原发性高血压合并焦虑相关因素及中医证型分布规律系统综述

Systematic Review of The Correlative Factors and Distribution of Syndrome Types of Primary Hypertension Combined With Anxiety

[主要目的]分析原发性高血压合并焦虑相关因素及中医证型分布规律。[资料来源]选取广西中医药大学附属瑞康医院心血管内科2010年10月至2012年3月住院及门诊高血压患者,发放基本情况量表及SAS量表。[选择文献量及依据]①研究类型:问卷调查。②研究对象:年龄>18岁;符合原发性高血压诊断标准;辨证分型:肝火亢盛、阴虚阳亢、阴阳两虚和痰湿壅盛;无合并症;未系统服药,或服用降压药治疗但未达到正常血压;知情同意,签署知情同意书。排除继发性高血压、高血压并发严重疾病;阳性精神病家族史和个人史,意识障碍及语言交流困难,不合作者。[数据提炼规则及应用方法]根据焦虑自评量表(SAS)评分,统计焦虑发生率。以是否合并焦虑分两组,分析性别、年龄、文化程度、是否单身、是否饮酒等方面差异性。统计中医证型出现焦虑例数,总结证型分布规律。采用SPSS18.0统计软件,按性别、年龄、文化程度、是否单身、是否饮酒、中医证型等分组,统计各因素对合并焦虑发病率的影响,计量资料采用均值±标准差(x珋±s)表示,计数资料采用χ2检验。[数据综合得出结果与结论]高血压合并焦虑与性别、饮酒无明显相关性(P>0.05),与年龄、文化程度、单身有明显相关性(P<0.05)。不同中医证型焦虑发病率有显著性差异(P<0.05)。焦虑症状发病率(SAS标准分>50)30%,低于以往调查发病率,可能原因:①样本量较少。②高血压发病率越来越高,发病人群越来越年轻,对高血压认识已普及。性别、是否饮酒对高血压合并焦虑的发病率没有显著影响。文化程度:大专以上焦虑发病率明显高于大专以下,可能与文化程度较高、自我意识较强,知识丰富,成就感和价值感较强,患病后考虑问题较多,对工作、家庭、经济等方面思想顾虑较大有关。是否单身:单身焦虑发病率较高,可能因单身不能得到良好的生活照顾,精神上得不到支持和安慰,心理上焦虑和烦恼不能通过与人交流并及时疏导有关。年龄:55～70岁焦虑发病率较高,可能因该年龄段刚好退休前后,生活方式发生变化较大,对将要发生的事件无法预知,感到焦虑恐慌有关。[未来展望]扩大样本量,深入研究,预防高血压焦虑症的发生,为高血压合并焦虑的中医辨证施治及心理治疗提供科学依据。

[Main Object]To analysize the correlative factors and distribution of syndrome type of primary hypertension combined with anxiety.[Data Source]Inpatients and outpatients were enrolled in cardiovascular medicine of affiliated Ruikang Hospital of Guangxi University of Chinese Medicine from October 2010 to March 2012.[Literature Selection and Criterion]①Research type： Questionnaire survey.②Study object： Age larger than 18;accord with the criterion of primary hypertension;differentiation of symptoms and signs： liver fire flaming upward,yin deficiency with effulgent fire,dual deficiency of yin and yang,excessive accumulation of phlegm-dampness;without complication;without systematic medication or normal blood pressure after treatment;informed consent signed.Exclude patients with secondary hypertension or other serious diseases;positive family or personal history with mental disorder,disturbance of consciousness,difficult to communicate,not conform to survey.[Data Extracting and Method]140 patients with hypertension were checked with self rating anxiety scale（SAS）,and incidence rate of hypertension combined with anxiety was counted.Difference of sex,age,education,married or not,drink or not et al.was compared between patients with hypertension combined with anxiety and without anxiety.Distribution of syndrome type of primary hypertension with anxiety was researched by counting the number cases of the four types.Effects of the factors such as sex,age,education,married or not,drinking or not et al on hypertension combined with anxiety were analysized with SPSS18.0.Mean is showed with x ± s,and enumeration data is checked with chi-square test.[Results and Conclusions]Hypertension combined with anxiety has no obvious correlation with sex,drinking（P0.05）,and has obvious correlation with age,education and marriage（P0.05）.Incidences of hypertension combined with anxiety of different TCM syndrome type have differences（P0.05）.Incidence of hypertension combined with anxiety（SAS50） is 30% which is lower than former investigation.Possible reasons maybe： ①Sample is small;Incidence of hypertension is increasing,and patients are younger,and awareness of hypertension has been popular.Sex,drinking have no obvious effects on incidence of hypertension combined with anxiety.In education,incidence of hypertension combined with anxiety in patients with college degree or above was significantly higher than those with college degree or under,the reason may be associated with strong self-awareness,knowledge,sense of accomplishment and a strong sense of the patients with higher educational level who consider many problems,and concerns about work,family,economic and other aspects.Incidence of hypertension combined with anxiety in patients who were single was significantly higher than those not,the reason may be associated with lacking of a good life care and spiritual support and comfort,diversion of spiritual and psychological anxiety and worry.Incidence of hypertension combined with anxiety in patients whose age was between 55 and 70 was significantly higher than those not,the reason may be associated with big changes of lifestyle before and after retirement.[Future Prospects]The survey showed that the incidence of primary hypertension combined with anxiety has significant relationship with age,educational level,whether single,TCM syndromes,and need to expand the sample size to do further research in the future for avoiding the occurrence of anxiety disorders in hypertension,and providing a scientific basis for TCM therapy and psychotherapy of hypertension combined with anxiety.