修回日期: 2019-10-31
接受日期: 2019-11-12
在线出版日期: 2019-11-28
老年功能性消化不良(functional dyspepsia, FD)反复发作易影响患者心理情绪和睡眠质量. 睡眠障碍和负面心理情绪相互影响, 长期形成恶性循环. 本研究对老年FD患者心理弹性、感知压力及睡眠质量进行调查分析, 旨在为临床提供重要客观依据.
旨在探讨老年FD患者感知压力、心理弹性及睡眠质量的关系.
选取2017-03/2019-06在浙江省金华市第二医院就诊的老年FD患者120例为研究对象, 采用匹兹堡睡眠质量指数量表(pittsburgh sleep quality index, PSQI), 感知压力量表(perceived stress scale, PSS)及心理弹性量表分别调查并分析.
老年FD患PSQI总得分2-17, 7.4分±2.9分, 其中72.50%(87/120)的患者PSQI评分>5分, 睡眠质量较差. 老年FD患者PSS评分为15.3分±4.8分, 心理弹性评分为26.1分±6.2分, PSQI评分为7.3分±2.7分. 心理弹性评分与PSS和PSQI评分呈负相关(r = -0.58, -0.41, P<0.05), PSS评分与PSQI评分呈正相关(r = 0.33, P<0.05). PSS能正性预测PSQI评分(β = 0.31, P<0.05), 心理弹性能负性预测PSQI评分(β = -0.28, P<0.05), 且PSS对PSQI的预测作用降低(β = -0.58, P<0.05); Bootstrap检验中介效应95%CI: 0.127-0.325, P<0.01.
老年FD患者睡眠质量较差, 感知压力和心理弹性是影响睡眠质量的危险因素, 在临床中可通过疏导心理压力改善睡眠.
核心提要: 探讨老年功能性消化不良患者心理弹性、感知压力及睡眠质量之间的关系是重要的研究课题, 对临床干预具有重要指导价值和意义.
引文著录: 童丽琴. 老年功能性消化不良患者心理弹性、感知压力及睡眠质量间的相关性分析. 世界华人消化杂志 2019; 27(22): 1391-1395
Revised: October 31, 2019
Accepted: November 12, 2019
Published online: November 28, 2019
Repeated epiodes of functional dyspepsia (FD) in the elderly tend to affect the psychological mood and sleep quality of patients. Sleep disorders and negative psychological mood can affect each other, forming a vicious circle. In this study, the psychological resilience, perceived pressure, and sleep quality of elderly FD patients were investigated, in order to provide important objective evidence for clinical management of this population.
To analyze the correlation among perceived stress, mental resilience, and sleep quality in elderly FD patients.
One hundred and twenty elderly patients with FD admitted to the Second Hospital of Jinhua City, Zhejiang Province from March 2017 to June 2019 were selected as study subjects, and Pittsburgh sleep quality index (PSQI), perceived stress scale (PSS), and mental resilience scale (CD-RISC-10) were used to analyze the sleep quality, perceived stress, and mental resilience.
Mean PSS score was 15.3 ± 4.8, mean mental resilience score was 26.1 ± 6.2, and mean PSQI score was 7.3 ± 2.7. Mean mental resilience scores were negatively correlated with PSS scores and PSQI scores (r = -0.58, -0.41, P < 0.05). PSS scores were positively correlated with PSQI scores (r = 0.33, P < 0.05). PSS scores can positively predict PSQI scores (β= 0.31, P < 0.05), and negatively predict PSQI scores (β= -0.28, P < 0.05).
Elderly FD patients have poor sleep quality, and perceived pressure and mental resilience are risk factors affecting sleep quality. In clinical practice, sleep can be improved by reducing psychological pressure.
- Citation: Tong LQ. Correlation among mental resilience, perceived stress, and sleep quality in elderly patients with functional dyspepsia. Shijie Huaren Xiaohua Zazhi 2019; 27(22): 1391-1395
- URL: https://www.wjgnet.com/1009-3079/full/v27/i22/1391.htm
- DOI: https://dx.doi.org/10.11569/wcjd.v27.i22.1391
功能性消化不良(functional dyspepsia, FD)是临床常见疾病之一, 多见于老年人, 病情易反复发作, 严重者影响患者心理情绪和睡眠质量. 有研究表明, 睡眠障碍是重要的行为危险因素, 能够预测FD的发生和进展[1,2]. 老年FD患者睡眠质量的高低将影响其健康结局, 增加负面心理情绪[3,4]. 研究表明, 压力将影响患者个体睡眠生理过程紊乱和睡眠结构改变[5], 这主要以与压力增大影响下丘脑-垂体-肾上腺(hypothalamic-pituitary-adrenal axis, HPA)轴调节功能紊乱有关, 引起5-羟色胺(5-hydroxytryptamine, 5-HT)分泌增多和觉醒期皮质醇水平增加, 导致睡眠减少[6]. 同时, 压力增大将使个体处于应激状态, 能够实现良好适应的过程称为心理弹性. 心理弹性与心理社会适应能力和良好身体健康呈正相关[7]. 基于以上认识, 可推测心理弹性、感知压力及睡眠质量之间存在一定关系. 本研究通过对120例老年FD患者的资料进行调查分析, 旨在为临床提供重要客观依据. 现报道如下.
选取2017-03/2019-06在浙江省金华市第二医院就诊的老年FD患者120例为研究对象, 其中男62例, 女58例; 年龄62-78岁, 平均68.4岁±7.2岁; 病程1-12年, 平均6.8年±3.4年; BMI为24.1-29.7 kg/m2, 平均26.4 kg/m2±3.2 kg/m2; 其中有吸烟史82例, 饮酒史68例; 合并冠心病者26例, 高血压者34例, 糖尿病24例, 高脂血症36例. 纳入标准: (1)诊断均符合罗马Ⅳ功能性消化不良标准, 且均为住院患者; (2)年龄>60岁, 意识清晰, 能正常交流者; (3)均经过患者及家属知情同意; (4)均经过医院伦理委员会批准同意者. 排除标准: (1)消化系统有器质性病变者, 或有手术史者; (2)有精神系统或神经系统疾病者; (3)有严重心肝肾疾病及血液系统疾病者; (4)有认知、意识障碍, 或语言沟通障碍者; (5)配合调查欠佳者; (6)有使用安眠药、精神类药物者.
课题负责人参照文献制定调查表, 在问卷调查前认真细心向患者讲解研究目的, 注意事项等, 要求患者均独立完成问卷调查, 时间控制在1 h内完成, 完成后回收问卷. (1)匹兹堡睡眠质量指数量表(pittsburgh sleep quality index, PSQI)[8], 包括19个条目, 7个维度, 总分为21分, 各维度得分之和为量表总分, 得分越高睡眠质量越差, 该量表内部一致性系数为0.71; (2)感知压力量表(perceived stress scale, PSS)[9], 该量表共有10个条目, 5级评分, 总分40分, 得分越高PSS越大. 该量表内部一致性系数为0.86; (3)心理弹性量表[10], 包括10个条目, 5级评分, 总分40分, 得分越高心理弹性越高. 该量表内部一致性系数为0.93.
统计学处理 采用SPSS 23.0软件分析数据. 计量资料以mean±SD表示, 采用t检验; 计数资料以百分比(%)表示, 采用χ2检验; 采用Pearson相关分析感知压力, 心理弹性及睡眠质量间的相关关系; 线性回归分析和Bootstrap法对心理弹性、感知压力及睡眠质量间的相关性分析. P<0.05为差异有统计学意义.
本研究共发放问卷120份, 回收有效问卷120份, 问卷有效回收率100.0%.
老年FD患PSQI总得分2-17, 7.4分±2.9分, 其中72.50%(87/120)的患者PSQI评分>5分, 睡眠质量较差(表1).
| PSQI不同维度 | 等级 | n (%) |
| 主观睡眠质量 | 很好 | 16 (13.33) |
| 较好 | 64 (53.33) | |
| 较差 | 35 (29.17) | |
| 很差 | 5 (4.17) | |
| 睡眠困扰 | 0 | 8 (6.67) |
| 1-9 | 82 (68.33) | |
| 10-18 | 28 (23.33) | |
| 19-27 | 2 (1.67) | |
| 入睡时长(h) | 0 | 25 (20.83) |
| 1-2 | 53 (44.17) | |
| 3-4 | 39 (32.50) | |
| 5-6 | 3 (25.00) | |
| 睡眠药物使用 | 0 | 106 (88.33) |
| 1-9 | 10 (8.33) | |
| 10-18 | 3 (25.0) | |
| 19-27 | 1 (0.83) | |
| 睡眠持续时间(h) | <5 | 32 (26.67) |
| 5-6 | 33 (27.50) | |
| 6-7 | 40 (33.33) | |
| >7 | 5 (4.17) | |
| 日间功能紊乱 | 0 | 15 (12.50) |
| 1-2 | 50 (41.67) | |
| 3-4 | 33 (27.50) | |
| 5-6 | 22 (18.33) | |
| 睡眠效率(%) | <65 | 50 (41.67) |
| 66-75 | 33 (27.50) | |
| 76-85 | 18 (15.0) | |
| >85 | 19 (15.83) | |
| PSQI总得分 | ≤5 | 33 (27.50) |
| >5 | 87 (72.50) |
老年FD患者PSS评分为15.3分±4.8分, 心理弹性评分为26.1分±6.2分, PSQI评分为7.3分±2.7分. 心理弹性评分与PSS和PSQI评分呈负相关(r = -0.58, -0.41, P<0.05), PSS评分与PSQI评分呈正相关(r = 0.33, P<0.05)(表2).
| 变量 | 范围 | 得分 | 年龄 | PSS | 心理弹性 | PSQI |
| 年龄 | 62-78 | 57.2±11.9 | 1.00 | - | - | - |
| PSS | 3-28 | 15.3±4.8 | -0.08 | 1.00 | - | - |
| 心理弹性 | 4-39 | 26.1±6.2 | -0.01 | -0.58 | 1.00 | - |
| PSQI | 2-17 | 7.3±2.7 | 0.02 | 0.29 | -0.41 | 1.00 |
PSS能正性预测PSQI评分(β = 0.31, P<0.05), 心理弹性能负性预测PSQI评分(β = -0.28, P<0.05), 且PSS对PSQI的预测作用降低(β = -0.58, P<0.05); Bootstrap检验中介效应95%CI: 0.127-0.325, P<0.01(表3).
| 因变量 | 自变量 | β值 | t值 | R2值 | F值 |
| PSQI | PSS | 0.31 | 5.289 | 0.175 | 12.987 |
| 心理弹性 | PSS | -0.58 | 11.76 | 0.389 | 36.271 |
| PSQI | 心理弹性 | -0.28 | 3.526 | 0.224 | 12.584 |
近年来, 随着生活压力的增加, 老年FD患者呈上升趋势, 严重影响老年患者身心健康和心理情绪. 本研究结果表明, 72.50%的老年FD患者睡眠质量较差. 既往有研究表明[11], 感知压力能预测睡眠质量, 且呈正相关. 因此, 本研究对老年FD患者进行感知压力、心理弹性和睡眠质量进行分析.
失眠是老年人常见症状之一, 与其对压力事件的反应密切相关. 感知压力越大, 睡眠质量较差, 这可能与压力增大影响个体HPA轴的调节功能, 导致睡眠质量降低[12]. 由于老年FD患者病情反复, 病程较长, 久之导致心理压力累积进而造成出现睡眠质量的降低和焦虑情绪的发生. 因此, 对老年FD患者采用合理的心理疏导是提高睡眠质量的关键所在[13]. 本研究中FD患者心理弹性能够预测较好的睡眠质量, 说明心理弹性越高, 睡眠质量越好, 从而能够维持良好的睡眠状态, 积极面对治疗和乐观的生活态度.
心理弹性是个体在面对各种压力时采取积极有效的保护性方案, 使患者通过内部调整尽快恢复身体功能并得以发展, 心理弹性评分较高的个体能有效调动机体心理资源, 调整心理状态, 正确认知心理水平, 从而减少感知压力对身体的负面影响, 以更好的维持良好的睡眠质量和积极向上的乐观态度[14,15]. 表3结果表明, 感知压力能正性预测睡眠质量, 可见老年FD患者心理弹性在PSS与PSQI间发挥一定作用, 由此说明, 感知压力可直接作用于睡眠质量, 也可通过心理弹性影响睡眠, 三者之间具有相关性. 反之, 睡眠质量的高低也会影响心理弹性, 在一定程度上增加心理压力.
本研究不足之处: 样本量小, 且为单中心研究, 对人口学资料统计不完善, 在今后的研究中将进一步补充和完善, 以更好的为临床大数据提供客观依据. 总之, 老年FD患者睡眠质量较差, 感知压力和心理弹性是影响睡眠质量的危险因素, 在临床中可通过疏导心理压力改善睡眠.
功能性消化不良(functional dyspepsia, FD)反复发作易影响患者心理情绪和睡眠质量. 睡眠障碍是重要的行为危险因素, 能够预测FD的发生和进展. 老年FD患者睡眠质量的高低将影响其健康结局, 增加负面心理情绪. 本研究对老年FD患者心理弹性、感知压力及睡眠质量进行调查分析, 旨在为临床提供重要客观依据.
睡眠障碍已经是困扰老年患者的重要疾病之一, 本研究通过调查分析以探讨老年FD患者感知压力、心理弹性及睡眠质量的关系.
本研究通过调查分析探讨老年FD患者感知压力、心理弹性及睡眠质量的关系.
本研究采用匹兹堡睡眠质量指数量表, 感知压力量表及心理弹性量表对老年FD患者进行调查分析.
72.50%的患者睡眠质量较差. 心理弹性评分与感知压力量表(perceived stress scale, PSS)评分和匹兹堡睡眠质量指数量表(pittsburgh sleep quality index, PSQI),评分呈负相关, PSS评分与PSQI评分呈正相关.
老年FD患者睡眠质量较差, 感知压力和心理弹性是影响睡眠质量的危险因素,
通过对老年FD患者睡眠质量, 感知压力和心理弹性进行分析, 以明确影响睡眠质量的危险因素, 为临床干预提供重要参考价值.
学科分类: 胃肠病学和肝病学
手稿来源地: 浙江省
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