發(fā)布時(shí)間：2018-04-21 08:46

  本文選題：埋藏式心律轉(zhuǎn)復(fù)除顫器 + 心理障礙�。� 參考：《昆明醫(yī)學(xué)院》2008年碩士論文

【摘要】： 目的了解埋藏式心律轉(zhuǎn)復(fù)除顫器(ICD)患者中心理障礙的發(fā)病率,探討心理障礙的病因與發(fā)病學(xué)機(jī)制,評(píng)價(jià)標(biāo)準(zhǔn)心理干預(yù)項(xiàng)目與綜合治療即“拼盤治療”的療效。 方法選取從1998年～2007年12月在昆明醫(yī)學(xué)院第一附屬醫(yī)院行ICD/CRT-D植入術(shù)的患者以及在外院植入而到本院隨訪的患者88人(男78人,女10人,平均年齡60.8歲),所有患者均接受中國(guó)生活事件量表(LES)、適應(yīng)不良自評(píng)量表、防御方式問卷(DSQ)、癥狀自評(píng)量表(SCL-90)、社會(huì)支持評(píng)定量表(SSRS)、ICD與回避行為問卷、漢密爾頓抑郁量表(HRSD)和漢密爾頓焦慮量表(HAMA)進(jìn)行心理狀態(tài)評(píng)估,并選取昆明醫(yī)學(xué)院部分在校研究生51例作為正常對(duì)照組(健康人群),采用相同量表進(jìn)行心理狀態(tài)評(píng)估,與ICD患者進(jìn)行對(duì)比分析。選取2006年8月～2007年8月進(jìn)行手術(shù)的病人分為兩組,一組僅予以簡(jiǎn)單的健康教育,另一組予以ICD相關(guān)信息的全面健康教育;所有手術(shù)病人于術(shù)前1周和術(shù)后1周、1月、3月、6月及9月分別采用上述量表進(jìn)行心理狀態(tài)評(píng)估。對(duì)于除外上述提及的手術(shù)患者中未接受ICD放電的隨訪病例,發(fā)現(xiàn)存在心理障礙的患者予以綜合治療即“拼盤治療”并在治療后1周、2周、4周、6周和10周再次進(jìn)行心理狀態(tài)評(píng)估,與此同時(shí)采用病情嚴(yán)重程度(SI)與療效總評(píng)(GI)兩項(xiàng)指標(biāo)進(jìn)行疾病嚴(yán)重程度和療效評(píng)價(jià)。病例追蹤隨訪采用門診復(fù)查、住院觀察、電話隨訪及上門隨訪等方式進(jìn)行,患者心理評(píng)估采用觀察法、問卷法及半結(jié)構(gòu)式晤談法進(jìn)行。 結(jié)果本研究過程中失訪兩例,均為男性死亡病例(具體死因不詳),總共完成隨訪292例次。研究發(fā)現(xiàn)ICD患者的心理健康狀況較差其中42%存在心理障礙,明顯高于健康對(duì)照組差異具有顯著統(tǒng)計(jì)學(xué)意義(P＜0.01),其中以焦慮(包括驚恐發(fā)作和廣泛性焦慮)、睡眠障礙、適應(yīng)不良和抑郁為主要表現(xiàn)。本研究表明以SCL-90作為ICD患者是否出現(xiàn)心理障礙的衡量指標(biāo),其中以軀體化、焦慮與恐怖是最有意義的預(yù)測(cè)因子;應(yīng)用HARD作為抑郁的評(píng)判指標(biāo),ICD患者抑郁狀態(tài)以焦慮/軀體化、絕望感、睡眠障礙、遲緩和認(rèn)知障礙作為預(yù)測(cè)指標(biāo);應(yīng)用HAMA作為焦慮的評(píng)判指標(biāo),ICD患者焦慮狀態(tài)中精神性與軀體性癥狀具有同等重要的意義,均是其發(fā)生的有力預(yù)測(cè)因素。在手術(shù)組患者的對(duì)照研究中采用SCL-90、HAMA、HRSD作為評(píng)價(jià)指標(biāo),實(shí)施經(jīng)驗(yàn)心理健康教育干預(yù)組的患者術(shù)后心理障礙程度明顯重于標(biāo)準(zhǔn)心理健康干預(yù)組的患者,心理障礙恢復(fù)時(shí)間也明顯長(zhǎng)于后者,兩組患者之間的差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05);標(biāo)準(zhǔn)干預(yù)組心理障礙發(fā)作高峰明顯提前,嚴(yán)重程度也有所減輕;并且兩組患者均表現(xiàn)出心理障礙會(huì)隨時(shí)間消退的趨勢(shì)。在應(yīng)用綜合治療療法治療ICD患者心理障礙的研究中,治療前后以適應(yīng)不良自評(píng)量表、SCL-90、HAMA、HRSD、SI和GI作為評(píng)價(jià)指標(biāo),結(jié)果證明該療法能夠明顯改善患者心理障礙的嚴(yán)重程度(P＜0.05),并在患者接受治療的第二周開始顯現(xiàn)療效(P＜0.05)。本研究發(fā)現(xiàn)ICD放電與心理防御方式是ICD患者心理障礙的強(qiáng)烈預(yù)測(cè)因素。由本研究揭示的心理障礙病因及其他研究的成果推論ICD患者心理障礙發(fā)病的可能潛在機(jī)制為經(jīng)典條件反射理論、學(xué)習(xí)無助理論和認(rèn)知評(píng)價(jià)理論所解釋。 結(jié)論1.ICD患者心理障礙的發(fā)病率顯著高于健康人群,不僅嚴(yán)重?fù)p害了患者的生活質(zhì)量,甚至降低了患者的生存率,并且長(zhǎng)期未受到應(yīng)有重視。2.ICD患者心理障礙的癥狀隨時(shí)間呈現(xiàn)山巒狀消退趨勢(shì)。3.本研究發(fā)現(xiàn)ICD患者心理障礙發(fā)病高危預(yù)測(cè)因素為:ICD放電、心理防御方式。4.ICD患者心理障礙發(fā)病的潛在機(jī)制可能為經(jīng)典條件反射理論、學(xué)習(xí)無助理論和認(rèn)知評(píng)價(jià)理論所解釋。5.標(biāo)準(zhǔn)心理健康教育干預(yù)措施能夠最大限度地減少ICD患者心理障礙癥狀的發(fā)生,減輕心理障礙的嚴(yán)重程度,更快的恢復(fù)到正常生活。6.綜合治療即“拼盤治療”對(duì)存在心理障礙的ICD患者能夠發(fā)揮上佳的治療效果,并在治療第二周開始發(fā)揮療效。7.ICD患者的常規(guī)隨訪中應(yīng)定期進(jìn)行心理狀態(tài)評(píng)估和心理咨詢,及時(shí)對(duì)ICD患者的心理障礙發(fā)揮早發(fā)現(xiàn)、早治療的一、二級(jí)預(yù)防作用。
[Abstract]:Objective to understand the incidence of psychological disorders in patients with buried cardiac arrhythmias (ICD), to explore the etiology and pathogenesis of psychological disorders, and to evaluate the therapeutic effect of standard psychological intervention and integrated treatment ("chicooy").
Methods from 1998 to December 2007, 88 patients (78 men, 10 women, 60.8 years old) were followed up in the First Affiliated Hospital of Kunming Medical University (78 men, 10 women, 60.8 years old). All the patients accepted the Chinese life event scale (DSQ), the Defense Style Questionnaire (DSQ), and the disease. Self rating scale (SCL-90), social support rating scale (SSRS), ICD and avoidance behavior questionnaire, Hamilton Depression Scale (HRSD) and Hamilton Anxiety Scale (HAMA) were used to evaluate the psychological status, and 51 postgraduates from Kunming Medical University were selected as the normal control group (healthy population), and the psychological state assessment was carried out by the same scale. The patients were compared with the ICD patients. The patients from August 2006 to August 2007 were divided into two groups. One group was only given a simple health education, the other was given a comprehensive health education with ICD related information. All the patients were evaluated by the above scale for mental state assessment in the 1 weeks before operation and 1 weeks after the operation, January, March, June and September, respectively. For a follow-up case that had not received ICD discharge in the patients with the exception of the above mentioned above, it was found that the patients with mental disorders were treated with a combination of "chawing therapy" and another psychological assessment for 1 weeks, 2 weeks, 4 weeks, 6 and 10 weeks after treatment, while two indexes of the disease severity (SI) and the total effect assessment (GI) were used. The severity and efficacy of the disease were evaluated. The follow-up follow-up was carried out by outpatient review, in-patient observation, telephone follow-up and follow-up. The patient's psychological assessment was observed by observation, questionnaire and semi structural discussion.
Results in this study, two cases were lost, all of which were male deaths (specific causes of death), and a total of 292 cases were followed up. The psychological health status of ICD patients was poor, and 42% of them had mental disorders, which were significantly higher than those of the healthy control group (P < 0.01). Generalized anxiety), sleep disorders, maladaptation and depression were the main manifestations. This study showed that SCL-90 was used as a measure of mental disorders in ICD patients, in which somatization, anxiety and terror were the most significant predictors; the use of HARD as a criterion for depression, and the depression of ICD patients with anxiety / somatization, despair, Sleep disorders, retardation, and cognitive impairment were used as predictors. Using HAMA as a marker of anxiety, the mental and physical symptoms of ICD patients were of the same importance, all of which were powerful predictors of their occurrence. In the control study of the operation group, SCL-90, HAMA, and HRSD were used as evaluation indicators to implement the experience. The psychological disorder of the patients in the health education intervention group was significantly higher than that in the standard mental health intervention group, and the recovery time of the mental disorder was also significantly longer than the latter. The difference between the two groups was statistically significant (P < 0.05); the peak of the mental disorder in the standard intervention group was obviously ahead of time and the severity was also reduced. The two groups of patients showed the tendency to decline with time. In the study of the treatment of psychological disorders in ICD patients with comprehensive treatment therapy, before and after treatment, SCL-90, HAMA, HRSD, SI and GI were used as evaluation indicators. The results showed that the therapy could significantly improve the severity of mental disorders in patients (P < 0.05). The effect of the second weeks of treatment was observed (P < 0.05). This study found that ICD discharge and psychological defense were a strong predictor of psychological disorders in ICD patients. The possible underlying mechanism of psychological disorders in ICD patients was deduced from the causes of psychological disorders and other research results revealed in this study. On the theory of learning helplessness and the theory of cognitive evaluation.
Conclusion the incidence of mental disorders in 1.ICD patients is significantly higher than that in healthy people, not only seriously damaging the quality of life of the patients, even reducing the survival rate of the patients, and the symptoms of the mental disorder of the patients with.2.ICD are not due to the trend of mountain range decline with time.3.. This study found the risk of psychological disorder in ICD patients. The test factors are: ICD discharge, psychological defense mode.4.ICD patients' psychological disorder may be the underlying mechanism of the classical conditioned reflex theory, learning helplessness theory and cognitive evaluation theory explained that.5. standard mental health education intervention measures can minimize the occurrence of psychological disorders in ICD patients and reduce the severity of psychological disorders. Degree, faster recovery to normal life,.6. comprehensive treatment is "platter therapy" for ICD patients with mental disorders, and the psychological status assessment and psychological counseling should be carried out regularly during the second week treatment of patients with therapeutic.7.ICD, and psychological disorders in ICD patients should be played in time. Early discovery, early treatment of one, two stage preventive effect.

【學(xué)位授予單位】：昆明醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R395

【共引文獻(xiàn)】

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