本文選題：心肌梗死 + 焦慮��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:急性心肌梗死(acute myocardial infarction,AMI)是指因持久而嚴(yán)重的心肌缺血所致的部分心肌急性壞死。作為心血管疾病中一種常見(jiàn)的危急重癥,嚴(yán)重威脅患者的身心健康。急性心肌梗死本身是一種死亡率較高的危急重癥,大部分患者有劇烈的胸痛、心悸、甚至瀕死感等不適,這使患者易產(chǎn)生一些諸如焦慮、抑郁[31]等負(fù)性情緒。而一部分患者會(huì)出現(xiàn)一種精神應(yīng)激狀態(tài),如焦慮抑郁狀態(tài)、創(chuàng)傷后應(yīng)激障礙、驚恐障礙、適應(yīng)障礙、人格偏離,久坐的生活方式和吸煙等行為問(wèn)題。焦慮和抑郁狀態(tài)是公認(rèn)的心血管疾病危險(xiǎn)因素,可存在于發(fā)生急性心肌梗死之前的老冠心病患者,或第一次出現(xiàn)癥狀的急性心肌梗死患者,對(duì)患者的病情發(fā)展、預(yù)后及生活質(zhì)量存在著巨大的影響。國(guó)外研究中發(fā)現(xiàn)腦細(xì)胞膽固醇減少時(shí)將會(huì)導(dǎo)致脂質(zhì)微粘度下降,暴露5-羥色胺受體,進(jìn)而引發(fā)抑郁癥狀[11]。也有學(xué)者在研究中發(fā)現(xiàn)血脂對(duì)情緒的影響并不大[12]。而Van Deedt Dortland[35]等研究則顯示,不良的脂質(zhì)蛋白與抑郁癥狀密切相關(guān),能導(dǎo)致LDL-C的增高,同時(shí)抑郁癥狀本身能導(dǎo)致HD-C降低。目前國(guó)內(nèi)關(guān)于焦慮、抑郁狀態(tài)對(duì)行介入治療的急性心肌梗死患者血脂水平的影響還鮮見(jiàn)報(bào)道,而雙心醫(yī)學(xué)模式對(duì)急性心肌梗死患者血脂水平的影響也鮮見(jiàn)報(bào)道。故本研究通過(guò)對(duì)行急診介入治療的急性心肌梗死患者進(jìn)行焦慮和抑郁量表測(cè)評(píng),觀察合并焦慮和抑郁情緒的患者,并測(cè)定其入院后及出院4-6周后血脂水平,觀察急性心肌梗死患者焦慮和抑郁狀態(tài)和血脂水平的相關(guān)關(guān)系。方法:入選武警后勤學(xué)院附屬醫(yī)院心血管內(nèi)科重癥監(jiān)護(hù)病房2015年7月至2016年7月共227名年齡80歲急診行介入治療的急性心肌梗死病例為研究對(duì)象�；颊呷朐汉�1周內(nèi)分別采用抑郁自評(píng)量表(SDS,Self rating Depression Scale)[5]焦慮自評(píng)量表(SAS,Self rating Anxiety Scale)[6]進(jìn)行焦慮和抑郁評(píng)估,依照焦慮和抑郁情緒評(píng)分結(jié)果,將患者分為觀察組和對(duì)照組,觀察組伴焦慮或抑郁情緒,對(duì)照組不伴焦慮或抑郁情緒。于入院第二天晨7時(shí)前空腹抽靜脈血測(cè)定血脂指標(biāo),出院后4-6周進(jìn)行隨訪,復(fù)查血脂指標(biāo),分析焦慮抑郁與血脂之間的相關(guān)關(guān)系。結(jié)果:1納入研究227例,111例(49.0%)存在焦慮,53例(23.0%)存在抑郁,39例(17.0%)焦慮抑郁共病.。觀察組125例,對(duì)照組102例,兩組患者一般資料具有可比性。2入院第二天血脂檢查,觀察組患者TC、Lp(a)、LDL-C、TG、HDL-C指標(biāo)與對(duì)照組指標(biāo)無(wú)比較意義(P0.05)。3出院4-6周復(fù)查血脂,兩組患者血脂指標(biāo)均得到改善,觀察組TC、TG、Lp、LDL-C指標(biāo)顯著高于對(duì)照組(P0.05),HDL-C指標(biāo)顯著低于對(duì)照組(P0.05)。4在院期間與出院后4-6周復(fù)查血脂指標(biāo)比較,觀察組TG、TC、LDL-C明顯下降(P0.05),HDL-C無(wú)明顯變化(P=0.0721)。對(duì)照組TG、TC、LDL-C明顯下降(P0.05),HDL-C有所上升(P0.05)。5觀察組與對(duì)照組血脂改善差值比較,對(duì)照組改善情況顯著優(yōu)于觀察組(P0.05)。6觀察組焦慮或抑郁評(píng)分與TG(r=0.271)、TC(r=0.291)、LDL-C(r=0.110)存在正相關(guān),與HDL-C(r=0.034)存在負(fù)相關(guān)。結(jié)論:急性心肌梗死患者出現(xiàn)焦慮或者抑郁狀態(tài)發(fā)生率較高,伴有焦慮和抑郁情緒的急性心肌梗死介入患者與不伴有焦慮和抑郁情緒的急性心肌梗死介入患者之間的血脂變化存在差異。急性心肌梗死伴隨焦慮(抑郁)評(píng)分與TG、TC、LDL-C呈現(xiàn)正相關(guān),評(píng)分越高,血脂異常越明顯,焦慮(抑郁)與HDL-C呈現(xiàn)負(fù)相關(guān)。
[Abstract]:Objective: acute myocardial infarction (AMI) is a part of acute myocardial necrosis caused by persistent and severe myocardial ischemia. As a common critical disease in cardiovascular disease, it is a serious threat to the physical and mental health of the patients. Acute myocardial infarction is a kind of critical mortality with high mortality and most of the patients have Severe chest pain, palpitations, and even dying feel discomfort, which makes the patient prone to negative emotions such as anxiety and depression [31]. Some patients have a mental stress state, such as anxiety and depression, post-traumatic stress disorder, panic disorder, adaptive disorder, personality deviation, sedentary lifestyle and smoking and other behavioral problems. The state of anxiety and depression is recognized as a risk factor for cardiovascular disease. It can exist in elderly patients with coronary heart disease before acute myocardial infarction, or in patients with acute myocardial infarction with first symptoms, which have a great influence on the development, prognosis, and quality of life of the patients. The decrease in lipid microviscosity, the exposure of 5- serotonin receptor, and further depressive symptoms [11]. have also been found in the study. Some scholars have found that the effect of blood lipid on emotion is not [12]. and Van Deedt Dortland[35] and other studies show that bad lipid protein is closely related to depressive symptoms, which can lead to higher LDL-C, and the depressive symptoms can lead to the depression itself. The influence of anxiety and depression on the level of blood lipid in patients with acute myocardial infarction with interventional therapy is rarely reported, and the effect of the double heart medical model on the level of blood lipid in patients with acute myocardial infarction is rarely reported. Therefore, the anxiety and anxiety of patients with acute myocardial infarction who have been treated with emergency intervention therapy are not reported. The depression scale was used to observe the patients with anxiety and depression, and the blood lipid level after admission and 4-6 weeks after discharge. The relationship between anxiety and depression and blood lipid levels in patients with acute myocardial infarction was observed. Methods: the intensive care unit of the cardio tube department of the Affiliated Hospital of Armed Police Logistics College was selected from July 2015 to July 2016. A total of 227 cases of acute myocardial infarction who were aged 80 years old were treated with acute myocardial infarction. The patients were assessed by the self rating Depression Scale (SDS, Self rating Depression Scale) [5] Anxiety Scale (SAS, Self rating Anxiety Scale) within 1 weeks after admission to the anxiety and depression assessment. The observation group was divided into the observation group and the control group, the observation group was accompanied with anxiety or depression, and the control group did not have the anxiety or depression. The blood lipid indexes were measured before the second day morning and 7 hours in the hospital. The blood lipid indexes were followed up for 4-6 weeks after discharge. The correlation between the blood lipid index and the anxiety and depression was analyzed. Results: 1 were included in 227 cases and 111 cases (49). .0%) existence of anxiety, 53 (23%) depression, 39 cases (17%) of anxiety and depression, 125 cases, 102 cases in the control group, two groups of patients with comparable.2 for second days of blood lipid examination, the observation group of TC, Lp (a), LDL-C, TG, HDL-C index and the control index no comparison significance (P0.05).3 for 4-6 weeks back examination of blood lipids, two groups of patients reviewed lipids, two groups of patients for the review of two patients The indexes of blood lipid were improved, and the indexes of TC, TG, Lp and LDL-C in the observation group were significantly higher than those in the control group (P0.05), and the HDL-C index was significantly lower than the control group (P0.05).4 during the hospital and 4-6 weeks after discharge. The difference between the P0.05.5 observation group and the control group was better than the control group. The improvement of the control group was significantly better than that of the observation group (P0.05). The anxiety or depression score of the.6 observation group was positively correlated with TG (r=0.271), TC (r=0.291), LDL-C (r=0.110), and HDL-C (r=0.034). Conclusion: the patients with acute myocardial infarction have anxiety or depression. The incidence of acute myocardial infarction with anxiety and depression was different from that of the patients with acute myocardial infarction without anxiety and depression. The scores of acute myocardial infarction associated anxiety (depression) were positively correlated with TG, TC, LDL-C, the higher the score, the more obvious dyslipidemia and anxiety (depression). There was a negative correlation with HDL-C.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.22;R749

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