| Background:Gastroesophageal reflux disease(GERD)is defined as the stomach contents back into the esophagus.Its clinical symptoms are diverse.GERD can cause anxiety,depression and other psychological problems.It is usually divided into three types:non-erosaged reflux disease(NERD),reflux esophagitis(RE)and Barrett’s esophagus(BE).5-hydroxytryptamine(5-HT)is an important neurotransmitter in the brain and intestine,which is closely related to the motility and sensation of the gastrointestinal tract.GAL is a neuropeptide consisting of 29 amino acids,widely distributed in the central and peripheral nerves.5-HT and GAL play important roles in the pathogenesis of GERD and are associated with the pathogenesis of various neuropsychiatric disorders.Psychological care means the nursing staffs use the concept of psychology in the daily care of patients,to actively interfere with the patient’s poor mental state and to ensure the patients maintain a good mental state in the course of treatment and rehabilitation,in order to promote rehabilitation of patients.Providing the necessary psychological care intervention to patients with GERD,can help patients to actively respond to adverse psychological mood and improve their quality of sleep and life.Grading psychological nursing care is based on the psychological status of patients to determine the psychological levels,and then determine the levels of psychological intervention.Different levels of psychological intervention contents and focuses are different.It can provide patients with more personalized psychological care.At present,there are few studies on GAL.The effect of 5-HT in the pathogenesis of GERD and the effect of GAL on the digestive tract have been reported,but the effect of GAL on GERD and the relationship between GAL and 5-HT levels in GERD patients and anxiety and depression have not been reported.In addition,after the concept of grading psychological nursing care is presented,the effect of the psychological care method to some of the diseases have been verified,but the effect to GERD has not been reported.In this study,we investigated the relationship between anxiety,depression,5-HT and GAL in GERD patients.The aim was to use 5-HT and GAL as targets to guide the selection of GERD drugs.Through the study of different psychological care methods on GERD patients,we can provide a new theoretical basis for the clinical implementation of personalized psychological care.Aim:A general epidemiological survey was conducted on GERD patients and healthy subjects to analyze the risk factors and the relationship between anxiety and depression in patients with GERD and 5-HT and GAL levels.By comparing the changes of anxiety,depression and the levels of 5-HT and GAL before and after different psychological care methods,we can provide a new scientific basis for clinical psychological care intervention in GERD patients.Methods:①Using Reflux disease questionnaire(RDQ),GERD patients were selected from the SuBei People’s Hospital from 2014.08 to 2016.02.Healthy people were selected from the SuBei People’s Hospital at the same period.②The general epidemiological data were collected by self-designed epidemiological questionnaire of patients with gastroesophageal reflux disease.The psychological status of GERD patients and healthy controls group were assessed by Self-rating anxiety scale(SAS)and Self-rating depression scale(SDS).90 symptom check list(SCL-90)and Pittsburgh sleep quality Index(PSQI)were used to determine the psychological levels.③GERD patients were divided into grading psychological nursing care group and routine psychological care group,randomly.SAS,SDS,SCL-90,PSQI and levels of 5-HT and GAL were analyzed before and after the intervention.The content of 5-HT and GAL was measured by ELISA.Results:Part 1:A total of 238 GERD patients were included in the study,including 114 patients with NERD and 124 patients with RE.Family history,high BMI,sitting,cough,smoking,drinking,high fat diet and over-saturated diet are the risk factors of GERD.Compared with the healthy control group,If GERD patients have normal anxiety and depression scores,5-HT increased(P<0.05)and GAL decreased(P<0.05).The scores of SDS and SAS in patients with NERD and RE were higher than those in healthy control group,and the scores of SDS and SAS in patients with NERD were higher than those in RE group.The difference was statistically significant.5-HT levels in NERD patients were lower than control group,and GAL levels were higher than control group,5-HT levels in RE patients were higher than healthy control group,GAL levels were lower than healthy control group.The difference was statistically significant.More serious the anxiety and depressive,lower the 5-HT levels,higher the GAL levels.Part 2:Before the intervention,there was no significant difference between the scores of SCL-90,PSQI,SDS,SAS and 5-HT and GAL in the two groups(P>0.05).After four weeks of intervention,compared with the conventional psychological care group,the patients in the grading psychological care group improved better in interpersonal sensitivity,depression,anxiety,paranoia,subjective sleep quality,sleep latency,sleep persistence,sleep efficiency and so on.The scores of SDS and SAS in patients with grading psychological care group were significantly lower than those in routine psychological care group.The 5-HT levels in the grading psychological care group increased and the GAL levels decreased more than the conventional psychological care group.The difference was statistically significant(P<0.05).Conclusion:Part 1:Most GERD patients have anxiety and depression symptoms,and NERD patients with anxiety and depression were more severe than RE patients.GERD is closely related to anxiety,depression and 5-HT and GAL levels.GAL is negatively correlated with 5-HT,the more serious anxiety and depression are,the lower the 5-HT,The higher the GAL.Part 2:Compared with conventional psychological care,grading psychological nursing care can more effectively improve the anxiety and depressive symptoms of GERD patients.And the 5-HT and GAL contents gradually returned to normal.It can achieve the purpose of promoting patient care and rehabilitation and improve the quality of sleep and life.It is worthy of clinical use. |
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