本文選題：卒中后睡眠障礙 + 生活質(zhì)量　； 參考：《湖北中醫(yī)藥大學》2017年碩士論文

【摘要】：目的比較缺血性腦卒中睡眠障礙與非睡眠障礙患者焦慮、抑郁、疲勞水平及生活質(zhì)量的差異,分析卒中后睡眠障礙(Post-Stroke Sleep Disorder,PSSD)患者睡眠質(zhì)量與生存質(zhì)量的相關(guān)性;觀察烏靈膠囊聯(lián)合草酸艾司西酞普蘭治療卒中后睡眠障礙的療效及兩藥聯(lián)用對患者生活質(zhì)量的改善情況。方法1.選取2016年6月-2017年2月在解放軍武漢總醫(yī)院神經(jīng)內(nèi)科住院治療的103例急性缺血性腦卒中(2周內(nèi))患者為研究對象,對所有患者進行匹茲堡睡眠質(zhì)量指數(shù)量表(Pittsburgh Sleep Quality Index,PSQI)測評,根據(jù)PSQI量表結(jié)果將患者分為兩組,PSQI評分≥7的患者作為睡眠障礙組,PSQI評分7的患者作為非睡眠障礙組。收集所有患者的人口統(tǒng)計學資料及臨床資料,分別對兩組患者行美國國立衛(wèi)生研究院卒中量表(Nation Institutes of Health Stroke Scales,NHISS)、漢密頓焦慮量表(Hamilton Anxiety Scale,HAMA)、漢密頓抑郁量表(Hamilton Depression Scale,HAMD)、疲勞嚴重度量表(Fatigue Severity Scale,FSS)及卒中專門生存質(zhì)量量表(Stroke-Specific Quality of Life Scale,SS-QOL)測評。比較缺血性腦卒中睡眠障礙患者與非睡眠障礙患者焦慮、抑郁情緒、疲勞水平及生活質(zhì)量的差異;運用多元逐步回歸分析法對卒中后睡眠障礙患者睡眠質(zhì)量與生活質(zhì)量的相關(guān)性進行分析。2.64例卒中后睡眠障礙患者隨機分為兩組,其中對照組31例,研究組33例,所有患者均給予急性缺血性腦卒中常規(guī)藥物治療,在此基礎(chǔ)上對照組給與草酸艾司西酞普蘭(口服10mg 1次/日),研究組給與烏靈膠囊(口服0.99g 3次/日)聯(lián)合草酸艾司西酞普蘭(口服10mg 1次/日)。分別于治療前及治療后2周、4周對兩組患者進行PSQI、HAMA量表、HAMD量表、FSS量表及SS-QOF量表評定,比較兩組患者治療前及治療后各時間段各項量表評分的差異,觀察兩組藥物治療卒中后睡眠障礙的療效及生活質(zhì)量的改善情況,同時記錄患者服用藥物的不良反應(yīng)。結(jié)果1.103例缺血性腦卒中患者分為兩組,其中睡眠障礙組64例,非睡眠障礙組39例,睡眠障礙組患者的PSQI量表評分、NHISS評分、HAMA量表評分、HAMD量表評分、FSS量表評分及SS-QOF量表評分與非睡眠障礙組患者相比差異具有統(tǒng)計學意義(P0.05)。64例卒中后睡眠障礙患者中,輕度睡眠障礙5例,中度睡眠障礙50例,重度睡眠障礙9例;對卒中后睡眠障礙患者睡眠質(zhì)量與生存質(zhì)量的多元逐步回歸分析結(jié)果顯示睡眠效率及睡眠時間與生活質(zhì)量呈正相關(guān),睡眠時間對卒中患者生活質(zhì)量的影響更為顯著。2.64例卒中后睡眠障礙患者隨機分為2組,對照組31例,研究組33例,兩組患者的年齡、男女構(gòu)成、PSQI評分、NHISS評分相比較無統(tǒng)計學差異(P0.05),具有可比性。(1)匹茲堡睡眠質(zhì)量指數(shù)(PSQI)評分:兩組患者治療后2周、4周的PSQI評分與治療前相比均有顯著性差異(P0.01);研究組治療后2周、4周的PSQI量表評分與對照組相比較差異具有統(tǒng)計學意義(P0.05)。(2)漢密頓焦慮量表(HAMA)評分、漢密頓抑郁量表(HAMD)評分:兩組患者治療后2周、4周的HAMA量表和HAMD量表評分與治療前相比均有顯著性差異(P0.01);研究組治療后2周、4周的HAMA量表和HAMD量表評分與對照組相比較差異具有統(tǒng)計學意義(P0.05)。(3)疲勞嚴重度量表(FSS)評分:研究組治療后2周、4周的FSS量表評分與治療前相比較有顯著性差異(P0.01);對照組的FSS量表評分治療前與治療后各時間段相比較無顯著性差異(P0.05);治療2周后兩組患者的FSS量表評分無顯著性差異(P0.05),治療4周研究組FSS量表評分低于對照組(P0.05)。(4)卒中專門生存質(zhì)量量表(SS-QOF)評分:兩組患者治療后2周、4周的SS-QOF量表評分與治療前相比較有顯著性差異(P0.01);研究組治療后2周、4周的SS-QOF量表評分與對照組相比差異具有統(tǒng)計學意義(P0.05)。結(jié)論1.缺血性腦卒中睡眠障礙患者的神經(jīng)功能缺損程度重于與非睡眠障礙患者,卒中后睡眠障礙患者相較于非睡眠障礙患者其焦慮、抑郁負性情緒嚴重,疲勞水平高,生活質(zhì)量差。對卒中患者進行積極的藥物治療和肢體康復(fù)訓練的同時還應(yīng)關(guān)注卒中患者的睡眠質(zhì)量,預(yù)防卒中后睡眠障礙的發(fā)生。對卒中后睡眠障礙患者應(yīng)積極干預(yù),對其負性情緒進行藥物治療和心理疏導,提高卒中患者的生活質(zhì)量。2.烏靈膠囊聯(lián)合草酸艾司西酞普蘭和單用草酸艾司西酞普蘭均能改善卒中患者的睡眠障礙,烏靈膠囊聯(lián)合草酸艾司西酞普蘭治療卒中后睡眠障礙的療效優(yōu)于單用草酸艾司西酞普蘭。烏靈膠囊能改善卒中患者的睡眠情況、緩解疲勞,草酸艾司西酞普蘭治療焦慮、抑郁,兩藥聯(lián)用較單用草酸艾司西酞普蘭能在短期內(nèi)改善卒中患者的生活質(zhì)量。
[Abstract]:Objective to compare the differences of anxiety, depression, fatigue and quality of life in patients with apoplexy and non sleep disorders, and to analyze the correlation between sleep quality and quality of life in patients with Post-Stroke Sleep Disorder (PSSD), and to observe the combination of Wuling capsule combined with oxalic acid Ai Sciplan in the treatment of post stroke sleep disorder. The curative effect and the improvement of the quality of life of the patients combined with the combined use of two drugs. Method 1. 103 cases of acute ischemic stroke (2 weeks) hospitalized in the Department of Neurology, Wuhan general hospital, Wuhan General Hospital of the Liberation Army in June 2016, were selected as the subjects. The Pittsburgh sleep quality index scale (Pittsburgh Sleep Quality Index) was carried out for all patients. PSQI) assessment, according to the results of the PSQI scale, the patients were divided into two groups, the patients with PSQI score more than 7 were used as sleep disorder group, and the patients with PSQI score 7 were used as non sleep disorder group. The demographic data and clinical data of all patients were collected, and the National Health Institute Stroke Scale (Nation Institutes of Health Str) was performed on the two groups of patients. Oke Scales, NHISS), the Hamilton Anxiety Scale (Hamilton Anxiety Scale, HAMA), the Hamilton Depression Scale (Hamilton Depression Scale, HAMD), the severity of the fatigue measurement, and the assessment of the apoplexy specific quality of life scale. The difference of anxiety, depression, fatigue, and quality of life in the patients with non sleep disorders, and the correlation of sleep quality and quality of life in patients with sleep disorders after stroke were analyzed by multiple stepwise regression analysis (.2.64), two groups were randomly divided into two groups, 31 in the control group and 33 in the study group. On the basis of the conventional drug treatment for acute ischemic stroke, the control group gave oxalitalopram (oral 10mg 1 times per day). The study group gave Wuling capsule (oral 0.99g 3 times / day) combined with oxalic acid Ai Sciplan (oral 10mg 1 times / day). Before and 2 weeks after treatment and 4 weeks, two groups were given PSQI, HA The MA scale, the HAMD scale, the FSS scale and the SS-QOF scale were evaluated to compare the difference of the scale scores between the two groups before and after the treatment. The curative effect and the improvement of the quality of life were observed in the two groups of drugs in the treatment of sleep disorders after stroke, and the adverse reactions of the patients were recorded. The results of 1.103 patients with ischemic stroke were observed. There were two groups, including 64 sleep disorders, 39 non sleep disorders, PSQI scale score, NHISS score, HAMA scale score, HAMD scale score, FSS scale score, SS-QOF scale score and non sleep disorder group with statistical significance (P0.05).64 case after stroke sleep disorder patients were mild. 5 cases of sleep disorders, 50 cases of moderate sleep disorder and 9 cases of severe sleep disorder. Multiple stepwise regression analysis of sleep quality and quality of life after stroke patients showed that sleep efficiency and sleep time were positively related to the quality of life. The effect of sleep time on the living quality of stroke patients was more significant.2.64 after stroke sleep. The patients were randomly divided into 2 groups, the control group 31 cases, the study group 33 cases, the age of the two groups, the PSQI score, the NHISS score and the comparable (P0.05). (1) the Pittsburgh sleep quality index (PSQI) score: two groups of patients after 2 weeks, 4 weeks of PSQI score compared with before treatment have significant difference (P0.01) 2 weeks after treatment, 2 weeks after treatment, 4 weeks of PSQI scale score compared with the control group had a statistically significant difference (P0.05). (2) Hamilton Anxiety Scale (HAMA) score, Hamilton Depression Scale (HAMD) score: two groups of patients after 2 weeks of treatment, 4 weeks of HAMA scale and HAMD scale scores compared with before treatment were significantly different (P0.01); the study group treatment After 2 weeks, the 4 week HAMA scale and the HAMD scale score compared with the control group was statistically significant (P0.05). (3) the fatigue severity scale (FSS) score: the FSS scale of the study group was significantly different from that before the treatment (P0.01) at the 4 week after treatment (P0.01); the FSS scale of the group was compared with the time period of the treatment before and after the treatment. There was no significant difference (P0.05), and there was no significant difference between the two groups after 2 weeks of treatment (P0.05). The score of the FSS scale in the 4 week treatment group was lower than that of the control group (P0.05). (4) the score of specific quality of life (SS-QOF) for stroke (SS-QOF): two groups of patients at 2 weeks after treatment, and 4 weeks' SS-QOF scale scores were significantly different from those before treatment (P0.01). The SS-QOF scale score of the study group after 2 weeks and 4 weeks was statistically significant compared with the control group (P0.05). Conclusion the degree of neural function defect in patients with 1. ischemic stroke sleep disorders is more severe than that of non sleep disorder patients, and the patients with sleep disorders after stroke are more anxious than those with non sleeping disorders, and the negative mood of depression is serious and fatigue. High level of work and poor quality of life. Active drug therapy and limb rehabilitation training for stroke patients should also pay attention to the quality of sleep in stroke patients and prevent the occurrence of sleep disorders after stroke. Quality of life.2. Wuling capsule combined with essialopram oxalate and single oxalate Ai Sciplan can improve the sleep disturbance in stroke patients. The efficacy of Wuling capsule combined with oxalic acid Ai Sciplan in the treatment of post stroke sleep disorders is better than that of oxalic oxalic citalopram. Fatigue and oxalic acid Ai Sciplan treatment of anxiety and depression, two drugs combined with escitalopram oxalate alone can improve the quality of life of stroke patients in a short time.
【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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