本文選題：冠心病 + 介入手術��； 參考：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本研究旨在調查冠心病PCI術后存在失眠的患者,其失眠同冠心病及PCI術相關性程度、失眠類型及中醫(yī)證型的分布狀況及生活質量情況,從而了解PCI術患者失眠的狀況以及中醫(yī)證型的比例。方法:本研究采用橫斷面調查研究的方式,納入2016年8月至2017年4月于東直門醫(yī)院心血管內科門診部及住院部進行治療的冠心病支架術后伴有失眠的患者40例,并納入冠心病未行支架術伴有失眠的患者20例,非冠心病的心血管疾病伴有失眠的患者20例作為兩個對照組通過調查問卷的方式收集患者的資料,采集患者的基本資料、病史及治療情況、危險因素控制情況、失眠情況、焦慮抑郁情況、生活質量調查和中醫(yī)癥候診斷。建立數據庫,采用SPSS17.0統計軟件進行資料的統計分析,比照對照組的數據,分析研究對象失眠的原因、類型與中醫(yī)癥候分布與PCI的相關性。結果:1.基本情況:本次研究納入患者80例,其中冠心病支架術后伴有失眠的患者40例,其中處于康復Ⅰ期患者3人,康復Ⅱ期患者4人,康復Ⅲ期患者33人;冠心病未行支架術伴有失眠的患者20例,非冠心病的心血管疾病伴有失眠的患者20例。全部患者中包括男性38人,女性42人;納入80名患者的平均年齡為66.99±11.049歲,其中最小年齡為42歲,最大年齡為91歲。納入全部患者的年齡分布差異具有統計學意義。三組間患者年齡分布無明顯差異。冠心病男性患者的患病年齡明顯小于女性患者的患病年齡。2.危險因素控制情況:本研究全部患者中61人(76.25%)確診患有高血壓病,全部患者中34人(42.5%)確診患有糖尿病,全部患者中60人(75%)確診患有高脂血癥,支架術后患者、冠心病患者及高血壓、心律失常患者的高血壓及高脂血癥的患病率均高于糖尿病患病率。本研究中PCI組有吸煙史的患者比例為42.5%,冠心病組為30%,非冠心病組的25%;有飲酒史的各組比例都在30%及以上。3.患病及治療情況:PCI組32名患者術前有心絞痛發(fā)作;冠心病組9名患者曾有心絞痛發(fā)作的情況。統計學計算結果支持有心絞痛癥狀的冠心病患者行PCI術的幾率明顯高于無心絞痛癥狀的冠心病患者。60-69歲患者心絞痛發(fā)作幾率最高。不同年齡層心絞痛的發(fā)作率不具有明顯差異。PCI組患者單支病變者20人,雙支病變者7人,三支病變者8人,不詳者5人。4.伴發(fā)心律失常:非冠心病組6名患者患有心律失常;冠心病組10個患者伴有心律失常;PCI組7個患者伴有心律失常,總計23人伴有心律失常。三組心律失常發(fā)生率具有明顯差異,PCI組的心律失常發(fā)生率明顯低于冠心病組心律失常發(fā)生率。5.失眠情況:納入患者80例開始出現失眠癥狀時的平均年齡為54.388± 16.044,其中最小患病年齡為13歲,最大患病年齡為86歲;年齡是患有失眠的影響因素在本研究中得到了統計學支持,不同年齡階段失眠的發(fā)病率不同�；颊咴�50-59歲年齡段更易發(fā)生失眠。冠心病男性患者失眠的發(fā)病年齡明顯較女性患者失眠的發(fā)病年齡更低。納入慢性失眠患者最多,占83.75%。80例失眠患者中癥狀表現為入睡困難者為62人,睡眠輕淺,容易驚醒者為62人,夢多者42人,起夜多者36人,醒后難以再次入睡者57人,睡眠較充足,醒后仍覺疲倦5人。三組在失眠癥狀上的差異具有統計學意義,PCI組入睡困難癥狀發(fā)生率高于其他兩組,PCI術后失眠患者以入睡困難發(fā)生率最高,其次是醒后難以再次入睡。患者受軀體因素影響睡眠者少于受精神因素影響睡眠者。PCI組影響患者睡眠的最多的原因為思索家庭或工作瑣事(42.50%)。80例患者中失眠有所改善者48例,沒有改善者20例,改善較少者12例;失眠有所改善者以服用藥物有效最多。PCI組術后出現失眠的患者為4人(10%),術后失眠較前更加嚴重者7人(17.5%),術后失眠較前減輕者3人(7.5%),失眠與之前無不同26人(65%)。65%患者的失眠情況在PCI術后無明顯變化。6.睡眠評分:以PSQI測評患者的失眠嚴重程度,各組差異不具有統計學意義。男性患者的PSQI明顯小于女性的匹茨堡評分。以AIS對80例患者進行失眠程度的測評,各組差異不具有統計學意義。以ISI進行失眠程度測評,全部患者中ISI評分女性明顯高于男性。7.嗜睡程度及疲勞程度:以ESS對患者進行嗜睡程度評價。83.75%患者都屬于正常范圍內。以FSS評價80名患者疲勞程度,80名患者中屬于疲勞范圍68人,不屬于疲勞范圍12人。8.焦慮抑郁情況:以SAS對患者進行焦慮情況評價,80名患者中60名屬于正常范圍,16名患者輕度焦慮,4名患者中度焦慮。無患者屬于重度焦慮。以SDS對患者進行抑郁情況評價,80名患者中7名屬于正常范圍,12名患者輕度抑郁,3名患者中度抑郁,1名患者屬于重度抑郁。83.75%患者屬于不達到抑郁程度,16.25%的患者處于抑郁狀態(tài)。9.中醫(yī)證型分布情況:對PCI組及冠心病組兩組患者的中醫(yī)證型分布具有明顯差異。支架術后患者氣虛血瘀證型最多,多于冠心病氣虛血瘀證型患者,支架術后患者的證型分布以氣虛血瘀最多,氣虛血瘀痰阻心脈心血瘀阻陽氣虛衰=陰寒凝滯氣滯血瘀氣陰兩虛心腎陰虛,與冠心病患者的中醫(yī)證型分布具有明顯差異。PCI組的癥狀評分低于冠心病組癥狀評分。冠心病患者(無論是否行支架術)中男性的癥狀評分低于女性的癥狀評分。結論:1.PCI術后失眠患者癥狀分布同PCI術相關性得到統計學支持。PCI術后患者失眠的癥狀分布同冠心病未行PCI治療患者,高血壓或心律失�；颊叩氖甙Y狀分布具有明顯的差異。PCI術后患者以入睡困難最多,其次多見醒后難以再次入睡。2.65%患者的失眠情況在PCI術后無明顯變化,PCI術導致或加重失眠者27.5%,PCI術后失眠減輕者僅有7.5%。3.以PSQI,AIS,ESS測評患者的失眠嚴重程度,PCI術后患者同冠心病患者,高血壓或心律失�；颊卟痪哂忻黠@差異。4.PCI術后患者及冠心病患者在中醫(yī)證型分布上具有明顯差異。支架術后患者的證型分布以氣虛血瘀最多,氣虛血瘀痰阻心脈心血瘀阻陽氣虛衰=陰寒凝滯氣滯血瘀氣陰兩虛心腎陰虛,與冠心病患者的中醫(yī)證型分布具有明顯差異。
[Abstract]:Objective: the purpose of this study was to investigate the relationship between insomnia, coronary heart disease and PCI, the type of insomnia, the distribution of TCM syndrome type and the quality of life, so as to understand the status of insomnia and the proportion of TCM syndrome in the patients with PCI. Methods: a cross-sectional study was used in this study. From August 2016 to April 2017, 40 patients with insomnia after coronary heart disease stenting in the outpatient department of cardiovascular medicine and inpatient department of Dongzhimen hospital were included, and 20 patients with coronary heart disease without stent and insomnia were included, and 20 cases of non coronary heart disease accompanied by insomnia were investigated as two control groups. The questionnaire was used to collect the patient's data, collect the patient's basic information, medical history and treatment, risk factors control, insomnia, anxiety and depression, quality of life survey and TCM syndrome diagnosis. Establish a database, use SPSS17.0 statistical software to carry out statistical analysis of data, compared with the control group data, analyze the research object. The causes and types of insomnia and the correlation of TCM Syndrome Distribution and PCI. Results: 1. basic conditions: This study included 80 patients, including 40 patients with insomnia after coronary stenting, 3 in rehabilitation stage I, 4 in rehabilitation stage II, 33 in stage III patients, and 20 in patients with coronary heart disease without stenting and insomnia. There were 20 patients with non coronary heart disease and insomnia. All the patients included 38 men and 42 women. The average age of 80 patients was 66.99 + 11.049 years old, the minimum age was 42 years and the maximum age was 91. The age distribution of all patients was statistically significant. The age distribution of the three groups was no more. The age of male patients with coronary heart disease was significantly less than the risk factor control of.2. in women: 61 (76.25%) of all patients in this study were diagnosed with hypertension, 34 (42.5%) of all patients were diagnosed with diabetes, 60 (75%) of all patients were diagnosed with hyperlipidemia, after stenting, crowns The prevalence rate of hypertension and hyperlipidemia in patients with heart disease and hypertension and arrhythmia was higher than that of diabetes. In this study, the proportion of patients with a history of smoking in the PCI group was 42.5%, the coronary heart disease group was 30%, and the non coronary heart disease group was 25%; the proportion of each group in the history of alcohol drinking was 30% and the condition of upper.3. and treatment: 32 patients in group PCI were preoperatively. Angina pectoris occurred in 9 patients with coronary heart disease. Statistical results showed that the risk of angina pectoris in patients with coronary heart disease with angina pectoris in patients with coronary heart disease (PCI) was higher than that of coronary heart disease without angina. The incidence of angina pectoris in different age groups was not significantly worse than that of.60-69 years old. In the group of.PCI, there were 20 patients with single lesion, 7 of double branch lesions, 8 in three diseased persons, 5 in unknown person, with arrhythmia in 6 patients in non coronary heart disease group; 10 patients in coronary heart disease group were accompanied by arrhythmia; 7 patients in group PCI were accompanied by arrhythmia, and 23 people were accompanied by arrhythmia. The incidence of arrhythmia in three groups was clear. The incidence of arrhythmia in group PCI was significantly lower than that of.5. insomnia in coronary heart disease group: the average age of 80 cases of insomnia was 54.388 + 16.044, the minimum age was 13 years and the maximum age was 86 years; age was the influence factor of insomnia in this study. Statistical support, the incidence of insomnia at different age stages is different. Patients are more prone to insomnia at the age of 50-59 years. The age of insomnia in male patients with coronary heart disease is significantly lower than that of women with insomnia. The majority of patients with chronic insomnia, accounting for the symptoms of insomnia in 83.75%.80 cases, are 62, sleeping. Sleepless and shallow, easy to wake up the 62 people, more than 42 people, more than 36 people, after waking up to sleep again 57 people, sleep more enough, and still feel tired after waking up 5. The three groups in the symptoms of insomnia have statistical significance, PCI group sleep difficulty symptoms are higher than the other two groups, PCI after the insomnia patients with the highest incidence of sleep difficulties, the highest incidence of insomnia, after PCI insomnia patients with difficulty falling asleep rate is the highest, insomnia patients. The second was that the body factors were difficult to fall asleep again. The patients were less affected by the physical factors than the mental factors. The most important reason for the sleep in the.PCI group was to think about the family or work Trivia (42.50%) 48 cases of insomnia improvement in the patients with.80, 20 cases without improvement, 12 cases with less improvement, and the improvement of insomnia. The patients with insomnia were 4 (10%) and 7 patients (17.5%) with insomnia more serious after operation, 3 (7.5%) after operation and 3 (7.5%) after operation, and insomnia and 26 (65%).65% patients with insomnia after PCI, and no significant change of.6. sleep score after PCI: the severity of insomnia was evaluated with PSQI, each of the severity of insomnia, each The PSQI of the male patients was obviously less than the Pittsburgh score of the female. The difference of the degree of insomnia was evaluated with AIS in 80 patients. The difference of each group was not statistically significant. The degree of insomnia was evaluated by ISI, and the ISI score in all the patients was significantly higher than the degree of male.7. drowsiness and the degree of fatigue: ESS The degree of somnolence evaluation of.83.75% patients was within the normal range. The degree of fatigue in 80 patients was evaluated with FSS, 68 in 80 patients and 68 in the range of fatigue, not 12 in the range of fatigue: SAS for anxiety and depression, 60 of 80 patients in the normal range, 16 patients with mild anxiety and 4 patients. Moderate anxiety. No patients belonged to severe anxiety. SDS was used to evaluate the depression of the patients. 7 of the 80 patients were in the normal range, 12 were mild depression, 3 were moderately depressed, 1 of the patients with severe depression.83.75% were not in the degree of depression, and 16.25% of the patients were in the depressive state of.9. syndrome type distribution: P The distribution of TCM syndrome type of the two groups in group CI and coronary heart disease group has obvious difference. The patients with Qi deficiency and blood stasis syndrome after stenting are most, more than patients with coronary heart disease, Qi deficiency and blood stasis syndrome. The syndrome distribution of patients after stenting is most with Qi deficiency and blood stasis, Qi deficiency and blood stasis phlegm stasis, blood stasis and blood stasis of Yang Qi deficiency = Yin cold stagnation of qi stagnation, blood stasis and blood stasis and two deficiency heart Deficiency of kidney yin, the distribution of TCM syndrome type in patients with coronary heart disease was significantly different from that of group.PCI, the symptom score of the patients with coronary heart disease was lower than that of the coronary heart disease group. The symptom score of the male in the patients with coronary heart disease (whether or not for stent) was lower than that of the female symptom score. Conclusion: the correlation between the symptom distribution of the patients with insomnia after 1.PCI and the PCI operation was statistically supported by.PCI The distribution of the symptoms of insomnia after the operation was similar to that of the patients who had not been treated with PCI for coronary heart disease. There was a significant difference in the distribution of insomnia in patients with hypertension or arrhythmia. The patients were most difficult to fall asleep after.PCI operation, and then the insomnia of.2.65% patients who were difficult to fall asleep again after waking up had no obvious change after PCI operation. PCI operation led to or aggravated insomniacs 2 7.5%, the patients with insomnia relieved after PCI had only 7.5%.3. to evaluate the severity of insomnia with PSQI, AIS, ESS, and there was no significant difference between patients with same coronary heart disease after PCI, hypertension or arrhythmia, and there was significant difference in the distribution of TCM syndrome in patients with coronary heart disease and coronary heart disease after.4.PCI operation. The syndrome distribution of patients after stenting was Qi deficiency. The blood stasis is the most, Qi deficiency and blood stasis obstructing the heart, blood stasis and yang qi deficiency. = Yin cold stagnation of qi stagnation and blood stasis Qi Yin Qi Yin deficiency of two heart kidney yin deficiency, and the distribution of TCM syndrome type of the patients with coronary heart disease is obviously different.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R256.23

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