本文選題：勃起功能障礙 + 缺血性腦卒中��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：隨著人民生活水平的不斷提高,人們對(duì)健康的關(guān)注度也與日俱增。對(duì)男性而言正常的性功能是男性健康的重要組成部分,也是維系滿意性生活的必要條件。然而,勃起功能障礙(ErectiledysfunctionED)的發(fā)病率有逐年增加的趨勢(shì)。ED的病因較多,但總體可以歸為心理型和器質(zhì)型兩大類,并且來越多的研究表明器質(zhì)型ED的比例逐漸升高。近年來,腦卒中已經(jīng)成為影響人類健康的主要原因,在我國(guó)因腦卒中死亡的人數(shù)占第二位,僅次于腫瘤,并具有高發(fā)病率、高致死率和高致殘率的特點(diǎn)。其中,缺血性腦卒中(Ischemic stroke IS)是最常見類型,占全部腦卒中的60%～80%。一些國(guó)外研究發(fā)現(xiàn),IS除引起患者肢體運(yùn)動(dòng)、心理及認(rèn)知障礙外,對(duì)患者的性功能也有重要影響,尤其表現(xiàn)在勃起功能、性生活頻率、性欲、性興奮度等方面。然而,當(dāng)前關(guān)于我國(guó)男性IS患者勃起功能狀況及性生活質(zhì)量的臨床研究報(bào)道較少,本研究將運(yùn)用流行病學(xué)方法調(diào)查IS患者發(fā)病前后的勃起功能狀況及性生活質(zhì)量,進(jìn)一步探討兩者的相關(guān)性,從而拓展勃起功能障礙的診療的思路。目的:了解男性缺血性腦卒中(IS)患者發(fā)病前后的勃起功能和性生活質(zhì)量的變化及其可能的原因,探討勃起功能障礙(ED)與IS之間的臨床相關(guān)性,為提高恢復(fù)期患者性生活質(zhì)量提供指導(dǎo)依據(jù)。方法:自2016年1月至2016年12月,采用連續(xù)抽樣方法選擇在北京中醫(yī)藥大學(xué)東直門醫(yī)院腦病科就診的缺血性卒中患者248例為研究對(duì)象(年齡≤65歲),采用自制量表,以面對(duì)面問卷形式進(jìn)行調(diào)查。調(diào)查內(nèi)容包括四個(gè)部分:第一部分為IS患者的一般情況,包括人口學(xué)資料、IS發(fā)病特點(diǎn)、既往史、用藥史、個(gè)人史等;第二部分為IS患者發(fā)病前后勃起功能狀況及性生活質(zhì)量,包括IIEF-5評(píng)分、性欲、性交頻率、射精情況、晨勃情況等;第三部分為IS患者中醫(yī)證候、證素分布情況;第四部分為IS患者發(fā)病后情緒狀態(tài),輔助評(píng)價(jià)患者病情變化及勃起功能狀況。調(diào)查開始前,獲取相關(guān)科室及患者的知情同意,向調(diào)查對(duì)象承諾本調(diào)查不記名,所采集的信息嚴(yán)格保存,不公開、不泄露;將新發(fā)病(病程≤6個(gè)月)且尚未恢復(fù)性生活的患者,作為電話隨訪對(duì)象,在病程超過6個(gè)月后,通過電話隨訪,了解患者相關(guān)情況,完善調(diào)查資料,后期拒絕隨訪或電話有誤者視為失訪,予以剔除。資料收集截止在2016年12月。試驗(yàn)為自身前后對(duì)照,對(duì)所收集的數(shù)據(jù),采用Excel軟件錄入,采用SPSS21.0作為統(tǒng)計(jì)學(xué)軟件對(duì)本研究所有數(shù)據(jù)進(jìn)行分析處理。結(jié)果:符合本研究要求的調(diào)查對(duì)象共272例,2例患者在隨訪過程中意外死亡、7例患者借故不愿意回答有關(guān)性生活方面的問題、10例患者因電話號(hào)碼改變無法進(jìn)行隨訪、5例患者中途改變決定,停止填寫問卷,最終有248例完成本次調(diào)查,總回應(yīng)率為91.18%。調(diào)查對(duì)象平均年齡為55.65±6.32歲,平均體重指數(shù)(BMI)為26.12±2.64。其中,診斷為腦血栓形成患者192例,腦栓塞患者8例,腔隙性腦梗死患者48例,臨床NIHSS平均分為4.68±2.38分。45.56%的患者在發(fā)病前6個(gè)月伴有ED的情況,77.73%的患者發(fā)病后6個(gè)月伴有ED,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。發(fā)病前伴有ED的98例患者中(已剔除病后無性生活者),IIEF-5 評(píng)分從 16.24 分(IQR:14.75-18)下降到 9.5 分(IQR:6.75-12);病后性欲普遍偏低;性交頻率從發(fā)病前的3次(中位數(shù),IQR:2-4)降低到發(fā)病后的1.25次(中位數(shù),IQR:0.5-2),其差異具有統(tǒng)計(jì)學(xué)意義(P0.01);發(fā)病后射精潛伏期、射精快感、性生活整體滿意度方面均有下降,結(jié)果有統(tǒng)計(jì)學(xué)差異(P0.01)。腦干區(qū)梗死患者ED的患病率為33/40(82.50%),基底節(jié)區(qū)為96/116(82.76%),側(cè)腦室旁為 124/148(77.03%),頂葉為 79/103(76.70%),枕葉為 25/33(75.76%),顳葉為 20/27(74.07%),丘腦為 44/60(73.33%),額葉為 102/142(71.83%),小腦為 7/10(70%)。卒中病后患者整體抑郁患病率為168/248(67.74%),焦慮總患病率為162/248(65.32%),抑郁焦慮共患率為124/248(50.00%);病后未恢復(fù)性生活患者和伴有ED者PHQ-9平均分高于不伴有ED的患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05);病后伴有ED的患者抑郁的患病率明顯高于其他兩種情況,差異有統(tǒng)計(jì)學(xué)意義(P0.01),病后伴有ED的患者抑郁焦慮共患率高于不伴有ED的患者,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。IS患者中肝陽上亢證14/16(87.50%)、氣虛血瘀證32/37(86.49%)、氣血兩虛證5/6(83.33%)、痰濕內(nèi)蘊(yùn)證10/12(83.33%)出現(xiàn)ED的頻率最多。證素拆分統(tǒng)計(jì)為,病位證素中肝部位ED發(fā)病率最高(87.50%),病性證素氣虛(88.37%)、血虛(83.33%)、濕(83.33%)導(dǎo)致的ED病發(fā)病率較高。結(jié)論:與中風(fēng)前相比,IS男性患者的ED患病率及嚴(yán)重程度明顯增高,患者在性欲、性生活頻率、射精潛伏期、性高潮快感、性生活滿意度等方面均有明顯下降。其可能的原因是與調(diào)控勃起及其他性功能的中樞區(qū)域梗死有關(guān),而中風(fēng)后所產(chǎn)生的心理障礙(尤其是抑郁障礙)和廣泛使用具有影響勃起功能的藥物也是導(dǎo)致ED發(fā)生發(fā)展的重要因素。其他如年齡、體重指數(shù)、相關(guān)基礎(chǔ)病數(shù)量可能是誘發(fā)ED的高危因素,但必須在更大樣本的前瞻性研究中進(jìn)一步證實(shí)。中風(fēng)患者以痰瘀阻絡(luò)、氣虛血瘀和風(fēng)痰阻絡(luò)為多見證候,但并未見到腎虛類證候,其中痰瘀阻絡(luò)和氣虛血瘀是中風(fēng)合并陽痿的主要證型;以治療中風(fēng)為目標(biāo)的患者其勃起功能也有較為明顯的改善,提示治療中風(fēng)的用藥思路同樣適用于治療陽痿。
[Abstract]:With the improvement of the people's living standard, people's attention to health is also increasing. The normal sexual function for men is an important part of male health and a necessary condition for maintaining a satisfactory life. However, the incidence of erectile dysfunction (ErectiledysfunctionED) has an increasing trend of.ED in the cause of the incidence of erectile dysfunction (the incidence of erectile dysfunction). But in general, it can be classified as two major categories of psychological and organic type, and the more research shows that the proportion of organic ED is increasing. In recent years, cerebral apoplexy has become the main cause of human health. In our country, the number of deaths from stroke is second, second only to the tumor, and has high incidence, high mortality and high disability rate. Among them, ischemic stroke (Ischemic stroke IS) is the most common type, which accounts for 60% to 80%. of all cerebral apoplexy, and some foreign studies have found that IS has an important influence on the sexual function of the patient, especially in the aspects of erectile function, sexual frequency, sexual desire and sexual excitability. However, there are few clinical reports on the erectile function and the quality of life of the male IS patients in China. This study will use epidemiological methods to investigate the erectile function and the quality of life of the patients with IS before and after the onset of the disease, and further explore the correlation between the two, so as to expand the diagnosis and treatment of erectile dysfunction. The changes of erectile function and sexual quality of life before and after the onset of male ischemic stroke (IS) and its possible causes are discussed, and the clinical relevance between erectile dysfunction (ED) and IS is discussed, and the guidance for improving the quality of sexual life in the recovery period is provided. Methods: from January 2016 to December 2016, the continuous sampling method was selected in the north. 248 cases of ischemic stroke in the Department of encephalopathy in Dongzhimen Hospital of Beijing University of traditional Chinese medicine were studied (age less than 65 years old). A self-made questionnaire was used to investigate the form of face-to-face questionnaire. The content of the investigation included four parts: the first part was the general situation of IS patients, including demographic data, IS disease characteristics, past history, history of medication, individual The second part was the erectile function and the quality of life before and after the onset of IS, including IIEF-5 score, sexual desire, sexual frequency, ejaculation, morning and Bo situation, and the third part was the TCM syndrome of IS patients and the distribution of syndrome elements; the fourth part was the mood state after the onset of IS, and assistant evaluation of the patient's condition change and erectile function. Before the start of the investigation, the informed consent of the related departments and patients was obtained, and the survey was unregistered. The information collected was strictly preserved, not open and not disclosed; the patients with new disease (course of illness less than 6 months) had not been restored to sexual life, and were followed up for more than 6 months after the course of the disease, and the patients were followed up by telephone to understand the patient's phase. After closing the situation, perfecting the investigation data, the later refusal of follow-up or the telephone error is considered to be lost and eliminated. The data collection is in December 2016. The test is the control of itself, the data collected, the Excel software is recorded, and SPSS21.0 is used as the statistical software to analyze all the data of the research. The required subjects were 272 cases, 2 patients died in the follow-up process, 7 cases were not willing to answer questions about sexual life, 10 patients were unable to follow up due to telephone number change, 5 patients changed the decision, stopped filling out the questionnaire, and finally completed the survey, the total response rate was 91.18%. survey. The average age was 55.65 + 6.32 years, and the average body mass index (BMI) was 26.12 + 2.64.. The diagnosis was 192 patients with cerebral thrombosis, 8 cases of cerebral embolism, 48 cases of lacunar infarction, and 4.68 + 2.38.45.56% in clinical NIHSS, with ED in 6 months before the onset of the disease, and 77.73% patients with ED after the onset of the disease. The difference was poor. The difference was statistically significant (P0.01). In 98 patients with ED before the onset of the disease, the IIEF-5 score decreased from 16.24 (IQR:14.75-18) to 9.5 (IQR:6.75-12), and the sexual desire was generally low after the disease; the frequency of sexual intercourse decreased from 3 times before the onset (median, IQR:2-4) to 1.25 times after the onset (median, IQR:0.5-2), and the difference between them (median, IQR:0.5-2). The difference was statistically significant (P0.01); there was a decrease in ejaculatory latency, ejaculatory sensation, and overall sexual satisfaction (P0.01). The prevalence of ED in patients with brain stem infarction was 33/40 (82.50%), 96/116 (82.76%) in the basal ganglia, 124/148 (77.03%) beside the lateral ventricle, 79/103 (76.70%) in the parietal lobe, and 25/33 in the occipital lobe. (75.76%) the temporal lobe was 20/27 (74.07%), the thalamus was 44/60 (73.33%), the frontal lobe was 102/142 (71.83%), and the cerebellum was 7/10 (70%). The overall depression rate of the patients after the stroke was 168/248 (67.74%), the total anxiety prevalence rate was 162/248 (65.32%), the depression and anxiety codevelopment rate was 124/248 (50%), and the average height of PHQ-9 in the patients who were not restored to sex after the disease and the PHQ-9 average height of those with ED after the disease. The difference was statistically significant (P0.05) in patients without ED, and the incidence of depression in patients with ED was significantly higher than those of the other two cases, and the difference was statistically significant (P0.01). The incidence of depression and anxiety in patients with ED was higher than those without ED, and the difference was statistically significant (P0.01) in.IS patients with hyperactivity of liver Yang (87.5) 0%) Qi deficiency and blood stasis syndrome 32/37 (86.49%), Qi and blood two deficiency syndrome 5/6 (83.33%), phlegm dampness syndrome 10/12 (83.33%) of the most frequent occurrence of ED. The incidence of ED in the liver site is the highest (87.50%), disease syndrome factor Qi deficiency (88.37%), blood deficiency (83.33%), and wet (83.33%) caused by the higher incidence of ED disease. Conclusion: compared with before stroke, IS male The prevalence and severity of ED in sex patients were significantly higher, and the patients had a significant decrease in sexual desire, sexual frequency, ejaculation latency, orgasm pleasure, sexual satisfaction, and so on. The possible reason is that it is related to central regional infarction that regulates erection and other sexual functions, and the psychological disorder (especially depression) after stroke. And extensive use of drugs that affect erectile function is also an important factor in the development of ED. Other factors such as age, body mass index and the number of related basic diseases may be the high risk factors for inducing ED, but it must be further confirmed in a prospective study of larger samples. The syndrome of kidney deficiency was not seen, among which phlegm and stasis and Qi deficiency and blood stasis are the main syndromes of Apoplexy with impotence, and the erectile function of the patients with the target of treating stroke is also obviously improved, suggesting that the thought of treating apoplexy is also applicable to impotence.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.7;R277.5

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