盆腔炎性疾病后遗症慢性盆腔痛中医证型与生存质量、焦虑抑郁相关性研究

发布时间：2018-01-13 00:04

本文关键词：盆腔炎性疾病后遗症慢性盆腔痛中医证型与生存质量、焦虑抑郁相关性研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：盆腔炎性疾病是育龄期妇女的常见生殖道感染疾病,如果治疗不彻底将导致盆腔炎性疾病后遗症的发生,包括不孕、异位妊娠、慢性盆腔痛及盆腔炎反复发作[1]。其中慢性盆腔痛,常在劳累、性交后及月经前后加剧,迁延难愈长期困扰患者,给患者的生理及心理造成了极大负担。中医中药在治疗盆腔炎性疾病慢性盆腔痛方面卓有成效,根据中医学辨证论治的特点,研究疾病的中医证型在一定程度上为中医规范化治疗奠定基础。随着对盆腔炎性疾病的不断认识,近年对其生存质量的研究也日渐增多,并且与生存质量密切相关的心理状态也日益得到重视。本课题旨在研究盆腔炎性疾病后遗症慢性盆腔痛主要的中医证型和患者的总体生存质量及焦虑抑郁状态,并且探讨中医证型证候与生存质量及焦虑抑郁之间的关系。研究目的:观察盆腔炎性疾病所致慢性盆腔痛患者的各种中医证型分布规律,观察此类患者的生存质量状况及焦虑抑郁的情绪变化,探讨中医证型与生存质量各维度之间的相关性及不同中医证型患者的焦虑抑郁情况。针对性指导临床治疗,全方位综合性干预疾病,帮助患者提高生存质量,为个性化治疗提供依据。研究方法:本研究采取横断面研究的方法,收集2016年2月至2017年2月就诊于中日友好医院、石景山中医医院、奥运村社区医院中医妇科诊断为盆腔炎性疾病后遗症慢性盆腔痛的患者共99例。发放调查问卷,收集患者年龄、病程等一般资料以及中医四诊信息。发放生存质量调查问卷(SF-36量表)以及焦虑自评量表(SAS)、抑郁自评量表(SDS)。将收集的四诊信息进行中医证候分类,采用聚类分析的方法判断中医证型。用描述统计计算SF-36各维度积分,积分越高代表生活质量越好,用单样本t检验分别对比本课题患者与正常人群的生存质量、焦虑、抑郁的差异,用方差分析比较主要证型之间的生存质量、焦虑抑郁的情况。研究结果:1.本课题盆腔炎性疾病后遗症慢性盆腔痛中医证型分为五个,其中以肾虚血瘀证比例最多,占33.3%;气虚血瘀证24.2%、气滞血瘀证20.2%,寒凝血瘀证与湿热蕴结证比例较少,分别为13.1%和9.2%。2.本研究的患者SF-36量表与正常人相比各个维度得分均下降。在生理功能方面:肾虚血瘀证与气滞血瘀证有差异(P=0.008),肾虚血瘀证与湿热血瘀证有差异(P=0.006);角色限制方面:肾虚血瘀证与寒凝血瘀证有差异(P=0.048);在躯体疼痛方面:寒凝血瘀证与气虚血瘀证有差异(P=0.034);社会功能:寒凝血瘀证与气虚血瘀证有差异(P=0.046);精神健康方面:肾虚血瘀证与气滞血瘀证(P=0.036)、肾虚血瘀证与寒凝血瘀证(P=0.009)有差异;生理健康领域方面:肾虚血瘀证与寒凝血瘀证(P=0.013),气虚血瘀证与寒凝血瘀证(P=0.028)均有差异;一般情况、精力、情感职能、心理健康领域方面各组无差异。3.抑郁自评量表(SDS)评分:无抑郁情况的患者20人,占20.2%;轻度抑郁患者48人,占48.4%;中度抑郁29人,占29.2%;重度抑郁2人,占2.2%。焦虑自评量表(SAS)评分无焦虑情况的患者75人,占75.7%;轻度焦虑21人,占21.2%;中度焦虑3人,占3.1%;重度焦虑0人。不同证型之间的焦虑抑郁情况P值均大于0.05,无统计学意义。研究结论:1.盆腔炎性疾病后遗症慢性盆腔痛患者常见的中医证型可以分为肾虚血瘀、气虚血瘀、气滞血瘀、寒凝血瘀及湿热蕴结等五个。2.盆腔炎性后遗症慢性慢性盆腔痛患者的生存质量较普通人群明显下降。分析主要证型的生存质量显示:肾虚血瘀证在生理功能得分、角色限制、生理健康方面得分最低;寒凝血瘀证在躯体疼痛、社会功能方面得分最低;气滞血瘀在精神健康方面得分最低。总体来讲肾虚血瘀生存质量最低。3.盆腔炎性疾病后遗症慢性盆腔痛患者存在焦虑抑郁情绪,但是不同证型之间的焦虑或抑郁情况没有差异。
[Abstract]:Pelvic inflammatory disease is common in women of childbearing age, reproductive tract infection, if incomplete treatment will lead to the occurrence of sequelae of pelvic inflammatory disease, including infertility, ectopic pregnancy, chronic pelvic pain and pelvic inflammation recurrent [1]. in chronic pelvic pain, often in tired, before and after sexual intercourse and after menstruation intensifies the protracted long-term troubled patients, caused a great burden to the physical and mental patients. The traditional Chinese medicine in the treatment of pelvic inflammatory disease and chronic pelvic pain has very fruitful, according to TCM syndrome differentiation characteristics of TCM Syndromes of the disease to a certain extent for the standardization of traditional Chinese medicine treatment foundation. Along with the increasing awareness of pelvic inflammatory disease in recent years, the research on the quality of survival is also increasing, which is closely related to quality of life and mental state becomes more and more important. This paper aims at the study of pelvic inflammatory disease sequelae The main symptoms of chronic pelvic pain syndromes and patients' overall quality of life and anxiety and depression, and to explore the relationship between TCM syndromes and the quality of life and anxiety and depression. Objective: To observe the various TCM Syndromes of pelvic inflammatory disease caused by chronic pelvic pain distribution, emotional changes of quality of life the anxiety and depression in these patients, to investigate the anxiety and depression of the correlation between TCM syndrome type and the various dimensions of quality of life of patients with different syndromes. To guide clinical treatment and comprehensive intervention comprehensive disease, help patients improve the quality of life, provide the basis for individualized treatment. Methods: This study adopted cross-sectional method the study, from February 2016 to February 2017 in China-Japan Friendship Hospital, Shijingshan Hospital of traditional Chinese medicine, the Olympic village community hospital for diagnosis of gynecological pelvic Inflammatory sequelae of chronic pelvic pain in patients with a total of 99 cases. The questionnaires were collected, age, duration and other general information and four diagnostic information issued. Quality of life questionnaire (SF-36 scale) and the self rating Anxiety Scale (SAS), self rating Depression Scale (SDS). The syndrome of traditional Chinese medicine the classification and collection of four diagnostic information, using the method of cluster analysis to determine TCM syndrome. To calculate the dimensional SF-36 integral with descriptive statistics, the higher the points represent the better quality of life, quality of life, with a single sample t test compared the patients and the normal people's anxiety, depression and difference analysis of quality of life between the main card the variance, anxiety and depression. Results: the sequelae of pelvic inflammatory disease of chronic pelvic pain syndrome type 1.. This research is divided into five, with kidney deficiency and blood stasis in the largest proportion, accounting for 33.3%; 24.2% Qi deficiency and blood stasis, Qi Stagnation of blood stasis 20.2%, blood stasis and stagnation of damp heat less proportion, respectively 13.1% and 9.2%.2. in patients with SF-36 on the table compared with normal people all scores were decreased. The physiological function of kidney deficiency and blood stasis syndrome: difference with qi stagnation and blood stasis syndrome (P=0.008), kidney deficiency and blood stasis syndrome is different from the damp heat and blood stasis card (P=0.006); role limitations: kidney deficiency and blood stasis and blood stasis have difference (P=0.048); the body pain: blood stasis has difference with Qi deficiency and blood stasis syndrome (P=0.034); social function: there are differences in blood stasis and Qi deficiency and blood stasis syndrome (P=0.046); mental health: kidney deficiency and blood stasis and qi stagnation and blood stasis syndrome (P=0.036), blood stasis and kidney deficiency and blood stasis (P=0.009) has the difference; physiological health: blood stasis and kidney deficiency and blood stasis, Qi deficiency and blood stasis syndrome (P=0.013) and blood stasis (P=0.028) were different in general, Energy, emotional function, mental health of each field and no difference in.3. self rating Depression Scale (SDS) score: no depression patients with 20 people, accounting for 20.2%; the patients with mild depression, 48 people, accounting for 48.4%; 29 people with mild depression, severe depression accounted for 29.2%; 2 people, accounting for 2.2%. (self rating Anxiety Scale SAS) score anxiety of patients with 75 people, accounting for 75.7%; 21 people with mild anxiety, moderate anxiety accounted for 21.2%; 3 people, accounting for 3.1%; 0. Severe anxiety between different syndromes of anxiety and depression P values are greater than 0.05, not statistically significant. Conclusions: 1. after pelvic inflammatory disease of traditional Chinese medicine. The common symptoms of chronic pelvic pain syndrome patients can be divided into kidney deficiency and blood stasis, Qi deficiency and blood stasis, qi stagnation and blood stasis, the quality of life of blood stasis and heat accumulation of five.2. pelvic inflammatory sequelae of chronic pelvic pain patients than the general population decreased significantly. The quality of survival analysis showed that the main syndromes of kidney deficiency and blood stasis Limited role in physiological function, physiological health score, the lowest score; blood stasis syndrome in bodily pain, social function scores were the lowest; Qi stagnation and blood stasis score in mental health. The lowest overall quality of life of the lowest.3. of kidney deficiency and blood stasis sequelae of pelvic inflammatory disease in patients with chronic pelvic pain, anxiety and depression mood, but anxiety or depression between different syndrome types have no difference.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.1

【参考文献】