in general hospitals. The prevalence of neurotic disorders in non psychiatric outpatients is characterized by the distribution characteristics and the three types of patients with neurotic disorders "neurotic disorders." The city of Xi'an, as the capital of Shaanxi province and the hub of the five northwest provinces, has brought together the patients in the northwest provinces and all over the country. The medical personnel of the general hospitals at all levels can correctly identify and treat the patients with neurotic disorders early, so as to effectively control and reduce the harm of neurotic disorders. The meaning of it.
Objective: To explore the prevalence, distribution and related factors of neurotic disorders in outpatients in Xi'an general hospital, and to find out the "knowledge, letter, and practice" of the outpatient and medical personnel in the general hospital, and to provide baseline data for the early intervention of neurotic disorders in the general hospital.
Methods: 1. A representative class of Xi'an City, grade two, three level general hospital, randomly selected outpatient patients, selected the Chinese version of the compound International Diagnostic conversation table (CIDI-3.0) recommended by the WHO, to investigate the neurotic disorder in the Chinese version, and the neurotic disorder according to the international classification of disease classification IC D-10 diagnostic criteria; (2) a self-made questionnaire was used to investigate the neurosis "knowledge, letter, and line" of the medical staff and outpatients in the general hospital. The SPSS17.0 software package was used to analyze the survey data. The comparison of the rate was compared with 2 tests. The multifactor analysis was analyzed by the unconditional Logistic return, and the 95% confidence interval of the OR value and the OR value was calculated. The test level (alpha) was bilateral 0.05, that is, P < 0.05 was statistically significant.
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本文編號：2007935