本文選題：腦卒中 + 情緒障礙�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景腦卒中又稱腦中風(fēng),是指急性發(fā)病,癥狀持續(xù)24小時以上或直接導(dǎo)致死亡的局部腦血管疾病。病后不僅有偏癱、失語、視覺缺損及意識障礙等生理功能受損表現(xiàn),還可能包括情感、精神等方面的障礙。目的通過研究腦卒中患者焦慮和抑郁情緒障礙現(xiàn)狀,分析生活質(zhì)量指數(shù)、認知能力、人際交往能力、家庭親密度與適應(yīng)性現(xiàn)狀對患者焦慮情緒、抑郁情緒的綜合影響,為腦卒中患者情緒關(guān)懷和干預(yù)提供理論依據(jù)。方法采用簡單隨機抽樣的方法依據(jù)入選標準,選擇于2015年9月至2016年9月在我院神經(jīng)內(nèi)科住院的197名腦卒中患者作為觀察組;同期依據(jù)入選標準選擇在我院體檢中心體檢的197名正常人作為正常對照組(C組),所有入組者均予以焦慮量表(SAS)和抑郁量表(SDS)評分,根據(jù)評分結(jié)果把觀察組分為伴情緒障礙組(A組)和不伴情緒障礙組(B組),并對各組入選者之間不同基本情況(性別、職業(yè)、文化程度、家庭年收入、醫(yī)療保險、年齡、婚姻狀況、家庭關(guān)系、醫(yī)護關(guān)系)和生活習(xí)慣(吸煙習(xí)慣、飲酒習(xí)慣、鍛煉習(xí)慣、飲食規(guī)律、睡眠質(zhì)量)進行分析,同時對腦卒中患者予以日常生活能力、認知能力、人際交往能力、家庭親密度與適應(yīng)性評分,并對兩亞組之間的各項得分進行比較。結(jié)果1、腦卒中伴情緒障礙組(A組)和正常對照組(C組)焦慮SAS量表中除了臉紅(t=0.72,P=0.511)、暈厥(t=1.17,P=0.34)、緊張(t=4.76,P=0.18)無顯著性差異外(P0.05),不幸預(yù)感(t=20.02,P=0.000)、手足無措(t=7.82,P=0.001)、胸悶(t=7.25,P=0.002)、害怕(t=5.29,P=0.004)、煩亂(t=6.88,P=0.000)、發(fā)瘋感(t=5.34,P=0.000)、發(fā)抖(t=10.03,P=0.000)、軀體疼痛(t=12.28,P=0.000)等17項得分均有顯著差異,具有統(tǒng)計學(xué)意義(P0.05),而腦卒中不伴情緒障礙組(B組)和正常對照組(C組)焦慮SAS量表中不幸預(yù)感、胸悶、手足無措、緊張、煩亂、害怕、發(fā)瘋感、軀體疼痛、發(fā)抖等20項得分均無顯著性差異,不具有統(tǒng)計學(xué)意義(P0.05)。2、腦卒中伴情緒障礙組(A組)和正常對照組(C組)抑郁SDS量表中除了易倦(t=1.32,P=0.19)、晨重晚輕(t=4.76,P=0.18)、體重減輕(t=0.36,P=0.234)無顯著性差異外(P0.05),憂郁(t=57.31,P=0.000)、易哭(t=12.66,P=0.000)、睡眠障礙(t=6.07,P=0.000)、食欲減退(t=18.23,P=0.000)、便秘(t=9.83,P=0.003)、心悸(t=13.66,P=0.000)、思考困難(t=9.55,P=0.000)、能力減退(t=12.60,P=0.000)、不安(t=22.85,P=0.000)、絕望(t=22.06,P=0.000)、易激怒(t=5.64,P=0.000)、決斷困難(t=5.98,P=0.002)、無用感(t=34.06,P=0.000)、生活空虛感(t=38.78,P=0.000)、無價值感(t=26.26,P=0.000)、興趣喪失(t=22.98,P=0.000)等均有顯著性差異,具有統(tǒng)計學(xué)意義(P0.05)。但是腦卒中不伴情緒障礙(B組)和正常對照組(C組)SDS量表中憂郁、晨重晚輕、易哭、睡眠障礙、食欲減退、體重減輕、便秘、心悸、思考困難、能力減退、不安、絕望、易激怒、決斷困難、無用感、生活空虛感、無價值感、興趣喪失等均無明顯差異,不具有統(tǒng)計學(xué)意義(P0.05)。3、與正常對照組(C組)相比,腦卒中伴情緒障礙組(A組)SAS量表(t=16.88,P=0.000)、SDS量表(t=16.88,P=0.000)得分的差異有統(tǒng)計學(xué)意義(均有P0.05),腦卒中伴情緒障礙組(A組)明顯高于正常對照組(C組);腦卒中不伴情緒障礙組(B組)和正常對照組(C組)的SAS量表和SDS量表得分均無明顯差異,不具有統(tǒng)計學(xué)意義(P0.05)。4、與正常對照組(C組)相比,腦卒中伴情緒障礙組(A組)中不同基本情況(性別、家庭年收入、醫(yī)療保險、年齡、婚姻狀況、家庭關(guān)系、醫(yī)護關(guān)系)和生活習(xí)慣(吸煙習(xí)慣、鍛煉習(xí)慣、睡眠質(zhì)量)焦慮情緒發(fā)生情況的差異有統(tǒng)計學(xué)意義(P0.05)。與正常對照組(C組)相比,腦卒中不伴情緒障礙組(B組)中不同基本情況(性別、職業(yè)、文化程度、家庭年收入、醫(yī)療保險、年齡、婚姻狀況、家庭關(guān)系、醫(yī)護關(guān)系)和生活習(xí)慣(吸煙習(xí)慣、飲酒習(xí)慣、鍛煉習(xí)慣、飲食規(guī)律、睡眠質(zhì)量)焦慮抑郁情緒發(fā)生情況的差異不具有統(tǒng)計學(xué)意義(P0.05)5、日常生活能力量表得分顯示:與不伴情緒障礙組(B組)相比,伴情緒障礙組(A組)日常生活能力量表(ADL)中軀體活動中上廁所(t=67.98,P=0.000)、進食(t=37.40,P=0.000)、穿衣(t=9.20,P=0.000)、洗梳(t=44.95,P=0.000)等6項的得分的差異均具有統(tǒng)計學(xué)意義,工具性日�；顒又写螂娫�(t=139.28,P=0.000)、購物(t=96.15,P=0.000)、備餐(t=68.47,P=0.000)、做家務(wù)(t=64.78,P=0.000)等8項得分的差異均具有統(tǒng)計學(xué)意義(P0.05)。6、MoCA量表得分顯示:與不伴情緒障礙組(B組)相比,伴情緒障礙組(A組)在MoCA量表總分和八個分量表得分上均有顯著性差異(P0.05),MoCA量表總得分不伴情緒障礙組(B組)高于伴情緒障礙組(A組)(t=125.67,P=0.000),其中視空間與執(zhí)行能力認知不伴情緒障礙組(B組)高于伴情緒障礙組(A組)(t=61.53,P=0.000)(P0.05)。7、人際交往能力量表得分顯示:伴情緒障礙組(A組)人際交往能力量表得分均高于臨界值,平均得分(184.99±59.86)分。與不伴情緒障礙組(B組)比較,其差異有統(tǒng)計學(xué)意義(t=65.44,P=0.000),(P0.05)。8、家庭親密度與適應(yīng)性量表得分顯示:與不伴情緒障礙組(B組)相比,伴情緒障礙組(A組)在家庭親密度(t=61.53,P=0.000)與家庭適應(yīng)性(t=19.41,P=0.000)均有顯著性差異(P0.05)。9、與不伴情緒障礙組(B組)相比,伴情緒障礙組(A組)其情緒障礙與生活質(zhì)量各量表得分的相關(guān)性,SAS量表得分、SDS量表得分與ADL量表、MoCA量表、家庭親密度與適應(yīng)性量表均呈現(xiàn)出顯著的線性相關(guān)和線性回歸關(guān)系。10、日常生活能力、認知能力、人際交際能力、家庭親密度和適應(yīng)性與伴情緒障礙組(A組)SAS得分擬合多元線性回歸方程有統(tǒng)計學(xué)意義(復(fù)合相關(guān)系數(shù)R=0.68,決定系數(shù)R2=0.47)。伴情緒障礙組(A組)SDS得分擬合多元線性回歸方程也有統(tǒng)計學(xué)意義(復(fù)合相關(guān)系數(shù)R=0.59,決定系數(shù)R2=0.35)。結(jié)論1、性別、文化程度、家庭年收入、醫(yī)療保險、年齡、婚姻狀況、家庭關(guān)系、醫(yī)護關(guān)系、吸煙習(xí)慣、飲酒習(xí)慣、鍛煉習(xí)慣、睡眠質(zhì)量對腦卒中患者焦慮和抑郁情緒均有顯著影響。而職業(yè)和飲食規(guī)律對腦卒中后焦慮抑郁無顯著相關(guān)。2、日常生活能力、認知能力、人際交際能力、家庭親密度與適應(yīng)性對腦卒中患者的焦慮和抑郁情緒均有顯著影響。3、腦卒中患者更易出現(xiàn)焦慮、抑郁,而導(dǎo)致腦卒中后焦慮、抑郁的原因繁多。
[Abstract]:Background cerebral apoplexy, also known as cerebral apoplexy, refers to acute onset, symptoms lasting more than 24 hours or local cerebral vascular diseases that lead to death directly. After disease, not only hemiplegia, aphasia, visual impairment and disturbance of consciousness are impaired, but also emotional and mental disorders may also be included. The current situation of depression mood disorder, analysis of quality of life index, cognitive ability, interpersonal communication ability, family intimacy and adaptability status on patients' anxiety and depression, and provide a theoretical basis for the emotional care and intervention of stroke patients. Methods using simple random sampling method based on the selection criteria, selected in September 2015. To September 2016, 197 stroke patients were hospitalized in the neurology department of our hospital as an observation group, and 197 normal people were selected as normal control group (group C) in the physical examination center of our hospital in the same period according to the criteria of admission. All the participants were given the Anxiety Scale (SAS) and the Depression Scale (SDS) score, and the observation group was divided into the accompanying mood according to the score results. The disorder group (group A) and the group without emotional disorder (group B) were analyzed with different basic conditions (sex, occupation, education level, family annual income, medical insurance, age, marital status, family relationship, medical care relationship) and life habits (smoking habits, drinking habits, exercise habits, eating habits, sleep quality) among the participants. Stroke patients were given daily life ability, cognitive ability, interpersonal skills, family intimacy and adaptability scores, and the scores were compared between the two subgroups. Results 1, the anxiety SAS scale of the stroke group (group A) and the normal control group (group C) anxiety (t=0.72, P=0.511), syncope (t=1.17, P=0.34), and tension (t=4). .76, P=0.18) had no significant differences (P0.05), t=20.02 (P=0.000), t=7.82 (P=0.001), chest tightness (t=7.25, P=0.002), fear (t=5.29, P=0.004), distraction, mad feeling, body pain, body pain, and so on, with significant differences, with statistical meaning. Meaning (P0.05), but the 20 scores of unfortunate premonition in the anxiety SAS scale of the cerebral apoplexy group (group B) and the normal control group (group C) anxiety, chest tightness, bewilret, nervousness, distraction, fear, madness, somatic pain, and tremor were not significant, and did not have the overall significance (P0.05).2, the cerebral apoplexy with the emotional disorder group (group A) and the normal control group (C). In the depression SDS scale, in addition to t=1.32 (P=0.19), late morning weight (t=4.76, P=0.18), and weight loss (t=0.36, P=0.234), there was no significant difference (P0.05), melancholy (t=57.31, P=0.000), easy to cry (t=12.66, P=0.000), sleep disorder (0), loss of appetite, constipation, heart palpitations, thinking difficulties. T=9.55 (P=0.000), t=12.60 (P=0.000), t=22.85 (P=0.000), despair (t=22.06, P=0.000), easily irritated (t=5.64, P=0.000), difficult decision (t=5.98, P=0.002), useless sense, life emptiness, loss of value, loss of interest, etc, there are significant differences. There was statistical significance (P0.05). But stroke without emotional disorder (group B) and normal control group (group C) SDS scale was melancholy, morning weight late, easy crying, sleep disorder, loss of appetite, loss of weight, constipation, palpitation, difficulty thinking, loss of ability, unease, unease, irritability, difficulty, sense of futility, sense of vain life, loss of value, loss of interest There was no statistically significant difference (P0.05).3, and compared with the normal control group (group C), the scores of SDS scale (t=16.88, P=0.000) in the stroke group (group A) and the SDS scale (t=16.88, P=0.000) were statistically significant (P0.05), and the stroke group (A group) was significantly higher than that of the normal control group (Group). There was no significant difference between the SAS scale and the SDS scale in the B group and the normal control group (group C), and did not have statistical significance (P0.05).4. Compared with the normal control group (group C), the different basic conditions (sex, annual family income, medical insurance, age, marital status, family relationship, medical care relationship) in the group of emotion disorder (group A) were compared with that of the normal control group (group C). Compared with the normal control group (group C), compared with the normal control group (group B), the different basic conditions (sex, occupation, cultural range, family income, medical insurance, age, marital status, family relationship, medical care) were not associated with the group of emotion disorder (group B). Relationship) and habits (smoking habits, drinking habits, exercise habits, diet rules, sleep quality) were not statistically significant (P0.05) 5, and the daily living ability scale scores showed that the daily living ability scale (ADL) in the group of emotional disorders (group A) was compared with the group (group B) without emotional disorder. T=67.98, P=0.000, t=37.40, P=0.000, t=9.20, P=0.000, t=44.95, P=0.000, and so on were all statistically significant in the 6 scores. The difference between the 8 scores of the instrumental daily activities (t=139.28, P=0.000), shopping (t =96.15), preparing meals, housekeeping, etc. The difference was statistically significant (P0.05).6, and the MoCA scale score showed that there were significant differences in the score of the MoCA scale and the eight subscales in the group of mood disorders (group A) with no emotional disorder group (group B), and the total score of the MoCA scale (group B) was higher than that in the group of mood disorders (A group) (t=125.67, P=0.000). The cognition of visual space and executive ability (group B) was higher than that of the group of emotional disorder (group A) (group A) (t=61.53, P=0.000) (P0.05).7, and the score of interpersonal communication ability scale showed that the score of interpersonal communication ability scale in the group of emotional disorder (group A) was higher than that of the critical value, and the average score was (184.99 + 59.86). Compared with the group without emotional disorder (B group), the difference of the score was poor. The difference was statistically significant (t=65.44, P=0.000), (P0.05).8, and the score of family intimacy and adaptive scale showed that there were significant differences in family cohesion (t=61.53, P=0.000) and family adaptability (t=19.41, P =0.000) in the group of emotional disorders (A group) compared with those without emotional disorder group (group B). The emotional disorder group (group A) had a correlation with the scores of the quality of life, the SAS scale, the SDS scale score and the ADL scale, the MoCA scale, the family intimacy and the adaptive scale, which showed a significant linear and linear regression relationship.10, daily life energy, cognitive ability, interpersonal communication ability, family intimacy and adaptation. The multiple linear regression equation fitted with SAS score in the group of stress and emotional disorder (A group) had statistical significance (compound correlation coefficient R=0.68, decision coefficient R2=0.47). The SDS score fitting multiple linear regression equation with emotional disorder group (A group) was also statistically significant (composite phase R=0.59, determining coefficient R2=0.35). Conclusion 1, sex, educational level, family Annual income, medical insurance, age, marital status, family relationship, medical care relationship, smoking habits, drinking habits, exercise habits, and sleep quality have significant influence on the anxiety and depression of stroke patients. The occupational and dietary rules have no significant correlation with anxiety and depression after stroke.2, daily living ability, cognitive ability and interpersonal communication ability. Stress, family intimacy and adaptability have significant influence on the anxiety and depression of stroke patients, and the patients with stroke are more likely to have anxiety and depression, and cause anxiety after stroke, and there are many causes of depression.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3;R749

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