精神心理因素对消化不良影响的临床研究.doc

精神心理因素对消化不良影响的临床研究 马雪柏 张敏 潘松旦（武警浙江省总队杭州医院 杭州310051） [摘要] 目的 消化不良发生率较高，其机制尚不完全清楚，综合分析，功能性消化不良（FD）和器质性消化不良（OD）症状特点，以提高消化不良的治疗水平。方法 连续调查980例消化不良的患者，根据主要症状及精神心理因素和评价，患者填写调查表（包括21项症状等内容），并根据症状、程度、精神心理因素进行评分和分型，并与对照组进行对比、研究、分析症状与精神因素及进餐等关系。结果 980例消化不良的患者中，伴有精神心理因素的FD611例（67.1%），伴有精神心理因素的OD369例（32.2%），与对照组比较高出对照组71.5%。患者SDS、SAS症状积分明显高于对照组（P0.01），消化不良症状评分FD组为21.5分，OD组为20.4分，两组平均积分差异无统计学意义（P0.05）。不同性别积分均无统计学意义。症状的加重与减轻与精神心理因素的影响相关OD组症状的轻重比率与分型密切相关。消化不良的胃肠排空率低于对照组（P0.05）。报警症状FD组与OD组均受精神心理因素的影响有显著差异（P0.05），OD组高于FD组（P0.01），FD组中女性高于男性（P0.05）。伴有精神心理因素的消化不良中OD组的HP感染率明显高于FD组。结论 胃肠动力障碍为消化不良的致病机制，而引起胃肠动力障碍的机制与精神心理因素有密切关系，消化不良症状的出现，加重或减轻与精神心理因素相关，症状可随精神心理因素的发生而改变，由此增加了治疗的难度，研究表明，患者的情绪应激变化可通过大脑边缘系统和下丘脑使植物神经功能发生改变，导致胃肠功能失调，并影响内脏感觉的感知即脑-肠轴功能异常等是发生精神心理因素的重要作用。通过分析研究提高对消化不良治疗用药的准确率和有效率。 [关键词] 精神心理因素 消化不良症状 The effects of mental-psychological factors to dyspepcia [Abstract] Objective The incidence of dyspepsia is a little high. However, the mechanism is not so clear by now. To study the characteristics of the symptoms of functional dyspepsia (FD) and organic dyspepsia (OD), so as to improve the therapeutic effectiveness. Methods 980 cases were assessed by the main symptoms and mental-psychological factors. The patients were asked to fill a questionnaire including 21 kinds of symptoms. Then make a score and classification according to the symptoms and mental-psychological factors, comparing with the control group. Finally, assay the relationship among the symptoms, mental-psychological factors and diet. Results Among the 980 cases, 611 cases (67.1%) are FD with mental-psychological factors while 369 cases (32.2%) are OD with mental-psychological factors, 71.5% higher than the control group. The score of SDS and SAS symptoms is distinctively higher than the control group (p＜0.01). The score of dyspepsia symptoms, in the FD group is 21.5, in the OD group is 20.4, with no statistical differences between the two groups according to the mean score (p＞0.05). There is no statistical diff