本文關(guān)鍵詞：失眠患者臨床特征及敘事醫(yī)學(xué)中醫(yī)平行病歷構(gòu)建　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 失眠 臨床特征 敘事醫(yī)學(xué) 平行病歷

【摘要】：研究目的通過(guò)對(duì)失眠患者臨床的采集及統(tǒng)計(jì)分析探討失眠患者臨床特征,根據(jù)生物學(xué)以外臨床特征的重要性,提出全面了解疾病背后的故事,構(gòu)建中醫(yī)平行病歷的必要性。研究方法自2015年10月至2017年2月就診于導(dǎo)師門診的符合標(biāo)準(zhǔn)的95名失眠患者,進(jìn)行調(diào)查統(tǒng)計(jì),收集記錄患者的臨床基本資料,采用匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI)進(jìn)行睡眠評(píng)價(jià),漢密爾頓焦慮量表(HAMA)進(jìn)行焦慮水平的評(píng)估。根據(jù)所收集資料建立相關(guān)數(shù)據(jù)庫(kù),采用SPSS20.0統(tǒng)計(jì)分析軟件對(duì)所采集資料進(jìn)行描述性統(tǒng)計(jì)、相關(guān)分析、卡方檢驗(yàn)、t檢驗(yàn)及非參數(shù)檢驗(yàn)等方法進(jìn)行數(shù)據(jù)分析。自2015年至2017年邀請(qǐng)本院不同科室五位副高級(jí)以上專家對(duì)患者進(jìn)行床旁訪談并進(jìn)行回顧性思考。通過(guò)錄音的方式,記錄并整理成文,共積累訪談案例10篇。研究結(jié)果通過(guò)對(duì)近兩年,東直門醫(yī)院腦病科門診失眠患者的信息采集及整理,發(fā)現(xiàn)失眠伴焦慮狀態(tài)人群(66.32%)與非焦慮人群(33.68%)的比例為1:1.97,提示失眠患者常伴隨焦慮狀態(tài)。PSCI及HAMA評(píng)分進(jìn)行描述性統(tǒng)計(jì)分析,得到PSQI評(píng)分最低為7分,最高為20分,平均分12.58±3.528。HAMA評(píng)分最低分為3分,最高為44分,平均分19.14±9.122。非焦慮狀態(tài)與伴焦慮狀態(tài)失眠患者的PSQI評(píng)分分別10.50(6)和13.33±3.943,P值0.05,提示焦慮與否的PSQI評(píng)分有差異,其中非焦慮組與焦慮組秩均值分別為37.83和53.17,說(shuō)明焦慮患者的PSQI評(píng)分較非焦慮組高。HAMA分組對(duì)PSQI各成分影響的統(tǒng)計(jì)結(jié)果顯示,HAMA分組對(duì)PSQI總分、睡眠質(zhì)量(習(xí)慣性睡眠效率)、入睡時(shí)間(睡眠潛伏期)、睡眠障礙(主觀睡眠質(zhì)量)、日間功能障礙(白天功能紊亂)的評(píng)分有影響,且此5項(xiàng)r值均0,P值0.05,可以認(rèn)為焦慮分組與PSQI各成分正相關(guān),r值的絕對(duì)值比較顯示:焦慮與否對(duì)入睡時(shí)間和日間功能的影響最顯著,其次是PSQI評(píng)分,然后為睡眠障礙,最末為睡眠質(zhì)量。非焦慮與焦慮組失眠患者的男女比例分別為1:2.2與1:2.94�？梢�(jiàn)在失眠患者中女性比例高于男性。年齡方面最高為40-59歲中老年人群(41.05%),其次為20-39歲的青中年人群(36.84%),最末為60-80歲老年人群(22.11%)。失眠患者中腦力勞動(dòng)與體力勞動(dòng)的比值為4:1,,單純失眠患者組比值為4.3:1;伴焦慮狀態(tài)組中比值為3.85:1。每組人群均可發(fā)現(xiàn)從事腦力勞動(dòng)的失眠人數(shù)明顯高于體力勞動(dòng)的,而單純失眠人群中的差異更明顯。文化程度方面,小學(xué)文化2例(占2.11%)初中文化共17例(占17.89%),高中或中專文化28例(占29.47%),大學(xué)文化41例(占43.16%),研究生文化7例(占7.37%)。一般資料中頻數(shù)描述可見(jiàn)性別、年齡、職業(yè)、文化程度對(duì)失眠均有顯著影響,但并未得到統(tǒng)計(jì)學(xué)差異(P0.05)。主要臨床特征:失眠的主要特征分別為入睡困難84例(88.42%)、多夢(mèng)83例(87.37%)、易醒83例(87.37%)、醒后疲乏78例(82.11%)和早醒73例(76.84%)。并且發(fā)現(xiàn)非焦慮組睡不實(shí)、易醒27例(占84.38%),早醒23例(占71.88%)。焦慮組睡不實(shí)、易醒56例(占88.89%),早醒50例(占79.37%)。失眠伴焦慮患者更易出現(xiàn)睡不實(shí)、易醒的臨床特征。次要臨床特征:將性格特點(diǎn)與生活工作方式各項(xiàng)與HAMA分組進(jìn)行卡方檢驗(yàn),按α=0.05的標(biāo)準(zhǔn),發(fā)現(xiàn)只有性格特點(diǎn)中的愛(ài)操心與HAAMA分組存在統(tǒng)計(jì)學(xué)意義,其余各項(xiàng)P值0.05。但根據(jù)頻數(shù)描述結(jié)果可知,愛(ài)操心70例(73.68%)、急脾氣61例(64.21%)、愛(ài)生氣58例(61.11%)、追求完美53例(55.79%)、承擔(dān)過(guò)多41例(43.16%)等性格特點(diǎn)及工作壓力大32例(占33.68%),視頻作業(yè)56例(占58.95%),長(zhǎng)期一個(gè)姿勢(shì)36例(占37.89%)等生活方式均與失眠密切相關(guān)。通過(guò)對(duì)失眠患者臨床特征的總結(jié),揭示次要特征與失眠密切相關(guān),明確生物學(xué)以外臨床特征的重要性。嘗試將敘事醫(yī)學(xué)理論引入臨床,邀請(qǐng)5位副高級(jí)以上專家對(duì)病人進(jìn)行床旁訪談,并整理成文。為中醫(yī)平行病歷的構(gòu)建提供經(jīng)驗(yàn)以及參考。研究結(jié)論1.性別、年齡、職業(yè)、文化水平、病程時(shí)間及性格特點(diǎn)、工作生活方式均與失眠相關(guān);2.女性、高知分子、中青年、腦力勞動(dòng)者,病程時(shí)間長(zhǎng);急脾氣、愛(ài)生氣,愛(ài)操心;工作壓力大、生活應(yīng)激事件,起居不規(guī)律等非生物學(xué)特征均為失眠次要臨床特征;3.通過(guò)臨床訪談與寫(xiě)作,進(jìn)行將敘事醫(yī)學(xué)引入中醫(yī)臨床的探索,構(gòu)建中醫(yī)平行病歷。
[Abstract]:Objective to explore the clinical features of patients with insomnia collection and statistical analysis of clinical insomnia patients, according to the importance of outside biology clinical features, put forward a comprehensive understanding of the disease and the story behind the necessity of the construction of Chinese parallel medical records from October 2015 to February 2017. The method of treatment in the outpatient department supervisor meets the standard of 95 patients with insomnia, investigation statistics collect, record the basic clinical data of patients, the Pittsburgh sleep quality index (PSQI) for sleep quality evaluation, Hamilton Anxiety Scale (HAMA) assessment of anxiety level. According to the data collected by the establishment of the database, using SPSS20.0 statistical analysis software for descriptive statistics, the collected data correlation analysis, chi square test. T test and non parametric test methods for data analysis. From 2015 to 2017 in Our Hospital Department invited different five vice senior The above expert bedside interviews with patients and the retrospective thinking. By recording, recorded and documented, a total of 10 cases of interviews accumulation. The results of the past two years, the information collection and collation of insomnia patients with encephalopathy outpatient hospital in Dongzhimen, found that insomnia associated with anxiety group and non anxiety group (66.32%) (33.68%) the ratio of 1:1.97, suggesting that patients with insomnia often accompanied by anxiety.PSCI and HAMA scores of descriptive statistical analysis, get the lowest PSQI score was 7 points, up 20 points, an average of 12.58 + 3.528.HAMA score lowest score was 3 points, up 44 points, an average of 19.14 + 9.122. and non anxiety with PSQI anxiety insomnia scores were 10.50 (6) and 13.33 + 3.943, P = 0.05, suggesting that anxiety and not PSQI score differences among non anxiety group and anxiety group rank mean were 37.83 and 53.17, indicating anxiety Patients with PSQI score than the non anxiety group statistical impact of high.HAMA grouping of components of PSQI showed that the HAMA groups of PSQI score, sleep quality (habitual sleep efficiency), sleep time (sleep latency), sleep disorders (subjective sleep quality), daytime dysfunction (daytime dysfunction) affect the score, and the 5 R value was 0, P value 0.05, can be considered as anxiety group and PSQI of each component is related to the absolute value of the R value of the comparison shows that the most significant anxiety of sleep time and daytime function, followed by the PSQI score, and sleep disorders, in the end for non anxiety and sleep quality. The proportion of male and female patients with insomnia anxiety group were 1:2.2 and 1:2.94. in patients with insomnia in women than men. The highest age for the elderly people at the age of 40-59 (41.05%), followed by the young and middle-aged population aged 20-39 (36.84%), the last for 60-80 years old people Group (22.11%). The ratio of insomnia in patients with mental and manual labor is 4:1, ratio of 4.3:1 group simple insomnia patients with anxiety; group 3.85:1. ratio of each group can be found that the number of insomnia engaged in mental work was higher than that of manual labor, and simply lost sleep in the crowd is more obvious differences. Cultural degree 2 cases of primary school, culture (2.11%) junior high school a total of 17 cases (17.89%), high school or secondary school culture in 28 cases (29.47%), 41 cases of university culture (43.16%), 7 cases of culture (7.37%). The frequency of visible description in the general information of gender, age, occupation, cultural degree have significant effects on insomnia, but did not get a statistically significant difference (P0.05). The main clinical features: the main features of insomnia were difficult to fall asleep in 84 cases (88.42%), 83 cases (87.37%), dreaminess, easy to wake up in 83 cases (87.37%), 78 cases of fatigue after waking (82.11%) and 73 cases (76.84%) wake up early and. 鍙戠幇闈炵劍铏戠粍鐫′笉瀹，

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