本文選題：社區(qū)高血壓 + 睡眠障礙�。� 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]通過對昆明市棕樹營社區(qū)高血壓患者的主觀睡眠狀況調(diào)查,探討性別、年齡、職業(yè)、文化程度、退休情況、既往軀體疾病史、經(jīng)濟收入及血壓控制水平對高血壓患者睡眠障礙患病率的影響,為高血壓的社區(qū)管理及防治提供參考。[方法]2017年1月至2017年4月調(diào)查在棕樹營社區(qū)衛(wèi)生服務(wù)中心建立健康檔案的高血壓患者共450人,33人因信息不全面剔除,共收入417人,通過社區(qū)門診對病人進(jìn)行隨訪調(diào)查,內(nèi)容包括性別、年齡、職業(yè)、文化程度、退休情況、既往軀體疾病史、經(jīng)濟收入、血壓控制水平、主觀睡眠質(zhì)量及焦慮抑郁情況。主觀睡眠質(zhì)量的評估目前公認(rèn)用于評估受試者近1個月主觀睡眠質(zhì)量的是匹茲堡睡眠質(zhì)量指數(shù)(PSQI)量表,其共包括19個自評條目和5個他評條目,其中第19個自評條目和5個他評條目不參與計分,總分0～21分,得分越高,表示睡眠質(zhì)量越差。0～6分為無睡眠障礙,7～11分為輕度睡眠障礙,12～16分為中度睡眠障礙,17～21分為重度睡眠障礙。焦慮及抑郁狀況評估使用醫(yī)院焦慮抑郁量表(HADS)評估,HADS在綜合醫(yī)院門診和健康人群體檢的中均有較高的信度及效度。HADS由14個條目組成,其中7個條目評定為抑郁,7個條目評定為焦慮。共有6條反向提問條目,5條在抑郁分量表,1條在焦慮分量表。抑郁/焦慮總分為0～21分:0～7分無抑郁/焦慮,8～10分可能或臨界抑郁/焦慮,11～21分明顯抑郁/焦慮。根據(jù)資料統(tǒng)計分析高血壓患者的睡眠障礙患病率與性別、年.齡、職業(yè)、文化程度、退休情況、既往軀體疾病史、經(jīng)濟收入及血壓控制水平是否具有相關(guān)性。[結(jié)果]1、本研究顯示417例高血壓患者中合并睡眠障礙者共189例,患病率為45.3%。2、女性高血壓患者睡眠障礙患病率(51.9%)高于男性高血壓患者(36.5%),高血壓患者不同性別之間睡眠障礙患病率差異有統(tǒng)計學(xué)意義(P0.05)。女性輕、中、重度睡眠障礙的患病率(分別為25.1%、22.6%、4.2%)均高于男性(分別為24.2%、10.1%、2.2%),以中度睡眠障礙的患病率差異最為明顯。3、65歲的高血壓患者與≥65歲的高血壓患者之間,其睡眠障礙的患病率分別為40.2%、47.7%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。4、腦力勞動與體力勞動的高血壓患者(以其未退休前的工作情況進(jìn)行區(qū)分,包括已退休的高血壓患者)其睡眠障礙患病率分別為46.1%,44.3%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。5、退休與未退休高血壓患者比較,兩者之間差異統(tǒng)計學(xué)意義(P0.05)。已退休的高血壓患者(包括既往為農(nóng)民、小商販等無工作單位但現(xiàn)已不再從事任何職業(yè)的人員)睡眠障礙的患病率(46.1%)明顯高于未退休的高血壓患者(35.5%)。6、不同文化程度高血壓患者之間其睡眠障礙的患病率分別為46.2%(小學(xué)及以下),48.7%(中學(xué)),37.6%(大學(xué)及以上),差異有統(tǒng)計學(xué)意義(P0.05)。7、有軀體疾病史的高血壓患者其睡眠障礙的患病率(58.1%)明顯高于無軀體疾病史的高血壓患者(36.3%),差異有統(tǒng)計學(xué)意義(P0.001),8、高血壓患者家庭平均月收入3500元及以下者與3500元以上者睡眠障礙患病率分別為48.0%、39.0%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。9、平均血壓SBP140mmHg和DBP90mmHg的高血壓患者及SBP≥140mmHg和(或)DBP≥90mmHg的高血壓者睡眠障礙患病率分別為51.1%、42.4%,兩者比較差異無統(tǒng)計學(xué)意義(P0.05)。[結(jié)論]1、本研究女性高血壓患者睡眠障礙的患病率高于男性高血壓患者,尤其以中度睡眠障礙的患病率明顯高于男性,當(dāng)女性高血壓患者血壓控制出現(xiàn)波動調(diào)整降壓藥物效果欠佳時,更應(yīng)注意其睡眠狀況。2、退休的高血壓患者(包括既往為農(nóng)民、小商販等無工作單位但現(xiàn)已不再從事任何職業(yè)的人員)睡眠障礙患病率明顯高于未退休的高血壓患者(包括農(nóng)民、小商販等只要尚在工作均歸于未退休人員)。已退休的高血壓患者的血壓控制更應(yīng)結(jié)合其睡眠情況進(jìn)行綜合分析。3、不同文化程度的高血壓患者之間其睡眠障礙的患病率存在差異,中學(xué)學(xué)歷者的睡眠障礙患病率最高,小學(xué)及以下者次之,大學(xué)及以上最低。本研究結(jié)果提示高血壓患者睡眠障礙患病率與文化程度有關(guān),中學(xué)學(xué)歷特別是初中學(xué)歷的高血壓患者更應(yīng)重視其睡眠質(zhì)量。4、既往有軀體疾病史的高血壓患者其睡眠障礙患病率明顯高于無軀體疾病史的高血壓患者。5、本研究高血壓患者睡眠障礙的患病率與年齡、職業(yè)、血壓控制水平、經(jīng)濟收入無相關(guān)性,需擴大樣本量進(jìn)一步研究。
[Abstract]:[Objective] to explore the influence of sex, age, occupation, education, retirement, past physical disease history, economic income and blood pressure control level on the prevalence of sleep disorders in hypertensive patients by investigating the subjective sleep status of hypertensive patients in Kunming brown tree camp community, and to provide reference for the community management and prevention of hypertension. [method]2 From January to April 2017, a total of 450 people were investigated for the establishment of health records in the palm tree camp community health service center. 33 people were excluded from the information and received 417 people. The patients were followed up through the community outpatient clinic, including gender, age, occupation, degree of literature, retirement, history of past somatic diseases, and economic income. The level of blood pressure control, subjective sleep quality and anxiety and depression. The assessment of subjective sleep quality is currently used to assess the subjective sleep quality of the subjects for the last 1 months. The Pittsburgh sleep quality index (PSQI) scale, which includes 19 self-evaluation items and 5 items of his evaluation, nineteenth self-evaluation items and 5 entries without participation. The score of the total score was 0~21 points, the higher the score, the worse the sleep quality was.0 to 6, 7~11 was mild sleep disorder, 12~16 was moderate sleep disorder, 17~21 was severe sleep disorder. The evaluation of anxiety and depression was assessed using the hospital anxiety and Depression Scale (HADS), and HADS was examined in the outpatient and healthy people of the general hospital. The high reliability and validity of.HADS was composed of 14 items, of which 7 items were rated as depression and 7 items were rated as anxiety. There were 6 reverse questions, 5 in the depression scale, 1 in the anxiety scale. The total score of depression / anxiety was 0~21, 0~7 had no depression / worry, 8~10 points or critical depression / anxiety, 11~21 points. Significant depression / anxiety. According to data analysis, whether the incidence of sleep disorders in hypertensive patients was correlated with sex, age, age, occupation, education, retirement, history of past somatic disease, economic income and blood pressure control. [results]1, this study showed that 189 patients with 417 patients with high blood pressure were associated with sleep disorders. The rate of 45.3%.2, the incidence of sleep disorders in women with hypertension (51.9%) was higher than that of men with hypertension (36.5%), and there was a significant difference in the incidence of sleep disorders among the patients with hypertension (P0.05). The prevalence of mild, moderate, and severe sleep disorders in women (25.1%, 22.6%, 4.2%) were higher than those of men (24.2%, 10.1%, 2.2%, respectively). The difference in the prevalence of moderate sleep disorders between.3,65 years old and hypertension patients aged 65 years was 40.2% and 47.7%, respectively, and there was no significant difference between the two (P0.05).4, and the high blood pressure patients with mental labor and physical labor were distinguished by their pre retirement work. The prevalence of sleep disorders, including retired hypertension, was 46.1%, 44.3%, and there was no significant difference between the two (P0.05).5. The difference between the retired and the non retired hypertension patients was statistically significant (P0.05). The prevalence of sleep disorders (46.1%) was significantly higher than that of non retired hypertension (35.5%).6, and the prevalence of sleep disorders among hypertensive patients with different educational levels was 46.2% (primary and below), 48.7% (middle school), 37.6% (P0.05), and the difference was statistically significant (P0.05).7, with a history of somatic disease The incidence of sleep disorders in hypertensive patients (58.1%) was significantly higher than that of hypertension patients without the history of somatic disease (36.3%), the difference was statistically significant (P0.001), 8, the average monthly income of 3500 yuan and less than 3500 yuan in patients with hypertension was 48% and 39%, respectively, and there was no significant difference between the two (P0.05). .9, the incidence of sleep disorders in hypertensive patients with average blood pressure of SBP140mmHg and DBP90mmHg and those with SBP > 140mmHg and (or) DBP > 90mmHg were 51.1%, 42.4%, respectively, and there was no significant difference (P0.05). [conclusion]1, the prevalence of sleep disorders in women with hypertension was higher than that of male hypertensive patients, especially moderate to moderate hypertension. The prevalence of sleep disorders is significantly higher than that in men. When women with hypertension have poor blood pressure control, they should pay more attention to their sleep status,.2. Retired hypertensive patients (including those who have no work units such as farmers, small vendors but no longer engaged in any profession) have a significant rate of sleep disorder. High blood pressure in patients with high blood pressure (including farmers, peddlers, etc. as long as they are still in work). The blood pressure control of retired hypertensive patients should be combined with their sleep conditions to make a comprehensive analysis of.3. There is a difference in the prevalence of sleep barriers between people with different educational levels and the sleep of high school students. The results of this study suggest that the prevalence of sleep disorders in hypertensive patients is associated with the degree of sleep disorder. High school education, especially those with high school education, should pay more attention to their sleep quality.4, and the prevalence of sleep disorders in patients with a history of somatic disease is clear. The incidence of sleep disorders in hypertensive patients with.5 was higher than in the history of somatic disease. The incidence of sleep disorders in hypertensive patients was not related to age, occupation, blood pressure control level, and economic income. Further study was needed to expand the sample size.

【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】：R544.1

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