發(fā)布時(shí)間：2018-04-08 23:37

  本文選題：老年高血壓　切入點(diǎn)：焦慮　出處：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的通過(guò)在老年高血壓合并焦慮狀態(tài)患者臨床診療基礎(chǔ)上應(yīng)用老年綜合評(píng)估(Comprehensive Geriatric Assessment CGA),在疾病、軀體功能、精神心理和社會(huì)環(huán)境等多個(gè)層面對(duì)患者進(jìn)行全面評(píng)估以及合理干預(yù),探討其在減輕患者焦慮癥狀、提高服藥依從性、控制血壓及動(dòng)態(tài)血壓、改善自主神經(jīng)功能及生存質(zhì)量方面的作用,從而為進(jìn)一步促進(jìn)患者病情恢復(fù)提供一定的臨床參考。方法收集2015年10月至2016年4月在華北理工大學(xué)附屬醫(yī)院入住老年病科的高血壓合并焦慮狀態(tài)患者,從中選取符合納入標(biāo)準(zhǔn)者152人作為研究對(duì)象。診斷標(biāo)準(zhǔn):1)原發(fā)性高血壓的診斷依照《中國(guó)高血壓防治指南(2010版)》的標(biāo)準(zhǔn):在未服用降壓藥的情況下非同日3次診室收縮壓≥140mm Hg和(或)舒張壓≥90mm Hg,或既往明確診斷過(guò)高血壓,正在接受降壓治療;2)焦慮狀態(tài)診斷:SAS焦慮自評(píng)量表評(píng)分(粗分)≥40分,且癥狀符合《中國(guó)精神疾病分類(lèi)及診斷標(biāo)準(zhǔn)》中廣泛性焦慮癥的臨床表現(xiàn):經(jīng)常或持續(xù)的無(wú)明確對(duì)象和固定內(nèi)容的恐懼或提心吊膽,伴植物神經(jīng)功能紊亂或運(yùn)動(dòng)性不安。納入標(biāo)準(zhǔn):1)年齡在≥60歲;2)意識(shí)清楚;3)住院時(shí)間超過(guò)72小時(shí);4)入選對(duì)象均已表示自愿參與本次研究,并于研究前簽訂相關(guān)知情同意書(shū)。將入選患者隨機(jī)分成干預(yù)組75例及對(duì)照組77例,研究前采集兩組患者的一般資料,測(cè)量并記錄患者的血壓、動(dòng)態(tài)血壓及心率變異性指標(biāo)(Heart Rate Variability HRV)。對(duì)所有入選患者在入院當(dāng)天完成焦慮癥狀評(píng)估,入院3天內(nèi)完成老年綜合評(píng)估、服藥依從性評(píng)估及生存質(zhì)量評(píng)估。研究過(guò)程中兩組患者均給予規(guī)范疾病治療、結(jié)合心理科會(huì)診給予心理安慰或抗焦慮藥物治療,干預(yù)組同時(shí)進(jìn)行老年綜合評(píng)估,針對(duì)評(píng)估過(guò)程中篩查的問(wèn)題給予針對(duì)性的干預(yù)措施。干預(yù)時(shí)間為2個(gè)月零14天,在本次研究結(jié)束時(shí)進(jìn)行第2次評(píng)估,并復(fù)查血壓、動(dòng)態(tài)血壓及心率變異性指標(biāo)。所有研究資料應(yīng)用SPSS20.0進(jìn)行結(jié)果分析,兩組計(jì)數(shù)資料采用例數(shù)和百分?jǐn)?shù)表示,組間比較采用χ2檢驗(yàn)。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,進(jìn)行正態(tài)性檢驗(yàn)后,兩組間比較采用兩獨(dú)立樣本t檢驗(yàn),組內(nèi)前后比較采用配對(duì)t檢驗(yàn)。P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1兩組患者的性別、年齡、婚姻、文化程度、職業(yè)、煙酒史、合并冠心病及2型糖尿病情況、β受體阻滯劑服用情況、高血壓病程年數(shù)、體質(zhì)指數(shù)等一般資料及老年綜合評(píng)估等基礎(chǔ)資料比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2入院第1天,兩組患者SAS評(píng)分比較,無(wú)明顯差異(P0.05)。出院2個(gè)月后復(fù)測(cè),兩組患者SAS評(píng)分較前均有不同程度減低,且干預(yù)組焦慮癥狀緩解效果優(yōu)于對(duì)照組(P0.01)。3入院后3天內(nèi)完成患者服藥依從性評(píng)估,兩組評(píng)分相比,無(wú)明顯差異(P0.05)。出院2個(gè)月后復(fù)測(cè),兩組患者服藥依從性較前均有不同程度提高,且干預(yù)組評(píng)分顯著高于對(duì)照組(P0.01),提示干預(yù)組患者服藥依從性提高更加明顯。4入院第1天兩組患者偶測(cè)血壓水平比較,無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。出院2個(gè)月后復(fù)查,兩組患者的收縮壓及舒張壓水平較前均有不同程度下降,且干預(yù)組比對(duì)照組血壓下降更加明顯(P0.05)。5入院后兩組患者動(dòng)態(tài)血壓水平相比,無(wú)明顯差異(P0.05)。出院2個(gè)月后復(fù)查,與對(duì)照組相比,除夜間平均舒張壓以外,干預(yù)組的其余5項(xiàng)指標(biāo)水平均較低(P0.05),提示兩組比較,干預(yù)組患者的動(dòng)態(tài)血壓平均水平改善程度較大。6入院后兩組患者血壓晝夜節(jié)律性呈杓型的人數(shù)相比,無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。出院2個(gè)月后復(fù)查,干預(yù)組血壓晝夜節(jié)律性呈杓型的人數(shù)較對(duì)照組增多(P0.05),提示干預(yù)組患者血壓晝夜節(jié)律性改善更加明顯。7入院后比較兩組患者HRV水平,無(wú)明顯差異(P0.05);出院2個(gè)月后復(fù)查時(shí)兩組患者各項(xiàng)HRV指標(biāo)較前均有所提高P0.01),且干預(yù)組HRV指標(biāo)明顯比對(duì)照組較高(P0.05),提示干預(yù)組患者自主神經(jīng)功能改善更加明顯。8入院3天內(nèi)完成兩組患者生存質(zhì)量評(píng)估,各項(xiàng)評(píng)分相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);出院2個(gè)月后復(fù)測(cè),兩組患者生存質(zhì)量各項(xiàng)評(píng)分均有所提高(P0.05),且兩組患者評(píng)分相比,除生理職能以外,其他7項(xiàng)干預(yù)組評(píng)分結(jié)果較高(P0.05)。結(jié)論在老年高血壓合并焦慮狀態(tài)患者的常規(guī)治療方案中引入CGA,并對(duì)篩查出的問(wèn)題給予科學(xué)干預(yù),可以有以下效果:1)有效緩解患者的焦慮癥狀。2)提高患者服藥依從性,促進(jìn)平穩(wěn)降壓,改善自主神經(jīng)功能。3)使患者的生存質(zhì)量得到明顯提高。
[Abstract]:Objective through the application of comprehensive geriatric assessment in elderly hypertensive patients with anxiety in patients with clinical diagnosis and treatment on the basis of (Comprehensive Geriatric Assessment CGA), the disease, physical function, psychological and social environment and other aspects were comprehensive evaluation and reasonable intervention on the anxiety symptoms of patients, improve medication compliance, and ambulatory blood pressure control of blood pressure, improve autonomic nerve function and quality of life of the role, so as to provide clinical reference to further promote the recovery of patients. The anxiety state of patients with hypertension were collected from October 2015 to April 2016 in the North Polytechnic in the Affiliated Hospital of University, the selection criteria of 152 people from the diagnostic criteria as the research object.: 1) the diagnosis of primary hypertension in accordance with the "guidelines for prevention and treatment of hypertension Chinese (2010 Edition) > standard: without Under the condition of non use of antihypertensive drugs on the same day 3 times more than 140mm Hg and consulting room, systolic blood pressure, diastolic blood pressure below 90mm (or Hg), or previous diagnosis had hypertension, are receiving antihypertensive treatment; 2) anxiety diagnosis: SAS self rating Anxiety Scale score (divided) more than 40 points, and in line with clinical symptoms. The performance of classification and diagnostic criteria of mental disorders China > in generalized anxiety disorder: often persistent or no clear object and fixed content of fear or always on tenterhooks, with autonomic dysfunction or motor restlessness. Inclusion criteria: 1) at the age of more than 60 years old; 2) clear consciousness; 3) hospitalization more than 72 h; 4) subjects have said voluntarily participated in this study and signed informed consent to the study. The patients were randomly divided into intervention group and control group in 75 cases and 77 cases, the research collected before the general information of the two groups of patients, measure and record the patient's blood pressure, ambulatory blood pressure and Heart rate variability index (Heart Rate Variability HRV). All patients in the day of admission completed anxiety symptom assessment, admission within 3 days of the completion of comprehensive geriatric assessment, assessment of medication compliance and quality of life assessment. Two groups of patients during the study were given the treatment of the disease, the combination of psychological consultation to give comfort or anti anxiety drug treatment the psychological intervention group, while the comprehensive geriatric assessment, aiming at the problems in the process of screening assessment given targeted intervention. The intervention lasted 2 months and 14 days, second assessment in the end of the study, and review the blood pressure, ambulatory blood pressure and heart rate variability index. Analysis results of all application data SPSS20.0, two groups of count data expressed by the number of cases and percentage were compared by 2 test measurement data using the mean and standard deviation (x + s) said that the normality test after, The two groups were compared using two independent samples t test, within groups using paired t test.P0.05 was statistically significant difference. Results 1 patients of the two groups of gender, age, marriage, education, occupation, smoking history, coronary heart disease and type 2 diabetes, beta blocker use, duration of hypertension years comparison of body mass index, general information and comprehensive geriatric assessment data, no significant difference (P0.05).2 on the first day, SAS scores in the two groups had no significant difference (P0.05). 2 months after discharge retest, the SAS score of the two groups were different degrees of reduction, and the intervention group anxiety the remission of symptoms better than the control group (P0.01) to complete the assessment of compliance of patients with.3 within 3 days after admission, compared two groups score, no significant difference (P0.05). 2 months after discharge retest, two groups of patients with medication compliance were different. Is high, and the intervention group were significantly higher than those in control group (P0.01), suggesting that the intervention group patients with medication compliance were better improved.4 on the first day of two groups of patients measuring blood pressure level comparison, no statistically significant difference (P0.05). After 2 months of discharge, two groups of patients with systolic blood pressure and diastolic blood pressure than before have varying degrees of decline, and the intervention group than the control group obviously decreased blood pressure (P0.05) compared to the level of blood pressure in two groups of patients with dynamic.5 after admission, no significant difference (P0.05). After 2 months of discharge, compared with the control group, except the night diastolic blood pressure, the intervention group of the remaining 5 indicators were low (P0.05), suggesting that the two groups of patients in the intervention group improved the average ambulatory blood pressure greater.6 blood pressure after admission of patients in two groups were the number of dipper circadian rhythm compared no significant difference (P0.05). After 2 months after the intervention group The circadian rhythm of blood pressure was the number of dipper was more than that in control group (P0.05), suggesting that the intervention of blood pressure circadian rhythm of the patients obviously improved.7 after admission were compared between the two groups HRV levels, no significant difference (P0.05); 2 months after discharge follow-up of the two groups were compared to that before HRV increased P0.01), and the intervention group than the control group, HRV index was significantly higher (P0.05), suggesting that the intervention group improved more obviously in autonomic nerve function in patients with.8 hospitalized within 3 days of the completion of the two groups of patients quality of life assessment, the score had no statistical difference (P0.05); the 2 months after the retest, the quality of life of patients in the two groups score were improved (P0.05), and the two group were compared, in addition to the physical function outside, the other 7 intervention group scores were higher (P0.05). Conclusion CGA was introduced into the conventional treatment combined with anxiety state in elderly patients with hypertension, and screening Scientific intervention can bring the following effects: 1) effectively alleviate the patient's anxiety symptoms.2), improve patient compliance, promote stable blood pressure, improve autonomic nervous function.3, and improve the quality of life of patients.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R544.1;R749.72

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