合并焦虑障碍冠心病患者介入治疗后抗焦虑干预的效果  

Anxiolytic intervention for coronary heart disease patients combined with anxiety disorder

作　　者：董会奕[1] 衣为民[2] 张斌[1] 杨海涛[1] 

机构地区：[1]北京大学深圳医院心内科,广东省深圳市518036 [2]深圳市孙逸仙心血管医院心内科,广东省深圳市518020

出　　处：《中国临床康复》2005年第32期23-25,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:观察抗焦虑药物治疗对冠心病患者合并焦虑障碍发生率的影响。方法:①选择2002-01/2004-09在北京大学深圳医院心内科及深圳市孙逸仙心血管医院心内科住院接受冠状动脉内支架植入术治疗的冠心病患者358例。患者对实验目的知情,并能积极配合检查。②焦虑障碍程度评估采用汉密顿焦虑量表犤包括心血管系统症状、呼吸系统症状、胃肠道症状、植物神经系统症状、躯体性焦虑(肌肉系统)症状、躯体性焦虑(感觉系统)症状、生殖泌尿系统症状、焦虑心境、紧张、害怕、失眠、认知功能、抑郁心境以及会谈时行为表现等14项症状。根据每项症状的严重程度将其界定为0～4分5个等级,0分为无焦虑症状,4分为症状极重。总分<7分为无焦虑症状,≥14分为肯定有焦虑症状,≥7分,<14分为可能有焦虑症状犦。评分在入院后3d内、冠状动脉介入治疗前进行。③经汉密顿焦虑量表评分确定有焦虑症状存在的冠心病患者160例。设汉密顿焦虑量表总分<7分的198例冠心病患者为单纯冠心病组,在对其实施冠状动脉血运重建手术后给常规药物治疗4周。④随机将汉密顿焦虑量表总分≥14分的冠心病患者160例分为2组:焦虑治疗组和焦虑对照组各80例。焦虑对照组与单纯冠心病组的治疗方法相同。焦虑治疗组在前两组治疗方案的基础上加用盐酸氟西汀,20mg/d,治疗4周。⑤所有患者于治疗4周末时接受第2次汉密顿焦虑量表评定,由相同的评定员以相同的方法进行。观察介入治疗及4周常规药物治疗前后各组患者临床症状缓解率及治疗4周后汉密顿焦虑量表评分的减分幅度,并观察盐酸氟西汀的不良反应。⑥计量和计数资料差异比较分别采用t检验和χ2检验。结果:冠心病患者258例均完成量表评估并进入结果分析。①治疗前临床症状发生率:单纯冠心病组的典型冠心病症状发生率高于�AIM： To observe the effect of anxiolytic intervention on the incidence of anxiety disorder in patients with coronary heart disease. METHODS：① Totally 358 inpatients with coronary heart disease treated in the Department of Cardiology at Beijing University Shenzhen Hospital and Shenzhen Sun Yat-Sen Cardiovascular Hospital from January 2002 to September 2004 were recruited. Informed consent was obtained from the patients who can accept examination actively. ② Hamilton Anxiety Scale （HAMA） was used to evaluate the level of anxiety disorder [ including cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, vegetative nervous system symptom , somatic anxiety （muscular system）, somatic anxiety anxiety （sensory） symptoms, genitourinary symptoms, anxious moods , tensions, fears , insomnia, intellectual, depressed mood as well as behavior at interview and so on 14 symptoms. Each item was rated on a 5-point scale , ranging from 0 （not present） to 4 （severe）. Total points 〈 7 was not present ,≥14 points was sure to have anxiety symptoms ,≥7 points and 〈 14 points might have anxiety symptoms. The psychiatric diagnoses were established within 3 days after admittance to hospital and before the coronary revascularization . ③Totally 160 patients were diagnosed as anxiety symptoms by HAMA . The total scores of HAMA less than 7 points of 198 patients with coronary heart disease were set as only coronary heart disease group. 4-week routine medication treatment was given before coronary revascularization. ④Totally 160 patients with coronary heart disease with the total points ≥ 14 diagnosed by HAMA were randomly divided into 2 groups ： Anxiety treatment group （n=80） and anxiety control group （n=80）. The treatment methods in the anxiety control group and only coronary heart disease group were the same. 20 mg/d of fluoxertine hydrochloride was added in the anxiety control group for 4 weeks based on the methods in the prior two groups. ⑤ All the patients accepted t

关 键 词：冠状动脉疾病/并发症 焦虑/药物疗法 抗焦虑药/治疗应用 

分 类 号：R749.4[医药卫生—神经病学与精神病学]