The Clinical Interventions Of Chronic Obstructive Pulmonary Disease With Anxiety

Chronic obstructive pulmonary disease (COPD) is a group of chronic airway inflammatory disease, with airflow limitation, cough, sputum, promoting difficulty breathing for main features. Now there are 6 billion people infected with the disease worldwide each year, and 290 million people died of the disease. In China's urban population death cause, respiratory diseases (mainly COPD) accounted for 13.89%, ranking fourth in the ten leading causes of death; in the countryside, accounted for 22.04%, ranking the first.With the transformation of medical model, the interaction between psychological factors and body disease has been increasing attentioned, and more and more evidence support that COPD is a kind of mental disease, these patients in the acute stage and remission are rife with mood disorders. Mood disorders may worsen and expand their various somatic symptoms and clinical manifestations of patients with COPD, affect the efficacy of COPD patients in remission ongoing rehabilitation and treatment, and reduce the patients'life quality. A mood disorder in COPD is one of the major causes of death. And anxiety is one of the most common mood disorders that received the least treatment in the patients of COPD.Objective: This study through investigation and scale screening, we can attain that patients with COPD are often merging anxiety; COPD patients with anxiety were carried out anti-anxiety drug and psychotherapy, to explore a comprehensive treatment for COPD patients, and to find a new direction for the treatment of COPD patients with mood disorders.Method:1 General information: In February 2007 to December 2008, 352 cases of COPD patients come to our hospital. Cases are in conformity with the standards: In line with the diagnostic criteria of AECOPD in "Chronic Obstructive Pulmonary Disease Diagnosis and Treatment Guidelines" (2007 revision). And eliminate serious illness, cognitive dysfunction and patients with pulmonary encephalopathy, cerebral apoplexy, no family or individual history of mental disorders; as a result of the elderly suffering from various diseases, the body of disease in the near future-oriented major diseases. Another take ECG, chest X-ray, color heart, abdomen color, the testing head CT who diagnosed without medical problems, and never suffered cerebral apoplexy, no family or individual history of mental disorders of elderly patients 352 cases as control group. All of the patients'consciousness is clear, can independence clearly answer the question.2 Method :2.1 Investigation contents: gender, age, consciousness and individual history and family history, SAS scale, and so on.2.2 Questionnaire: Using the Self-Rating Anxiety Scale(SAS) to assessment, the scale should be filled out by their own, the patients who could not should be given a detailed description by the testers, and finish them according to the patients' choices. Testers from the doctors and undergraduate. After the self-evaluation,at the end of the 20 projects that we add up the points total to be rough, and then through the conversion formula: Y = int1.25x. That is, by rough riding to 1.25, round figures, have been standard on the total score (index score, Y) to conduct statistical analysis. The boundary value evaluation anxiety for 50 cents, the higher scores the more obvious tendency of anxiety.2.3 Group: The 125 patients of COPD with anxiety were randomly divided into three groups: conventional group, 46 cases; anti-anxiety drugs (doxepin) group, 40 cases; combined treatment group, 39 cases. All patients were treated in accordance with GOLD standard; doxepin group were treated by doxepin additional, combined treatment group were taken a treatment combined doxepin therapy and psychotherapy. Observation treatment time for 2 weeks. 2.4 Observing indexes: SAS score, pulmonary function (FEV1%, FEV1/FVC%), the clinical symptoms and signs, 6-minute walking distance, 2 weeks discharge rate.2.5 Statistical method: Data was entered into a database and analyzed using SPSS13.0 software. Group mean values and standard deviations were calculated. Measurement data is treated with the t-test and the One-Way ANOVA test and LSD; and enumeration data is treated with the chi-square test. The statistical significance level was set at P<0.05, and P<0.01 were thought to have statistic significance obviously.Result:1 There were no statistically significant difference between COPD group and healthy control group in gender and age (P>0.05),the two groups were comparable. The SAS scores of COPD group were higher than control group, and the proportion of combined anxiety was obviously higher than control group, the difference was statistically significant (P<0.01).2 COPD patients with anxiety were randomly divided into three groups, there were no statistically significance in clinical symptoms and signs, SAS score, FEV1% , FEV1/FVC% and 6MWD before treatment among three groups (all P>0.05).3 There was markedly reduction in SAS scores within the three groups after treatment, and had statistically significant obviously (all P<0.01). The reduction of SAS scores before and after treatment was much more in the combined group than in both the doxepin group and conventional group, and the doxepin group was more than the conventional group ,the difference had statistically significance (P<0.05).4 After treatment, FEV1% and FEV1/FVC% of all the three groups were improved, the differences were statistically significant obviously (all P<0.01). In the three groups, the doxepin group compared with conventional group improved significantly of pulmonary function, and the combined treatment group improved more than doxepin group, but the differences among the three groups had no statistical significance (P>0.05). 5 The 2 weeks discharge rate in the doxepin group and the combined group were higher than the conventional group, and the combined group was higher than the doxepin group (P<0.05).6 Outcome of disease: the markedly effective rate and the effective rate were 77.50% and 92.50% in the doxepin group, 82.05% and 94.87% in the combined group, and 54.34% and 89.13% in the conventional group respectively, there was statistical significance (P<0.05).7 There was markedly improvement in 6MWD of three groups after treatment, and had statistically significant obviously (all P<0.01). The improvement of 6MWD before and after treatment was higher in the combined group than in both the doxepin group and conventional group, and the doxepin group was higher than the conventional group (P<0.05).Conclusion:1 COPD patients are often accompanied with anxiety.2 The anxiety condition of COPD patients can alleviate with the remission of the disease after treatment.3 The anti-anxiety treatment can increase the exercise capacity of COPD patients, and improves their quality of life.4 The anti-anxiety treatment has no obvious effect to improve COPD patients'pulmonary function.5 The anti-anxiety treatment can improve the clinical symptoms and condition of COPD patients.6 In this study, the anti-anxiety treatment in the acute exacerbation period stage is more advantageous to alleviate the condition of COPD patients; both the anti-anxiety drugs therapy and psychotherapy play an important role in the treatment of COPD disease, and the combined both treatment is the best.