老年心臟病病人的護(hù)理

論文編號(hào):HL148  論文字?jǐn)?shù):9372.頁(yè)數(shù):21

論文題目：老年心臟病人的心理護(hù)理
摘　要
 
 研究目的：了解心臟病病患者抑郁焦慮的發(fā)生率及其與社會(huì)支持、述情障礙的相關(guān)性，從而為建立心臟病病人社區(qū)綜合治療模式，改善心臟病病人的心身健康提供客觀依據(jù)。
 研究方法：根據(jù)2005年中國(guó)心臟病防治指南心臟病診斷標(biāo)準(zhǔn)，入選觀察組100人，來(lái)源于2007年3月1日至2008年11月30日某社區(qū)衛(wèi)生服務(wù)中心已建檔的心臟病病患者，年齡41～75(57±7.78)歲，男性56人，女性44人；初中以上文化程度，能夠正確理解量表含義；入組前三個(gè)月未服任何精神藥品或已過(guò)藥物的5個(gè)半衰期。采用Hamilton(HAMD)、Hamilton焦慮量表(HAMA)、社會(huì)支持評(píng)定量表(SSRS)、應(yīng)付方式問(wèn)卷(CSQ)、多倫多述情障礙量表(TAS)。在統(tǒng)一指導(dǎo)語(yǔ)和填表方法的前提下，讓2組對(duì)象完成以上量表。量表由專(zhuān)業(yè)軟件進(jìn)行評(píng)分，對(duì)評(píng)分結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。
 研究結(jié)果：1）心臟病患者抑郁、焦慮發(fā)生率(分別為11.11％，30.16％)高于正常對(duì)照組(分別為0.00％，7.69％)，兩者比較有顯著性差異(p＜0.025)；HAMD、HAMA總分均分(分別為12.11±4.83，12.59±6.26)均比對(duì)照組(分別為7.96±4.56，7.25±4.56)高，兩者比較有顯著性差異(p＜0.001)。并發(fā)現(xiàn)心臟病組收縮壓、舒張壓與HAMD、HAMA總分呈正相關(guān)。提示社區(qū)心臟病患者有明顯的抑郁焦慮負(fù)性情緒體驗(yàn)。
 2）心臟病患者的社會(huì)支持總分均分(35.38±6.17)、主觀支持均分(19.59±4.06)及社會(huì)支持利用度均分(6.79±2.27)均低于正常對(duì)照組(分別為39.54±6.74，22.44±4.02，7.71±2.08)，兩組比較有顯著性差異(p＜0.001或p＜0.05)。而客觀支持分(9.17±3.19)與對(duì)照組(9.53±3.17)相近，兩者比較無(wú)顯著性差異(p＞0.05)。提示心臟病患者的社會(huì)支持方面存在缺陷，尤其在主觀支持及社會(huì)支持利用度方面。HAMD總分與社會(huì)支持總分(P＜0.01)、客觀支持分(P＜0.01)、主觀支持分(P＜0.01)及對(duì)支持的利用度(P＜0.01)呈負(fù)相關(guān)；心臟病組HAMA總分與社會(huì)支持總分(P＜0.01)、主觀支持分(P＜0.01)及對(duì)支持的利用度分(P＜0.01)呈負(fù)相關(guān)。
 結(jié)論：心臟病患者有著明顯的抑郁焦慮等負(fù)性情緒，其抑郁焦慮情緒與社會(huì)支持、應(yīng)付方式及述情障礙相關(guān)，對(duì)其進(jìn)行心理衛(wèi)生教育，改善不良的認(rèn)知行為模式及社會(huì)支持，選擇適宜的心理治療措施，是心臟病綜合治療的有效途徑之一。
 
 關(guān) 鍵 詞：老年人 心理特點(diǎn)
 
 
 
 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  錄
1   前言 7
1.1 背景 7
1.2 目的 ..8
1.3 關(guān)鍵詞定義 8
1.4 文獻(xiàn)回顧 10
2   方法 12
2.1 研究設(shè)計(jì) 12
2.2 研究人群 12
2.3 研究方法/工具 12
2.4 研究步驟 13
3   結(jié)果 14
3.1 一般資料 14
3.2 結(jié)果分析 14
4   討論 18
5   結(jié)論與展望 21
致    謝 27
參考文獻(xiàn) 29