老年心脏病病人的护理

论文编号:HL148  论文字数:9372.页数:21

论文题目：老年心脏病人的心理护理
摘　要
 
 研究目的：了解心脏病病患者抑郁焦虑的发生率及其与社会支持、述情障碍的相关性，从而为建立心脏病病人社区综合治疗模式，改善心脏病病人的心身健康提供客观依据。
 研究方法：根据2005年中国心脏病防治指南心脏病诊断标准，入选观察组100人，来源于2007年3月1日至2008年11月30日某社区卫生服务中心已建档的心脏病病患者，年龄41～75(57±7.78)岁，男性56人，女性44人；初中以上文化程度，能够正确理解量表含义；入组前三个月未服任何精神药品或已过药物的5个半衰期。采用Hamilton(HAMD)、Hamilton焦虑量表(HAMA)、社会支持评定量表(SSRS)、应付方式问卷(CSQ)、多伦多述情障碍量表(TAS)。在统一指导语和填表方法的前提下，让2组对象完成以上量表。量表由专业软件进行评分，对评分结果进行统计学分析。
 研究结果：1）心脏病患者抑郁、焦虑发生率(分别为11.11％，30.16％)高于正常对照组(分别为0.00％，7.69％)，两者比较有显著性差异(p＜0.025)；HAMD、HAMA总分均分(分别为12.11±4.83，12.59±6.26)均比对照组(分别为7.96±4.56，7.25±4.56)高，两者比较有显著性差异(p＜0.001)。并发现心脏病组收缩压、舒张压与HAMD、HAMA总分呈正相关。提示社区心脏病患者有明显的抑郁焦虑负性情绪体验。
 2）心脏病患者的社会支持总分均分(35.38±6.17)、主观支持均分(19.59±4.06)及社会支持利用度均分(6.79±2.27)均低于正常对照组(分别为39.54±6.74，22.44±4.02，7.71±2.08)，两组比较有显著性差异(p＜0.001或p＜0.05)。而客观支持分(9.17±3.19)与对照组(9.53±3.17)相近，两者比较无显著性差异(p＞0.05)。提示心脏病患者的社会支持方面存在缺陷，尤其在主观支持及社会支持利用度方面。HAMD总分与社会支持总分(P＜0.01)、客观支持分(P＜0.01)、主观支持分(P＜0.01)及对支持的利用度(P＜0.01)呈负相关；心脏病组HAMA总分与社会支持总分(P＜0.01)、主观支持分(P＜0.01)及对支持的利用度分(P＜0.01)呈负相关。
 结论：心脏病患者有着明显的抑郁焦虑等负性情绪，其抑郁焦虑情绪与社会支持、应付方式及述情障碍相关，对其进行心理卫生教育，改善不良的认知行为模式及社会支持，选择适宜的心理治疗措施，是心脏病综合治疗的有效途径之一。
 
 关 键 词：老年人 心理特点
 
 
 
 Title: psychological characteristics of the elderly and psychological care
Abstract Objective: To understand the heart disease patients the incidence of depression and anxiety and its relationship with social support, alexithymia correlated to heart disease patients for the establishment of integrated community treatment model to improve the physical and psychological health of cardiac patients provide an objective basis.
 Key words: psychological characteristics of elderly
Methods: According to heart disease prevention guidelines in 2005, heart disease diagnostic criteria, 100 were selected for the observation group, from March 1, 2007 to November 30, 2008 a community health service centers have been on file for heart disease patients, age 41 ~ 75 (57 ± 7.78) years, male 56, female 44; junior high school or higher, be able to correctly understand the meaning of scale; into the group of the first three months without taking any drugs, psychotropic substances or five half-lives have passed. With Hamilton (HAMD), Hamilton Anxiety Scale (HAMA), Social Support Rating Scale (SSRS), Coping Style Questionnaire (CSQ), Toronto Alexithymia Scale (TAS). Filling in a unified language and methods of guiding premise, let two groups object to complete the above scale. Scale by professional software score right score the results were analyzed statistically.
Results: 1) heart disease, depression, anxiety and the incidence of (respectively 11.11%, 30.16%) was higher than the normal control group (respectively 0.00%, 7.69%), both have more significant difference (p <0.025); HAMD , HAMA total score divided equally (respectively, 12.11 ± 4.83,12.59 ± 6.26) than those in the control group (7.96 ± 4.56,7.25 ± 4.56) high, in comparison with a significant difference (p <0.001). And found that heart disease group systolic and diastolic blood pressure with the HAMD, HAMA total score was positively correlated. Prompted the community with heart disease has obvious negative emotional experience depression and anxiety. 2) heart disease patients, equally divided among social support total score (35.38 ± 6.17), subjective support sharing (19.59 ± 4.06) and the use of degree of equalization of social support (6.79 ± 2.27) were lower than the control group (39.54 ± 6.74 , 22.44 ± 4.02,7.71 ± 2.08), two groups had significant difference (p <0.001 or p <0.05). The objective support points (9.17 ± 3.19) and the control group (9.53 ± 3.17) are similar, both showed no significant difference (p> 0.05). Tip of social support in patients with heart defects, especially in subjective support and utilization aspects of social support. HAMD total score and social support total score (P <0.01), objective support points (P <0.01), subjective support points (P <0.01), and to support the use of degree (P <0.01) negative correlation; heart disease group HAMA total split between the social support total score (P <0.01), subjective support points (P <0.01), and to support the use of sub-degree (P <0.01) negative correlation. Conclusion: The patients with heart disease have a significant negative emotions such as depression and anxiety, their depression, anxiety and social support, coping style and alexithymia related to their psychological health education to improve the poor cognitive behavioral patterns and social support, to choose suitable psychological treatments, comprehensive treatment of heart disease is one effective way.
Key words: psychological characteristics of elderly

目  录
1   前言 7
1.1 背景 7
1.2 目的 ..8
1.3 关键词定义 8
1.4 文献回顾 10
2   方法 12
2.1 研究设计 12
2.2 研究人群 12
2.3 研究方法/工具 12
2.4 研究步骤 13
3   结果 14
3.1 一般资料 14
3.2 结果分析 14
4   讨论 18
5   结论与展望 21
致    谢 27
参考文献 29