综合心理干预对老年高血压伴抑郁焦虑患者生活质量的影响

高血压是临床常见的一种慢性疾病,为心、脑、肾等脏器疾病的重要病因和危险因素,需长期治疗。高血压是一种身心疾病,社会环境、不良行为及患者自身心理因素均为诱发高血压的重要原因。老年性高血压患者常伴有焦虑和抑郁等不良心理反应〔1〕。我院对57例老年高血压伴抑郁焦虑患者采用心理护理干预,观察其对患者生活质量的影响。     

睡眠障碍对老年慢性功能性便秘患者焦虑抑郁情绪和生活质量的影响分析

背景随着饮食结构的改变和生活方式的快速变化,慢性便秘发病率呈逐渐上升趋势.睡眠障碍可增加胃肠道症状,也是焦虑、抑郁形成的一个危险因素.本研究旨在探讨睡眠障碍对老年慢性功能性便秘患者焦虑抑郁情绪和生活质量的影响进行分析,以期为治疗老年慢性功能性便秘患者的新思路提供客观依据.目的旨在探讨睡眠障碍对老年慢性功能性便秘患者焦虑抑郁情绪和生活质量的影响分析.方法选择2017-03/2019-09在我院就诊的126例老年慢性功能性便秘患者为研究对象,根据是否有睡眠障碍分为睡眠障碍组和睡眠正常组.对所有患者进行便秘评分系统(constipatipation scoring system, CSS)、便秘患者症状自评问卷(patient assessment of constipation symptom,PAS-SYM)、睡眠质量评估、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(selfrating depression scale, SDS)及生活质量量表评分.结果睡眠障碍组CSS评分为19.63分±3.36分, PAS-SYM评分为1.59分±0.52分,SAS评分为58.92分±6.72分, SDS评分为57.74分±6.38分,均高于睡眠正常组(P 0.05).睡眠障碍组患者社会功能评分为71.56分±3.38分、情绪评分为75.89分±2.95分、躯体角色评分为76.86分±2.92分、躯体健康评分为80.25分±3.35分、心理卫生评分为78.36分±3.65分、总健康评分为76.19分±2.56分,均低于睡眠正常组,差异有统计学意义(P0.05). CSS、PAC-SYM各维度评分以及总分均与SAS、SDS评分呈正相关(P0.05);生活质量量表中6个维度的得分与SAS、SDS评分均呈负相关(P0.05).结论睡眠障碍和焦虑、抑郁可能是影响老年慢性功能性便秘患者临床症状的重要因素,并影响患者生活质量.     

焦虑、抑郁情绪对心房颤动患者生活质量的影响

目的 探讨心房颤动（简称房颤）患者焦虑、抑郁情绪的发生情况及其与患者生活质量（QOL）的关系.方法 入选房颤患者80例,根据主诉、病史、体格检查及其他辅助检查排除器质性心脏病及可引发心房颤动的其他器质性疾病,选取同年龄、同性别的80名健康人（无器质性疾病及精神疾病）作为对照组,采用美国简明健康测量量表（SF-36）评估两组受试者生活质量评分,采用医院焦虑、抑郁量表（HADS）评估两组受试者的情绪情况,通过SPSS 12.0软件对患者生活质量评分和焦虑抑郁评分进行统计分析.结果 根据HADS评分结果,房颤患者情绪反应阳性（焦虑或抑郁）53例,占66.3％,情绪反应阴性27例,占33.7％;对照组情绪反应阳性5例,占6.25％,两组比较差异有统计学意义（x2 =62.31,P＜0.01）.将80例房颤患者分为情绪异常组和情绪正常组,两组患者生活质量评分比较差异有统计学意义（P＜0.05）.分别以焦虑、抑郁情绪评分和患者生活质量各维度评分进行相关分析,发现房颤患者生活质量各维度评分与焦虑、抑郁情绪反应程度呈负相关（P＜0.05）.结论 房颤患者常伴有焦虑或抑郁情绪反应;且焦虑、抑郁情绪反应程度越严重,患者生活质量下降越明显.     

住院房颤患者伴焦虑抑郁对生活质量的影响

目的探讨住院房颤患者焦虑抑郁的发病情况,以及房颤伴焦虑抑郁情感障碍是否影响其生活质量。方法入选住院房颤患者。患者自填焦虑抑郁量表,依据量表评分结果分为焦虑组、抑郁组、焦虑抑郁共病组及无焦虑抑郁状态的单纯房颤组。患者自填SF-36生活质量量表,经过量表评分后,对各组生理功能（PF）、生理职能（RP）、躯体疼痛（BP）、总体健康（GH）、活力（VT）、社会功能（sF）、情感职能（RE）和精神健康（MH）八个纬度的生活质量评分并进行比较分析。结果①入选118例房颤患者,焦虑、抑郁、焦虑抑郁共病及单纯房颤的发生率分别是12．7％（15／118）、22．0％（26／118）、8．5％（10／118）和56．8％（67／118）。②焦虑、抑郁及焦虑抑郁共病房颤患者的生活质量在PF、SF、MH、VT、GH五个方面比无焦虑抑郁的单纯房颤患者得分低;其中抑郁组、焦虑抑郁共病组患者的生活质量评分比无焦虑抑郁的单纯房颤患者的生活质量评分更低,差异有统计学意义（P〈0．05）。结论部分房颤患者存在焦虑、抑郁及焦虑抑郁共病的情况。合并这类情感障碍的房颤患者生活质量在PF、SF、MH、VT、GH五个方面受到一定影响,需要更为积极的临床干预。     

链式亲情护理模式对老年原发性干燥综合征患者焦虑和抑郁及生活质量的影响

目的 探讨链式亲情护理模式对老年原发性干燥综合征(primary Sj?gren’s syndrome,pSS)患者焦虑、抑郁及生活质量的影响,为治疗该病提供护理方法。方法 选取2020年10月—2021年11月在上海交通大学医学院附第九人民医院门诊就诊的老年pSS患者100例,按数字表法随机分为观察组(n=50)和对照组(n=50)。观察组采用个体化教育方案护理,对照组采用常规护理。干预前和干预12周时,分别采用心理焦虑自评量表(SAS)和心理抑郁自评量表(SDS)对患者的焦虑和抑郁程度进行评估,采取健康调查简表(SF-36)评价患者的生活质量,采取医学应对问卷MCMQ[8]对患者的应对疾病方式的程度进行评估,评估患者服药依从情况;并对2组上述评估结果进行统计学分析和比较。结果 干预12周,2组SAS和SDS评分明显低于同组干预前(P <0.05),观察组SAS和SDS评分明显低于对照组(P<0.05);2组SF-36评分高于同组干预前(P<0.05),观察组SF-36评分明显高于对照组(P<0.05);2组MCMQ各项维度评分中面对项评分明显高于同组干预前(...     

小针刀治疗老年颈性眩晕过程中叙事医学对患者抑郁焦虑和生活质量的影响

目的观察小针刀治疗老年颈性眩晕过程中叙事医学对患者抑郁、焦虑和生活质量的影响。方法选择2017年1月-2019年12月31日因颈性眩晕在上海市金山区廊下镇社区卫生服务中心行小针刀治疗的老年患者64例,采用随机数字表法分为观察组和对照组每组32例。对照组进行1个疗程为7周的小针刀治疗,观察组在与对照组相同的小针刀治疗的同时,采用叙事医学进行干预。评估并比较2组干预前后GAD-7抑郁量表评分、PHQ-9焦虑量表评分及SF-36生活质量量表评分的变化。结果治疗后,观察组GAD-7及PHQ-9量表评分均有所下降,对照组评分分值则有所上升,2组比较差异均有统计学意义(P<0.05);2组SF-36量表评分分值均上升,观察组明显高于对照组(P<0.05)。结论在老年颈性眩晕小针刀治疗中,叙事医学可减轻患者的焦虑和抑郁,有助于提高小针刀治疗效果,改善患者的生活质量。     

老年帕金森病病人焦虑和抑郁情绪与生活质量的相关性研究

目的 探讨老年PD病人焦虑和抑郁情绪与生活质量的相关性。方法 选取南京医科大学第一附属医院神经内科、神经外科214例≥60岁PD病人作为研究对象,采用PD生活质量调查表(PDQ-39)、贝克焦虑量表(BAI)、老年抑郁量表(GDS)分别调查病人生活质量,焦虑、抑郁情绪,分析焦虑、抑郁情绪与病人生活质量之间的相关性。结果 老年PD病人生活质量得分为(90.75±22.34)分,处于中等偏下水平;焦虑情绪与情感存在正相关,与社会支持存在负相关;抑郁情绪与情感、屈辱度、认知、躯体不适存在正相关。结论 焦虑、抑郁情绪是影响PD病人生活质量最大的危险因素,关注老年病人的心理状态,加强心理护理,有利于改善病人的生活质量。     

老年冠心病患者抑郁患病率调查及抑郁对患者生活质量的影响

目的探讨老年冠心病(OHD)患者抑郁患病情况及其对患者生活质量的影响。方法 2013年6月至2014年8月该院心血管内科收治的老年CHD患者80例为研究组,同期于该院体检的健康老年人80例为对照组,采用汉密尔顿抑郁量表(HAMD17)评估患者抑郁情况,对比两组抑郁患病率;采用健康调查简表(SF-36)评价CHD患者生活质量,分析老年CHD伴抑郁对生活质量的影响。结果研究组抑郁患病率明显高于对照组(P0.05)。研究组中不同病种患者抑郁患病率无明显差异(P0.05),不同性别、文化程度抑郁患病率差异有统计学意义(P0.05)。SF-36调查结果显示伴抑郁患者生理健康、心理健康各维度评分明显低于不伴抑郁患者(P0.05)。结论老年CHD患者存在明显抑郁患病情况,受教育程度较低的女性患者可能抑郁情况更为显著,且抑郁会不同程度地加重CHD患者的生活质量损害,临床需引起重视,并给予重点关注。     

老年高血压患者焦虑抑郁情绪对血压变异性、心率变异性和生活质量的影响

目的探讨老年高血压患者焦虑抑郁情绪对血压变异性、心率变异性和生活质量的影响。方法选取60例高血压合并焦虑抑郁老年患者为观察组,同期诊治的单纯老年高血压患者60例为对照组。监测两组动态血压、动态心电图,计算比较血压变异性、心率变异性等指标,并比较两组生活质量评分。结果观察组24 h收缩压变异性(24 h SSD)、白昼收缩压变异性(dSSD)均明显高于对照组(P0.05),而两组24 h舒张压变异性(24 h DSD)、白昼舒张压变异性(dDSD)、夜间收缩压变异性(nSSD)、夜间舒张压变异性(nDSD)比较无明显差异(P0.05)。观察组正常窦性节律R-R间期总体标准差(SDNN)、相邻R-R间期差的均方根(rMSSD)、每5 min正常R-R间期平均值的标准差(SDANN)均明显低于对照组(P0.05)。观察组的生理职能(RP)、生理功能(PF)、总体健康(CH)、躯体疼痛(BP)、活力(VT)、情感职能(RE)、精神健康(MH)、社会功能(SF)等八个方面的评分均明显低于对照组(P0.05)。结论伴有焦虑抑郁情绪的老年高血压患者的动态血压变化幅度增加,血压变异性增加,而心率变异性、生活质量均显著降低。因此,可通过加强对老年高血压患者的心理疏导和支持以减少焦虑抑郁情绪的出现,从而改善老年患者的血压、心率变异性及生活质量。     

肾病综合征患者的焦虑、抑郁情绪及生活质量研究

目的探讨肾病综合征患者的心理状态及生活质量,为心理干预提供依据。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）及生活质量综合评定问卷（GQOLI-74）对53例肾病综合征患者进行评定,并与53例健康自愿者评定结果对照。结果肾病综合征患者存在普遍的焦虑、抑郁情绪,中度以上焦虑与抑郁的发生率分别为56.6%和67.9%。生活质量综合评定问卷评分,除物质生活维度及认知功能、住房、社区服务、生活环境因子与对照组之间无显著性差异外,其余维度及各因子与生活质量总体评价均显著低于对照组。结论肾病综合征患者存在广泛的焦虑、抑郁情绪,且生活质量较差,应对其进行积极有效的心理干预。     

慢性乙型肝炎患者远期生存质量研究

目的 对慢性乙型肝炎患者远期生存质量进行研究,为其预后判断,药物疗效的分析及药品经济学评估提供依据。 方法 采用补充修订的SF-36健康相关生存质量量表调查101例6～l 8年前经肝穿活组织检查诊断的慢性乙型肝炎和105例门诊体检的普通人群。 结果 慢性乙型肝炎患者在生理机能、生理职能、总体健康、精神健康、肝病特有症状5个方面的远期生存质量低于普通人群,差异有显著性(μ≥2.10,P<0.05)。 结论 慢性乙型肝炎患者远期生存质量差。     

Comparing the safety,tolerability and quality of life in patients with chronic hepatitis B vs chronic hepatitis C treated with peginterferon alpha‐2a

Background/Aims: Hepatitis B and C viruses (HBV and HCV) are two clinically distinct but related diseases. Pooled data from five studies of peginterferon alpha‐2a in patients with chronic HCV infection (CHC) were compared with two studies of the drug in patients with chronic HBV infection (CHB). Method: The HBV studies included both hepatitis B e antigen (HBeAg)‐positive (n=271) and HBeAg‐negative (n=177) patients; 791 patients took part in the HCV trials. In all studies, patients were treated with 180 μg peginterferon alpha‐2a monotherapy once weekly for 48 weeks. The number of adverse events (AEs), discontinuations and dose modifications were documented. Health‐related quality of life (HRQL) was assessed using the Short‐Form 36 questionnaire. Safety was assessed throughout the treatment period. A 24‐week treatment‐free follow‐up period was also included. Results: Differences (HBV vs HCV) were observed in the incidence of AEs (88–89 vs 96–100%), serious AEs (4–5 vs 7–16%) and treatment withdrawals (6–8 vs 17–33%). The frequency of depression‐related events was lower in CHB patients (4 vs 22%, P<0.001), as was the impact of treatment on HRQL. Conclusions: The safety and tolerability of peginterferon alpha‐2a in patients with CHB compares favourably with that observed in CHC patients, with a lower incidence of common interferon‐related AEs and a significantly lower incidence of depression.     

核苷和核苷酸类药物治疗对慢性乙型肝炎患者生活质量的影响

目的分析核苷和核苷酸类药物治疗对慢性乙型肝炎(CHB)患者生活质量的影响,并探讨相应护理措施。方法选取2010年3月-2014年7月于南方医科大学南方医院感染内科临床研究的102例CHB患者,分为持续治疗组(n=54)与停药组(n=48),以SF-36表测量生活质量。治疗组于治疗前与治疗96周接受评估,停药组于停药点与停药48周接受评估。计量资料组间比较采用t检验,组内比较采用配对t检验;计数资料组间比较采用χ2检验。单因素及多因素分析采用Logistics回归分析。结果与抗病毒前比较,持续治疗组患者抗病毒治疗96周后,其生理功能、生理职能、躯体疼痛、总体健康均明显升高(94.91±7.11 vs 92.13±10.58,81.94±24.96 vs 71.76±34.01,87.72±8.64 vs 82.85±12.88,59.63±14.59 vs 53.52±16.79,t=-3.786~-2.623,P值均0.05)。但心理质量除精神健康由67.30±18.94提高至75.56±15.53(t=-3.883,P0.001)外,其余维度均无明显改善。停药组在停药后48周生理职能、总体健康与精神健康均有显著提高(84.20±18.97 vs 72.49±24.38,69.28±22.94 vs 56.41±18.27,75.02±16.03 vs 68.94±14.07,t=-3.206~-2.078,P值均0.05)。多因素相关分析提示婚姻状况与抗病毒治疗后生存质量改善相关(比值比=11.61,95%可信区间:2.28~59.00,P=0.003)。未婚患者生活质量改善优于已婚患者,尤其是生理功能(t=-2.176,P=0.034)、生理职能(t=-2.173,P=0.034)与情感职能(t=-2.811,P=0.007)。结论抗病毒治疗能改善CHB患者的生理质量及精神健康,有效的心理干预对CHB患者尤其是已婚患者非常必要。     

慢性乙型肝炎患者生存质量研究现状

本文就慢性乙型肝炎患者生存质量的现状、测评量表及影响因素和干预措施等方面进行综述,为提高该人群的生存质量提供依据,并指出制定特异性量表的重要性。     

Association between spiritual well-being,quality of life,anxiety and depression in patients with gynaecological cancer in China

The physical and psychological condition of patients with gynaecological cancer has received much attention, but there is little research on spirituality in palliative care. This study aimed to investigate spiritual well-being and its association with quality of life, anxiety and depression in patients with gynaecological cancer. A cross-sectional study was conducted in China in 2019 with 705 patients diagnosed with primary gynaecological cancer. European Organisation for Research and Treatment of Cancer quality of life instruments (EORTC QLQ-SWB32 and EORTC QLQ-C30) and the Hospital Anxiety and Depression Scale were used to measure spiritual well-being, quality of life, anxiety and depression. Univariate and multiple linear regression analyses were performed to examine associations between spiritual well-being, quality of life, anxiety and depression. Functioning scales and global health status were positively correlated with spiritual well-being (P < .05). Anxiety and depression were negatively correlated with spiritual well-being (P < .05). Depression (−0.362, P < .001) was the strongest predictor of Existential score. Anxiety (−0.522, P < .001) was the only predictor of Relationship with self. Depression (−0.350, P < .001) and Global health (0.099, P = .011) were the strongest predictors of Relationship with others. Religion (−0.204, P < .001) and Depression (−0.196, P < .001) were the strongest predictors of Relationship with someone or something greater. Global health (0.337, P < .001) and Depression (−0.144, P < .001) were the strongest predictors of Global-SWB. Well spiritual well-being is associated with lower anxiety and depression, and better quality of life. Health providers should provide more spiritual care for non-religious patients and combine spiritual care with psychological counselling to help patients with gynaecological cancer, especially those who have low quality of life or severe symptoms, or experience anxiety or depression.     

Relationship between urinary incontinence and quality of life/depression in elderly patients

PurposeThe aim of this study was to investigate the relationship between urinary incontinence (UI) and quality of life/depression in elderly patients.MethodsThe study included a total of 109 elderly adults aged 65 years and older, consisting of 44 patients with and 65 patients without UI. Demographic data were recorded and UI was assessed using a questionnaire. The Standardized Mini-Mental State Examination was used to evaluate cognitive function. Depression status was assessed using the Yesavage Geriatric Depression Scale and quality of life was assessed using Short Form-36 (SF-36) Health Survey scoring.ResultsThe mean ± standard deviation (SD) age of the elderly patients with UI was 80.06 ± 6.25 years; 21 (47.7%) were women and the other 23 (52.3%) were men. The mean ± SD visual analog scale score for the severity of UI was 6.22 ± 0.85; the mean ± SD number of diurnal voidings was 7.20 ± 0.87 and the mean ± SD number of nocturnal voidings was 3.81 ± 0.97. The mean ± SD depression score of elderly patients with UI was significantly higher than those without UI (p < 0.0001). There was a strong negative correlation between depression and UI (p < 0.0005; r = −0.886). Both the mental and physical scores of the SF-36 quality of life scale were significantly lower in elderly patients with UI than in those without (p < 0.005). An increased risk of depression (5.90-fold) was found in elderly patients with UI compared with those without UI. UI was found to cause a 0.037 point reduction in the physical component score and a 0.055 point reduction in the mental component score; these are statistically significant.ConclusionUI in elderly adults leads not only the loss of physical abilities, but also to changes in their mental condition.     

慢性乙型肝炎患者生存质量的测量与评价

目的测量并评价慢性乙型肝炎患者的生存质量(QOL).方法采用SF-36量表,对260例慢性乙型肝炎患者和260例正常对照进行QOL测量与评价,并对QOL的影响因素进行单因素分析和多因素逐步回归分析.结果慢性乙型肝炎患者的平均SF-36总评分及生理机能、角色生理状况、心理健康状况、角色心理状况、社会机能、活力、躯体疼痛和主观健康状况的平均评分分别为56±17、65±24、21±30、62±18、28±34、55±28、57±2、68±25和52±16,与对照组相比,差异有非常显著性(P均＜0.01).慢性乙型肝炎患者的平均生存质量指数评分(7.2±2.2)与对照组相比,差异有非常显著性(P＜0.01).慢性乙型肝炎患者SF-36总评分及其8个分项目相互之间的相关系数均具有显著性意义(P＜0.01).SF-36总评分与生存质量指数评分呈极显著性正相关(r=0.7841,P＜0.001);影响慢性乙型肝炎患者QOL的主要因素是临床分型、乏力、腹水、黄疸、脾肿大、血清ALT与总胆红素(TBil)升高、血浆白蛋白或(A/G)降低以及HBeAg、HBV-DNA持续阳性等.结论SF-36适用于我国慢性乙型肝炎患者QOL的测量.     

The relationship between fibromyalgia and depression,anxiety, anxiety sensitivity,fear avoidance beliefs,and quality of life in female patients

The study aims to determine whether there is a relationship between fibromyalgia (FM) disease and depression, anxiety, anxiety sensitivity, fear-avoidance beliefs, and quality of life in female patients with a diagnosis of fibromyalgia. 37 female patients followed up with FM diagnosis in pain medicine clinic and a control group consisting of 37 healthy women were included in the study. Sociodemographic and Clinical Characteristics Data Form, Quality of Life Form, fear-avoidance beliefs questionnaire, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale was applied to the participants. When the patients in the FM group were compared to the control group; Statistically lower scores in all Quality of Life Form subscales except emotional role difficulty and social functionality scores; statistically higher scores in both physical and work activity subscales in fear-avoidance beliefs questionnaire; statistically higher scores in cognitive symptoms subscale in Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale scores were found. In FM patients, it has been determined that anxiety, depression and perceived pain severity reduce social functionality and quality of life in areas such as mental health, physical function, and emotional role difficulties. It was determined that the functionality and quality of life of patients diagnosed with FM decreased in daily life. An important contribution of the study to the literature is that it shows that the behavior of avoiding activity due to pain-induced fear exacerbates the pain and even contributes to its chronicity. These results, which show the effects of anxiety, depression, anxiety sensitivity, and fear-avoidance behavior on the prognosis of the disease in FM patients, indicate that psychiatric evaluation and treatment in FM patients is an important factor that determines the functionality and quality of life.     

Influence of anxiety/depression on health related quality of life of patients with various pacing modes

Background The thesis is to study the influence of anxiety/depression on health related quality of life （HRQoL） of patients with various pacing modes a month after they have had a pacemaker implanted. Methods HRQoL was assessed consecutively in patients （50 men, 48 women, mean age 52.7±14.1 years） with implanted pacemaker （PM） from June to December 2009 in our hospital （22 patients received VVI pacemaker, 26 received VVIR pacemaker, 26 received DDD pacemaker, 24 received DDDR pacemaker）. HRQoL was measured by the SF-36 and Aquarel questionnaires, anxiety by Zung anxiety scale （SAS） and depression by Zung depression scale （SDS）. Results Patients with rate-adaptive pacing had higher scores in SF-36 scales （health perception, vitality, social functioning and mental health） and Aquarel （chest pain, dyspnea and arrhytmia）; they also presented lower degree of anxiety and depression compared with those with non-rate-adaptive pacing. Differences were shown only in the group with dual chamber pacemakers, but not in the group with single chamber pacemakers. Significant differences were observed between patients with single chamber and dual chamber PM in rate-adaptive pacing. There was a strong correlation between the degree of anxiety and depression and the HRQoL for pacemaker patients. Conclusion Dual chamber rate-adaptive pacing offers better HRQoL and psychological profile than dual chamber non-rate-adaptive pacing. Significant improvement in five SF-36 subscales was observed with DDDR pacing compared with VVIR pacing. Anxiety and depression are important factors in the HRQoL of patients with implanted pacemakers. Early detection and intervention in patients with psychological problems are imperative.