“老胃病”也可能是心理?。?/title> <h1>“老胃病”也可能是心理??？</h1> <p>◎ 李 勇 江蘇省人民醫(yī)院心理科副主任醫(yī)師醫(yī)學(xué)心理學(xué)教研室副主任</p> <p>親朋好友中，不少人經(jīng)常受到“老胃病”的困擾，輕者食欲下降、反復(fù)胃脹不適，重者頻繁胃痛、反酸、失眠、消瘦。</p> <p>很多“老胃病”患者都有這樣的疑惑，為什么胃病總是反反復(fù)復(fù)發(fā)作，吃了不少胃藥也不管用？周阿姨（化名）就是這樣一位患者，十幾年來(lái)飽受“胃病”困擾，每年都有數(shù)月反復(fù)感到上腹脹痛、噯氣、反酸，沒有胃口，早飽、惡心，喉嚨堵塞感，嚴(yán)重時(shí)還經(jīng)常伴隨心慌、頭痛、失眠。為了治“胃病”，她幾乎看遍了當(dāng)?shù)厮嗅t(yī)院，做過(guò)多次全身檢查，結(jié)果僅是“慢性淺表性胃炎”，服藥卻不見好轉(zhuǎn)。以致整天唉聲嘆氣，多思多慮，認(rèn)為自己得了“胃癌”，只是家人隱瞞不說(shuō)。</p> <p>今年，家人再次帶她就診時(shí)，醫(yī)生囑咐她到臨床心理科解決情緒和睡眠問(wèn)題，開始，周阿姨還挺疑惑，胃病為什么要到心理科看？等臨床心理科的醫(yī)生診斷她是“功能性胃病”，并告訴她“功能性胃病”的臨床特點(diǎn)時(shí)，她和家人才確信看對(duì)路了，醫(yī)生給她開了抗抑郁、抗焦慮和改善睡眠的藥，服藥半個(gè)月以后，困擾她十幾年的老胃病癥狀居然消失了一大半，周阿姨和家人都感到很奇怪，為什么服用抗抑郁藥可以治療“老胃病”呢？</p> <p>其實(shí)，功能性胃病是綜合醫(yī)院臨床心理科常見病之一，是一種常見的心理生理功能失調(diào)性疾病，發(fā)病年齡多在 20～50歲之間，病程緩慢，病情常受情緒、飲食等因素影響。癥狀持續(xù)存在或反復(fù)發(fā)作，其發(fā)病與精神、飲食、起居、生活方式等密切相關(guān)。42%～61%的功能性胃病患者合并焦慮、抑郁、失眠等精神心理障礙。仔細(xì)詢問(wèn)病史，往往可以找到精神誘因，比如上述周阿姨，自幼性格內(nèi)向、敏感，多年來(lái)與丈夫感情不和，與婆婆矛盾多，因經(jīng)常生悶氣，而導(dǎo)致“胃病”越來(lái)越重。</p> <p>科學(xué)研究表明，情緒低落、精神緊張時(shí)，大腦的情緒中樞會(huì)發(fā)生功能紊亂，緊挨在一起的自主神經(jīng)中樞就會(huì)受到影響，發(fā)生自主神經(jīng)功能性紊亂，其中控制胃腸的自主神經(jīng)最容易發(fā)生失調(diào)，從而影響胃腸蠕動(dòng)，使消化液分泌減少或過(guò)分增加，出現(xiàn)胃部疼痛、反酸，以及食欲下降等消化不良癥狀，有科學(xué)家稱胃腸是對(duì)情緒最敏感的器官。</p> <p>此外，工作壓力大、生活飲食不規(guī)律、煙酒刺激、酸辣刺激等外部刺激，會(huì)擾亂人的正常消化、吸收功能，為誘發(fā)“功能性胃病”提供了條件。</p> <p>如果不及時(shí)用藥，放縱不良的生活飲食習(xí)慣，功能性病變也可能轉(zhuǎn)變?yōu)椴∏楦鼮閲?yán)重的器質(zhì)性病變。</p> <p>治療方面，重在綜合調(diào)養(yǎng)，用藥為輔，針對(duì)病因糾正激發(fā)因素。已經(jīng)導(dǎo)致胃腸炎癥的患者要在消化科醫(yī)生指導(dǎo)下使用抗生素，濫用抗生素會(huì)破壞腸道正常菌群，導(dǎo)致菌群紊亂使病情加重。治療存在心理誘因的功能性胃腸病患者時(shí)，對(duì)病情較輕者應(yīng)立足于調(diào)整心態(tài)、改變生活方式，必要時(shí)可加用胃腸道調(diào)節(jié)藥物，輔以認(rèn)知療法等心理調(diào)節(jié)治療。對(duì)重度患者，在積極調(diào)整胃腸運(yùn)動(dòng)和感覺功能的同時(shí)，需選擇心理認(rèn)知和行為治療以及放松、催眠、生物反饋治療等，必要時(shí)加用抗焦慮、抑郁藥物。另外，經(jīng)常做腹部按摩操、多運(yùn)動(dòng)、保持樂觀情緒等均可改善病情。</p> <p>（編輯 宋 瑾）</p> <p>（投稿郵箱：656582829@qq.com）</p>
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