本文選題：耳鳴 + 心理學(xué)�。� 參考：《中南大學(xué)》2010年碩士論文

【摘要】： 研究背景耳鳴通常被定義為沒(méi)有外界聲源或電刺激時(shí)所產(chǎn)生的聲音的感覺(jué),一種非常普遍的現(xiàn)象。流行病學(xué)表明大約6-17%的人經(jīng)歷過(guò)至少5分鐘的耳鳴,但只有0.5-2.5%的人認(rèn)為耳鳴嚴(yán)重影響他們的生活。 目前普遍認(rèn)為耳鳴病人由于耳鳴的干擾以及患者本身的認(rèn)知水平,可能會(huì)出現(xiàn)抑郁、焦慮、睡眠障礙等癥狀,嚴(yán)重者社會(huì)功能受到損害,甚至可能會(huì)自殺。Jastreboff提出了耳鳴的神經(jīng)生理學(xué)模型,指出耳鳴通過(guò)條件反射導(dǎo)致邊緣系統(tǒng)和自主神經(jīng)系統(tǒng)的持續(xù)興奮,從而在臨床上出現(xiàn)與耳鳴相關(guān)的抑郁等心理障礙。在這個(gè)基礎(chǔ)上提出了耳鳴再訓(xùn)練療法,讓患者建立一個(gè)新的“耳鳴觀”,不再因?yàn)槎Q出現(xiàn)上述心理障礙。 目的通過(guò)詳細(xì)的耳鳴相關(guān)檢測(cè)和心理學(xué)評(píng)估,詳細(xì)的了解耳鳴患者的心理狀態(tài),是否存在抑郁、焦慮等,同時(shí)評(píng)估患者的生活質(zhì)量和睡眠質(zhì)量,并分析這些心理障礙在耳鳴患者中的分布,為臨床上診療耳鳴提供參考。 資料與方法患者均來(lái)自于中南大學(xué)湘雅醫(yī)院耳鼻咽喉頭頸外科門診就診的耳鳴患者。所有的患者均進(jìn)行耳鳴的頻率和響度測(cè)試,并使用90項(xiàng)癥狀清單(symptom checklist 90, SCL-90)、生活滿意度量表、匹茲堡睡眠質(zhì)量指數(shù)量表(Pittsburgh Sleep Quality Index, PSQI)、耳鳴殘疾量化表(tinnitus handicap inventory, THI)對(duì)患者進(jìn)行相關(guān)的評(píng)估。 90項(xiàng)癥狀清單(symptom checklist 90, SCL-90),由90個(gè)項(xiàng)目組成,可以概括為9個(gè)因子,分別為軀體化,強(qiáng)迫癥狀,人際關(guān)系,抑郁,焦慮,敵對(duì),恐怖,偏執(zhí),精神病性,將此9個(gè)因子分別積分。量表協(xié)作組曾對(duì)全國(guó)13個(gè)地區(qū)1388名正常成人的SCL-90進(jìn)行分析,主要結(jié)果如下： 生活滿意度量表包括三個(gè)獨(dú)立的量表,其一是他評(píng)量表,即生活滿意度評(píng)定量表(Life Satisfaction Rating Scale),簡(jiǎn)稱LSR；另兩個(gè)分量表是自評(píng)量表,分別為生活滿意度指數(shù)A (Life Satisfaction Index A)和生活滿意度指數(shù)B,簡(jiǎn)稱LSIA和LSIB。文獻(xiàn)表明國(guó)內(nèi)常模得分為L(zhǎng)SR=17.8±4.6,LSIA=12.4+4.4, LSIB=15.5+4.7。 匹茲堡睡眠質(zhì)量指數(shù)量表(Pittsburgh Sleep Quality Index, PSQI)適用于睡眠障礙患者、精神障礙患者的睡眠質(zhì)量評(píng)價(jià)、療效觀察,一般人群睡眠質(zhì)量的調(diào)查研究,以及睡眠質(zhì)量與心身健康相關(guān)性研究的評(píng)定工具。國(guó)外Buysse博士等的研究表明,以PSQI總分5為劃界分,靈敏度為89.6%,特異度為86.5%；國(guó)內(nèi)劉賢臣等的測(cè)試表明以PSQI總分7為劃界分,靈敏度為98.3%,特異度為90.2%。本研究采用國(guó)內(nèi)的標(biāo)準(zhǔn)。 耳鳴殘疾量化表(tinnitus handicap inventory, THI)：由25個(gè)條目組成,每個(gè)條目有3個(gè)選擇項(xiàng),分別為否、有時(shí)、是,得分分別是O分、2分、4分。統(tǒng)計(jì)25個(gè)條目得分,進(jìn)行分級(jí)。1級(jí)：無(wú)殘疾,THI得分為0-16分；2級(jí)：輕度殘疾,THI得分為18-36分；3級(jí)：中度殘疾,THI得分為38-56分；4級(jí)：重度殘疾,THI得分為58-76分；5級(jí)：極重度殘疾,THI得分為78-100分。得分越高,級(jí)別越高,表示自覺(jué)耳鳴越嚴(yán)重。 將所取得的數(shù)據(jù)建立數(shù)據(jù)庫(kù),采用SPSS11.0統(tǒng)計(jì)分析軟件進(jìn)行分析。 結(jié)果1、耳鳴的頻率、響度和患者的SCL-90、LSR、LSIA、LSIB、PSQI、THI得分均無(wú)直線相關(guān)。 2、76例耳鳴患者的SCL總分(X=165.72±53.68,t=5.808,P=0.000),總均分(X=1.84±0.59,t=5.866,P=0.000),陽(yáng)性項(xiàng)目數(shù)(X=40.86±21.8,t=6.354,p=0.000),陽(yáng)性癥狀均分(X=2.72±0.47,t=2.275,P=0.026),均高于國(guó)內(nèi)常模。其中除人際關(guān)系因子(X=1.73±0.69,t=1.031,P=.306)外,軀體化(X=1.74±0.56,t=5.790,P=0.000),強(qiáng)迫(X=2.10±0.73,t=5.745,P=0.000),抑郁(X=1.94±0.73,t=5.299,P=0.000),焦慮((X=1.91±0.72,t=6.230,P=0.000)、敵對(duì)(X=1.87±0.84,t=4.092,P=0.000)、恐怖(X=1.55±0.59,t=4.776,P=0.000)、偏執(zhí)(X=1.59±0.70,t=2.059,P=.043)、精神病性(X=1.74±0.71,t=5.495,P=0.000)這幾項(xiàng)因子分高于國(guó)內(nèi)常模。 76例患者的調(diào)查中共獲得生活滿意度量表(LSR)67份,生活滿意度指數(shù)A量表(LSIA)64份,生活滿意度指數(shù)B量表66份,與國(guó)內(nèi)常模比較,其中LSR(X=16.63±3.90,t=-2.460,P=0.017),LSIA(X=10.69±4.29,t=-3.190,P=0.002),LSIB(X=13.74±4.18,t=-3.415,P=0.001),均低于國(guó)內(nèi)常模。 76例患者共獲得PSQI量表60份,其中大于7的患者有45例；睡眠障礙患病率為62%,高于普通人群。 3、根據(jù)THI分組,THI3級(jí)組的軀體化因子高于國(guó)內(nèi)常模；THI4級(jí)組的生活滿意度降低,SCL-90中軀體化、強(qiáng)迫、抑郁、焦慮、敵對(duì)、恐怖、精神病性這些因子分均高于國(guó)內(nèi)常模；THI5級(jí)組的生活滿意度明顯降低,睡眠障礙患病率高于普通人群,而且SCL-90中軀體化、強(qiáng)迫、人際關(guān)系、抑郁、焦慮、敵對(duì)、恐怖、偏執(zhí)、精神病性各因子均高于國(guó)內(nèi)常模。 結(jié)論耳鳴的頻率、響度和患者的SCL-90、LSR、LSIA、LSIB、PSQI、THI得分均無(wú)直線相關(guān)。 根據(jù)THI得分對(duì)耳鳴患者進(jìn)行分組,THI4級(jí)組、THI5級(jí)組的心理障礙明顯,應(yīng)給予重點(diǎn)關(guān)注。
[Abstract]:Background tinnitus is usually defined as the sound of sound produced without external sound sources or electrical stimuli. Epidemiology shows that about 6-17% people have experienced at least 5 minutes of tinnitus, but only 0.5-2.5% people think tinnitus seriously affects their lives.
At present, it is generally believed that the patients with tinnitus, due to the interference of tinnitus and the cognitive level of the patients themselves, may have symptoms such as depression, anxiety, sleep disorder, and so on. The social function of the serious people may be impaired, and even may commit suicide.Jastreboff to put forward the neurophysiological model of the tinnitus, pointing out that the tinnitus can lead to the marginal system and autonomy through the conditioned reflex. The persistent excitement of the nervous system leads to a psychological disorder, such as the depression associated with the tinnitus. On this basis, a retraining therapy for tinnitus is proposed to set up a new "tinnitus", no longer because of the psychological barriers to the tinnitus.
Objective to understand the mental state of the patients with tinnitus, whether there is depression and anxiety, and evaluate the quality of life and sleep of the patients, and analyze the distribution of these mental disorders in the tinnitus patients, and provide a reference for the clinical diagnosis and treatment of tinnitus.
Data and methods were all from the tinnitus patients in the outpatient of the otolaryngology and head and neck surgery in Xiangya Hospital of Central South University. All patients were tested for the frequency and loudness of the tinnitus and used 90 symptoms list (symptom checklist 90, SCL-90), the life satisfaction scale, and the Pittsburgh sleep quality index scale (Pittsburgh Sleep Quali). Ty Index (PSQI) and tinnitus handicap inventory (THI) were used to assess the patients.
The 90 symptom checklist (symptom checklist 90, SCL-90), composed of 90 items, can be summed up as 9 factors: somatization, compulsive symptoms, interpersonal relationships, depression, anxiety, hostility, terror, paranoia, psychosis, respectively. The scale collaboration group has analyzed the SCL-90 of 1388 normal adults in 13 regions of the country. The results are as follows:
The life satisfaction scale includes three independent scales, one is the scale of life satisfaction rating scale (Life Satisfaction Rating Scale), or LSR for short, and the other two subscales are the self-assessment scale, which are the life satisfaction index A (Life Satisfaction Index A) and the life satisfaction index B, referred to as LSIA and literature states. The score of internal norm was LSR=17.8 + 4.6, LSIA=12.4+4.4, LSIB=15.5+4.7.
The Pittsburgh sleep quality index (Pittsburgh Sleep Quality Index, PSQI) is suitable for the sleep quality of patients with sleep disorders, the quality of sleep in patients with mental disorders, the observation of curative effect, the study of the quality of sleep in the general population, and the assessment tool for the study of the correlation between sleep quality and psychosomatic health. The study of Dr. Buysse in foreign countries showed that PSQ The total score of I was 5, the sensitivity was 89.6%, the specificity was 86.5%. The national Liu Xianchen test showed that the total score of PSQI was 7, the sensitivity was 98.3%, the specificity was 90.2%., and the domestic standard was adopted.
Tinnitus disability quantitative table (tinnitus handicap inventory, THI): consists of 25 entries, each item has 3 options, respectively, and sometimes, the score is O, 2, 4. Statistics 25 entries to score, grade.1 grade: no disability, THI score 0-16 points; 2: mild disability, THI score 18-36; 3 grade: moderate disability The THI score was 38-56 points; level 4: severe disability, THI score 58-76; level 5: extremely severe disability and THI score of 78-100. The higher the score, the higher the level, the more serious the conscious tinnitus was.
The database was established and analyzed by SPSS11.0 statistical analysis software.
Results 1, there was no linear correlation between tinnitus frequency, loudness and SCL-90, LSR, LSIA, LSIB, PSQI and THI scores of patients.
The total score of SCL (X=165.72 + 53.68, t=5.808, P=0.000) in 2,76 patients with tinnitus, the total average score (X=1.84 + 0.59, t=5.866, P=0.000), the number of positive items (X=40.86 + 21.8, t=6.354, p=0.000). + 0.56, t=5.790, P=0.000), coercion (X=2.10 + 0.73, t=5.745, P=0.000), depression (X=1.94 0.73, t=5.299, P=0.000), anxiety (X=1.91 + 0.72, t=6.230, P=0.000), hostility (X=1.87 0.84, 0.59), paranoid (0.59, 0.70), psychosis The factor is higher than the domestic norm.
The survey of 76 patients received 67 copies of the life satisfaction scale (LSR), 64 copies of the life satisfaction index A scale (LSIA) and the life satisfaction index B scale, compared with the domestic norm, in which LSR (X=16.63 + 3.90, t=-2.460, P=0.017), LSIA (X=10.69 + 4.29, t= -3.190) were all lower than the domestic norm.
A total of 60 PSQI scales were obtained from 76 patients, of whom 45 were more than 7, and the prevalence rate of sleep disorders was 62%, which was higher than that of the general population.
3, according to the THI group, the somatization factor of the THI3 group was higher than the domestic norm, the life satisfaction of the THI4 group was lower, the somatization in the SCL-90, the compulsion, the depression, the anxiety, the hostility, the horror and the psychosis were all higher than the domestic norm; the life satisfaction of the THI5 group was significantly lower, and the incidence of sleep disorder was higher than that of the ordinary people, and SCL-9 0 somatization, compulsion, interpersonal relationship, depression, anxiety, hostility, terror, paranoia, psychotic factors were all higher than domestic norm.
Conclusion there is no linear correlation between the frequency and loudness of tinnitus and the scores of SCL-90, LSR, LSIA, LSIB, PSQI and THI of patients.
According to the THI score, the patients with tinnitus were grouped. The mental disorder of group THI4 and group THI5 was obvious and should be given priority attention.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類號(hào)】：R764

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本文編號(hào)：1908321