本文選題：高血壓 + 焦慮�。� 參考：《南昌大學》2017年碩士論文

【摘要】：背景及目的:心血管疾病具有較高的心理障礙發(fā)生率,同時伴有焦慮障礙的心血管人群更容易發(fā)生心腦血管事件。明顯的焦慮情緒或者抑郁情緒是高血壓獨立的危險因素,不僅降低藥物治療效果,影響高血壓患者的預后,還因為焦慮抑郁情緒與高血壓相互作用而明顯降低患者生活質(zhì)量。本研究擬初步探討高血壓合并焦慮、抑郁及混合焦慮抑郁狀態(tài)(MADD)患者的流行病學資料;同時比較正常血壓、正常血壓合并MADD、高血壓、高血壓合并焦慮、高血壓合并抑郁及高血壓合并MADD人群相關指標差異,并探討高血壓合并MADD的有效治療方案,以為高血壓合并焦慮、抑郁或MADD患者的診斷、治療提供有參考。研究方法:橫斷面調(diào)查研究以門診確診為高血壓患者2000例為調(diào)查對象,收集調(diào)查患者的年齡、性別、血壓、血管內(nèi)皮功能、血小板因子4及焦慮自評量表(SAS)、抑郁自評量表(SDS)評分等資料。前瞻性對照研究以正常血壓、正常血壓合并MADD、高血壓、高血壓合并焦慮、高血壓合并抑郁及高血壓合并MADD共6類人群作為研究對象。6組研究對象納入研究后分別給予個體化的最佳治療方案,其中高血壓的治療用藥均首選長效二氫吡啶類鈣拮抗劑(氨氯地平),若血壓不能達標則加用血管緊張素轉化酶抑制劑(依那普利),若仍不能達標則退出研究;高血壓合并焦慮、抑郁及MADD組患者均給予氟哌噻噸美利曲辛(商品名:黛力新;生產(chǎn)廠家:丹麥靈北制藥;批準文號:H20080175)治療,6組患者的研究周期均為2個月。2個月后重新收集患者的相關指標,并比較治療后與治療前相關指標的改善程度及比較各組間的治療效果差異。研究結果:橫斷面研究共納入高血壓患者2000例,其中單純高血壓、高血壓合并焦慮、高血壓合并抑郁及高血壓合并MADD分別為1275例(63.75%)、269例(13.45%)、283例(14.15%)及173例(8.65%);高血壓合并焦慮組的SAS評分(59.7±18.5)顯著高于另外3組(38.9±11.4,P=0.000;37.8±12.43,P=0.000;38.4±10.6,P=0.000),高血壓合并抑郁組的SDS評分(64.7±18.1)顯著高于其他3組(44.1±13.2,P=0.000;44.7±11.9,P=0.000;45.6±12.7,P=0.000),差異具有顯著性。高血壓合并MADD組的RHI(1.49±0.36)明顯低于另外3組(1.93±0.54,P=0.000;1.65±0.51,P=0.000;1.62±0.47,P=0.000),血小板因子(49.41±2.73)顯著高于其他3組(6.73±2.15,P=0.000;7.19±1.98,P=0.000;7.45±2.10,P=0.000),差異均具有顯著性。前瞻性研究共納入正常血壓組、高血壓組、正常血壓合并MADD組、高血壓合并焦慮組、高血壓合并抑郁組及高血壓合并MADD組6組各40例。組間比較:高血壓合并MADD組RHI(1.47±0.38)顯著低于高血壓組(1.91±0.52),而血小板因子4(9.14±2.37)、dSBP(38.9±35.9)、dDBP(117.9±24.2)、nSBP(117.8±24.6)、nDBP(94.1±22.2)、24hSBP標準差(16.9±5.4)、24hSBP變異系數(shù)(31.95)、24hDBP標準差(10.9±3.4)及24hDBP變異系數(shù)(31.19)顯著高于高血壓組。治療后高血壓合并MADD組RHI(1.66±0.48)明顯低于高血壓組(1.94±0.56,P=0.017);高血壓合并MADD組RHI(1.66±0.48)明顯低于高血壓合并焦慮組(1.83±0.56,P=0.04)及高血壓合并抑郁組(1.82±0.71,P=0.017),差異均具有顯著性。組內(nèi)比較:治療后高血壓合并焦慮組SAS評分38.2±11.2顯著低于治療前59.8±18.6,高血壓合并抑郁組的SDS評分(43.1±12.8)明顯低于治療前(64.8±18.8,P=0.000);治療后高血壓合并MADD組、高血壓組、高血壓合并焦慮組及高血壓合并抑郁組的RHI明顯升高,而血小板因子4、dSBP、dDBP、nSBP、nDBP、24hSBP標準差、24hSBP變異系數(shù)、24hDBP標準差及24hDBP變異系數(shù)明顯降低;差異均具有顯著性(P0.05)。結論:1.高血壓合并MADD患者的血管內(nèi)皮功能低于單純高血壓、高血壓合并焦慮及高血壓合并抑郁患者,而血壓變異性更高;2.降壓藥物聯(lián)合黛力新治療高血壓合并焦慮、高血壓合并抑郁及高血壓合并MADD患者均可延緩甚至逆轉血管內(nèi)皮功能降低,同時降低血壓變異性
[Abstract]:Background and purpose: cardiovascular disease has a high incidence of mental disorders. Cardiovascular events in people with anxiety disorders are more likely to occur in cardiovascular and cerebrovascular events. Obvious anxiety or depression is a risk factor for hypertension, which not only reduces the effect of drug treatment, but also affects the prognosis of hypertensive patients, but also because of anxiety and depression. The study of hypertension combined with anxiety, depression and mixed anxiety and depression (MADD) was a preliminary study of the epidemiological data of hypertension, normal blood pressure, normal blood pressure combined with MADD, hypertension, high blood pressure combined with anxiety, hypertension combined with depression and hypertension. MADD population related indicators difference, and explore the effective treatment of hypertension combined with MADD, think of hypertension combined with anxiety, depression or MADD diagnosis, treatment provides a reference. Research methods: a cross-sectional study of 2000 cases of hypertension patients diagnosed as outpatient diagnosis of the image, collect investigation of the age, sex, blood pressure, intravascular Skin function, platelet factor 4 and anxiety self rating scale (SAS), self rating Depression Scale (SDS) score and other data. Prospective control study on normal blood pressure, normal blood pressure combined with MADD, hypertension, hypertension and anxiety, hypertension combined with depression and hypertension combined with MADD in a total of 6 groups were taken as subjects in group.6 after the study was included in the study, respectively. The best individualized treatment scheme was given, in which the treatment of hypertension was the first choice of the long effect two hydropyridine calcium antagonist (amlodipine). If the blood pressure could not reach the standard, the angiotensin converting enzyme inhibitor (Bea Knapp Leigh) was added to the study. The patients in the group of high blood pressure combined with anxiety, depression and MADD were given fluperthiazine. (commodity name: Deanxit: Deanxit; manufacturer: Danish Ling north pharmaceutical; Approval Number: H20080175) treatment. The study cycle of 6 groups of patients was 2 months after.2 months to re collect the related indexes, and compared the improvement of the related indexes after treatment and before treatment and compared the difference of treatment effect between each group. The results of the study: cross section The study included 2000 patients with hypertension, of which simple hypertension, hypertension combined anxiety, hypertension combined with depression and hypertension combined with MADD were 1275 (63.75%), 269 (13.45%), 283 (14.15%) and 173 (8.65%), and high blood pressure combined anxiety group (59.7 + 18.5) (59.7 + 18.5) was significantly higher than that of another 3 group (P=0.000; P =0.000; 38.4 + 10.6, P=0.000), the SDS score of the hypertension combined with depression group (64.7 + 18.1) was significantly higher than the other 3 groups (44.1 + 13.2, P=0.000; 44.7 + 11.9, P=0.000; 45.6 + 12.7, P=0.000), with significant difference. The RHI (1.49 + 0.36) of the hypertension combined with MADD group was significantly lower than that of the other groups (P=0.000, P=0.000; P=0.000; P=0.000, P=0.000), Platelet factor (49.41 + 2.73) was significantly higher than that of other 3 groups (6.73 + 2.15, P=0.000; 7.19 + 1.98, P=0.000, 7.45 + 2.10, P=0.000), and the differences were all significant. The prospective study included normal blood pressure group, hypertension group, normal blood pressure combined with MADD, hypertension combined anxiety group, hypertension combined with depression group and 6 groups of hypertension with MADD group 40 cases each. Group MADD: hypertension combined with RHI (1.47 + 0.38) was significantly lower than that of hypertension group (1.91 + 0.52), platelet factor 4 (9.14 + 2.37), dSBP (38.9 + 35.9), dDBP (117.9 + 24.2), nSBP (117.8 + 24.6), 24hSBP standard deviation, 24hSBP variation coefficient, 24hDBP standard deviation and 24hDBP variation coefficient. MADD group RHI (1.66 + 0.48) after treatment was significantly lower than that of hypertension group (1.94 + 0.56, P=0.017); hypertension combined with MADD group RHI (1.66 + 0.48) was significantly lower than hypertension combined anxiety group (1.83 + 0.56, P=0.04) and hypertension combined with depression group (1.82 + 0.71, P=0.017), and the difference was significant. The SAS score of hypertension combined anxiety group was 38.2 + 11.2 significantly lower than 59.8 + 18.6 before treatment. The SDS score of hypertension combined with depression group (43.1 + 12.8) was significantly lower than that before treatment (64.8 + 18.8, P=0.000). After treatment, the RHI of hypertension group, hypertension group, hypertension combined anxiety group and hypertension combined with depression group increased significantly, and platelets were significantly increased, and platelets were platelets. Factor 4, dSBP, dDBP, nSBP, nDBP, 24hSBP standard deviation, 24hSBP variation coefficient, 24hDBP standard deviation and 24hDBP variation coefficient significantly decreased, the difference was significant (P0.05). Conclusion: 1. the vascular endothelial function of patients with hypertension combined with MADD is lower than that of simple hypertension, hypertension combined with anxiety and hypertension with depression, and the blood pressure variability is higher; 2 Hypotensive drugs combined with Deanxit in the treatment of hypertension combined with anxiety, hypertension combined with depression and hypertension combined with MADD patients could delay or even reverse the decrease of vascular endothelial function and reduce blood pressure variability.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R544.1;R749

【參考文獻】

相關期刊論文 前10條

1 孫振曉;劉化學;焦林瑛;周濤;楊洛寧;范金云;;SAS和HADS-A對心血管疾病患者焦慮癥狀評定結果比較[J];四川精神衛(wèi)生;2016年04期

2 陳玉姣;陳友慶;;精神障礙患者心理推理能力研究綜述[J];中國心理衛(wèi)生雜志;2016年06期

3 王燕;李琳;叢偉紅;黃力;;原發(fā)性高血壓與血管內(nèi)皮功能的相關性分析[J];世界中西醫(yī)結合雜志;2016年03期

4 吳憲明;孫躍民;;焦慮抑郁與高血壓[J];中華高血壓雜志;2016年02期

5 劉粹;于雅琴;康嵐;吳燕華;廖金敏;王詩斌;孫麗君;黃成兵;谷朝霞;王希林;;北京市和吉林省高血壓共病抑郁及焦慮障礙患病率和心理社會因素分析[J];中華精神科雜志;2015年02期

6 ;在心血管科就診患者的心理處方中國專家共識[J];中華心血管病雜志;2014年01期

7 胡強;萬玉美;蘇亮;李惠;金一;李婷;王繼軍;李春波;張明園;;中國普通人群焦慮障礙患病率的薈萃分析[J];中華精神科雜志;2013年04期

8 段泉泉;勝利;;焦慮及抑郁自評量表的臨床效度[J];中國心理衛(wèi)生雜志;2012年09期

9 王福軍;向紅菊;石翔;羅亞雄;;氟西汀對高血壓伴焦慮抑郁患者治療效果和生活質(zhì)量的影響[J];中華高血壓雜志;2012年08期

10 劉力生;;中國高血壓防治指南2010[J];中國醫(yī)學前沿雜志(電子版);2011年05期

相關碩士學位論文 前2條

1 曹成;高血壓患者性別差異內(nèi)皮功能障礙危險因素研究[D];南昌大學醫(yī)學院;2015年

2 趙曼;心血管內(nèi)科門診患者焦慮、抑郁發(fā)生率及其影響因素[D];中南大學;2011年

，

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