پایان نامه بررسی مقایسه ای کیفیت زندگی قبل و بعد از مداخلات درمانی در مبتلایان به سندرم حاد کرونری

فهرست:

فصل اول:  بیان مسئله

1-1 مقدمه........................................................................................................................................................... 2

1-2 اهداف و فرضیات........................................................................................................................................ 4

1-2-1 هدف کلی............................................................................................................................................... 4

1-2-2 اهداف اختصاصی................................................................................................................................... 4         

1-2-3 فرضیه..................................................................................................................................................... 5

1-3 تعریف واژه‌های کلیدی.............................................................................................................................. 5

1-3-1 کیفیت زندگی......................................................................................................................................... 5         

1-3-1-1 تعریف نظری..................................................................................................................................... 5

1-3-1-2 تعریف عملیاتی................................................................................................................................. 5         

1-3-2 مداخلات درمانی.................................................................................................................................... 5

1-3-2-1 تعریف عملیاتی: شامل  PTCA,CABGو مداخلات داروئی می باشد.................................... 5

1-3-3 گروه تهاجمی و غیر تهاجمی................................................................................................................ 5

1-3-3-1 تعریف عملیاتی................................................................................................................................. 5

1-3-4 گروه غیر تهاجمی.................................................................................................................................. 6

1- 4 محدودیت های پژوهش و ارائه راه حل ان............................................................................................ 6

فصل دوم: چارچوب پنداشتی و پیشینه تحقیق            

2-1 سندرم حاد کرونری .................................................................................................................................... 8

2-2 حمله قلبی.................................................................................................................................................... 9

 2-2-1 آنژین پایدار........................................................................................................................................... 9

 2-2-2 سندرم کرونری حاد.............................................................................................................................. 9

 2-2-2-1 آنژین ناپایدار................................................................................................................................... 9

 2-2-2-2 انفارکتوس میوکارد بدون صعود قطعه NSTEMI)ST ) ......................................................... 10

2-2-3 آنژین قلبی یا سندروم حاد کرونری...................................................................................................... 10

2-3 تعریف آنژین قلبی....................................................................................................................................... 10

2-3-1 آنژین پایدار............................................................................................................................................. 10

2-3-2 آنژین ناپایدار.......................................................................................................................................... 11

2-3-2-1بررسی دلایل آنژین ناپایدار یا انفارکتوس....................................................................................... 11

2-3-2-1-1مراحل آترواسکلروزیس............................................................................................................... 12

2-3-2-1-1-1کلسترول و لیپوپروتئین ......................................................................................................... 12

 2-3-2-1-1-2 اکسیداسیون ........................................................................................................................ 12

2-3-2-1-1-3 پاسخ التهابی.......................................................................................................................... 12

2-3-2-1-1-3-1 بسته شدن رگ................................................................................................................. 13

2-4 علایم بالینی سندروم کرونری.................................................................................................................... 13

4-2-1 کیفیت درد ............................................................................................................................................. 14

 4-2-2 مدت درد .............................................................................................................................................. 14

4-2-3 مکان درد ............................................................................................................................................... 14

4-2-4 شروع کننده های درد............................................................................................................................ 14

4-2-5 حمله قلبی جدیدترین برونده سندرم کرونری حاد.............................................................................. 15

2-5 تظاهرات بیماری سندروم کرونری............................................................................................................. 15

2-5-1 آنژین پرینزمتال...................................................................................................................................... 15

2-5-2 ایسکمی خاموش................................................................................................................................... 15

 2-5-3 سندرم X .............................................................................................................................................. 16

 2- 6 روش های تشخیص سندروم حاد کرونری یا حمله قلبی..................................................................... 16

2-6-1شرح حال و معاینه بالینی....................................................................................................................... 16

2-6-2نوار قلب یا ECG ................................................................................................................................. 17

2-6-3مارکرهای آزمایشگاهی.......................................................................................................................... 17

2-6-4 تستهای غیرتهاجمی ............................................................................................................................. 18

2-6-4-1 اکوکاردیو گرافی............................................................................................................................... 18

2-6-4-2 تست ورزش...................................................................................................................................... 18

2-6-4-3 اسکن تالیوم...................................................................................................................................... 18

2-6-4-4آنژیوگرافی ......................................................................................................................................... 19

2-6-4-5CT Angiography ....................................................................................................................... 19

2-5 راههای درمان............................................................................................................................................. 20

2-5-1 درمان دارویی......................................................................................................................................... 20

2-5-1-1 نیتروگلیسیرین یا نیترات ها.............................................................................................................. 20

2-5-1-2 بتابلوکر............................................................................................................................................... 21

 2-5-1-3 وراپامیل -هپارین و LMWH...................................................................................................... 21

2-5-1-4آنژین ناپایدار...................................................................................................................................... 23

2-5-1-5انفارکتوس میوکارد همراه با بالارفتن قطعه ST............................................................................. 23

تداخلات کرونری از طریق پوست...................................................................................................................... 23

2-5-2استنت....................................................................................................................................................... 23

2-5-3 جراحی کنارگذر شریان کرونری........................................................................................................... 25

2-5-3-1اهمیت................................................................................................................................................. 25

2-5-4 بای پس قلبی ریوی.............................................................................................................................. 25

2-5-4-1 خطرات.............................................................................................................................................. 26

2-5-5 ریسک فاکتورهای سندروم کرونری.................................................................................................... 26

2-5-5-1 سن ................................................................................................................................................... 27

2-5-5-2جنسیت............................................................................................................................................... 27

2-5-5-3 فاکتور های ژنتیکی ......................................................................................................................... 27

2-5-5-4  نژاد.................................................................................................................................................... 27

2-5-5-5 کیفیت زندگی.................................................................................................................................... 28

2-5-5-1 تاریخچه کیفیت زندگی.................................................................................................................... 30

2-5-5-2 مفهوم کیفیت زندگی از نگاه نظریه پردازان................................................................................... 31

2-5-5-2-1 کالمن........................................................................................................................................... 31

2-5-5-2-2 گودمن.......................................................................................................................................... 32

2-5-5-2-3 ریف و سینگر............................................................................................................................... 32

2-5-5-2-4 موری............................................................................................................................................ 32

2-5-5-2-5 دیوید فیلیپس............................................................................................................................... 33

2-5-5-3 ویژگی های کیفیت زندگی............................................................................................................... 33

2-5-5-3-1چند بعدی بودن............................................................................................................................. 33

2-5-5-3-2 ذهنی بودن................................................................................................................................... 34

2-5-5-3-3 پویا بودن...................................................................................................................................... 34

2-5-5-4 رویکرد روان شناختی اجتماعی و جامعه شناختی مفهوم کیفیت زندگی...................................... 34

2-5-5-4-1نظریه یادگیری اجتماعی.............................................................................................................. 35

2-5-5-4-2نظریه آنومی دورکیم.................................................................................................................... 35

2-5-5-4-3 نظریه کنش اجتماعی پارسونز.................................................................................................... 36

2-5-5-4-4 نظریه زیمل.................................................................................................................................. 37

2-6 پیشینه تحقیقات........................................................................................................................................... 39

2-6-1 تحقیقات خارجی.................................................................................................................................... 39

2-6-2 تحقیقات داخلی...................................................................................................................................... 41

فصل  سوم: روش شناسی تحقیق

3-1 نوع پژوهش................................................................................................................................................. 44

3-2 محیط پژوهش............................................................................................................................................. 44

3-3 جامعه پژوهش............................................................................................................................................. 44

3-4 معیارهای ورود و خروج مطالعه ................................................................................................................ 44

3-4-1 معیارهای ورود........................................................................................................................................ 44

3-4-2 معیارهای خروج از مطالعه..................................................................................................................... 45

3-5 روش نمونه گیری........................................................................................................................................ 45

3-6  تعیین حجم نمونه ..................................................................................................................................... 45

3-7 روش اجرای مطالعه.................................................................................................................................... 46

3-8 روش گردآوری اطلاعات............................................................................................................................ 47

3- 9 ابزار گرد آوری داده ها............................................................................................................................... 47

3-10پرسشنامهSF6 نمره گذاری .................................................................................................................... 47

3 -11معرفی متغیرهای تحقیق.......................................................................................................................... 50

3-12روش تجزیه و تحلیل اطلاعات .............................................................................................................. 51

3-13نرم افزارهای مورد استفاده........................................................................................................................ 51

3- 14   ملاحظات اخلاقی................................................................................................................................ 51

فصل  چهارم: توصیف و تحلیل داده ها (یافته ها)

4-1 یافته های کلی پژوهش............................................................................................................................. 53

4-2-بررسی ویژگی های جمعیت شناختی مبتلایان به سندرم حاد کرونری................................................. 54

4-3 تعیین کیفیت زندگی مبتلایان به سندرم حاد کرونری در ابتدای مطالعه................................................ 56

4-4- تعیین کیفیت زندگی مبتلایان به سندرم کرونری دو ماه پس از درمان 58

4-5 مقایسه کیفیت زندگی بیماران قبل و بعد از مداخلات درمانی63

فصل پنجم: بحث و نتیجه گیری

5- 1  بحث و نتیجه گیری.................................................................................................................................. 66

5-2 نتیجه گیری.................................................................................................................................................. 69

5- 3 پیشنهادات ................................................................................................................................................. 69

5-3-1 پیشنهادات کاربردی............................................................................................................................... 69

5-3-2 پیشنهادات پژوهشی.............................................................................................................................. 70

منابع و مآخذ.......................................................................................................................................................... 72

پیوست................................................................................................................................................................... 79

چکیده انگلیسی ................................................................................................................................................... 85

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