经不同血管径路行冠状动脉介入治疗对患者心理状况的影响  

Psychologic status comparison in patients treated with transradial or transfermoral approach coronary catheterizations

作　　者：陈瑶[1] 邱原刚[1] 朱建华[1] 郑萍[2] 陈君柱[1] 张芙荣[1] 赵莉莉[1] 陶谦民[1] 郑良荣[1] 

机构地区：[1]浙江大学医学院附属第一医院心内科,杭州310003 [2]浙江医学高等专科学校图书信息中心

出　　处：《中华心血管病杂志》2006年第8期714-717,共4页Chinese Journal of Cardiology

基　　金：浙江省科技攻关基金资助项目(2004C33025;2003C33008);浙江省教育厅基金资助项目(20020805)

摘　　要：目的经股动脉行冠状动脉介入治疗后,应用中国版90项症状清单(Symptom Checklist 90,SCL-90)评价发现患者的躯体化因子评分高于常模。本研究的目的是了解经不同血管径路行冠状动脉介入手术是否会影响患者的心理状况。方法本研究为非随机同期对照研究。198例因疑诊冠心病首次行冠状动脉造影或介入治疗的患者,其中经股动脉径路者105例,经桡动脉径路者93例。所有患者均于术前24 h内及术后24～48 h行中国版90项症状清单评价。根据数据的分布特点、基线指标分别采用x2检验或t检验进行两组间比较;采用双因素方差分析检验经不同血管径路及冠状动脉介入手术本身对患者SCL-90评分的影响。结果两组之间年龄、性别、体重、烟酒嗜好、职业、文化程度、婚姻状况、家庭关系、心脑血管病家族史、本人及家庭年收入以及医疗费用的支付方式(即是否有医疗保险)等方面差异均无统计学意义;两组间合并高血压和糖尿病的人数也无差别;确诊冠心病以及行冠状动脉介入治疗的患者数亦相似。与术前相比,冠状动脉介入手术后躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、总均分和阳性项目数等项目评分均有明显下降(分别为1.50±0.51比1.64±0.53;1.50±0.48比1.67±0.55;1.28±0.41比1.38±0.49;1.42±0.43比1.55±0.53;1.38±0.41比1.58±0.54;1.32±0.35比1.44±0.41;1.38±0.34比1.49±0.42;和23.08±17.30比27.72±18.79,P均<0.05)。与经股动脉径路相比,经桡动脉行冠状动脉介入手术显著减少躯体化、抑郁和阳性症状均分等项目评分(分别为1.52±0.51比1.62±0.53;1.43±0.54比1.54±0.43;2.36±0.66比2.50±0.43,P均<0.05)。结论经桡动脉行冠状动脉介入手术可减轻患者的躯体化及抑郁症状;冠状动脉介入手术后患者的心理症状明显减轻。Objective We previously showed that factorial score of somatization, which was obtained by the examination of symptom checklist-90 （SCL-90） , was higher in patients received transfemoral coronary catheterization than norm. The aim of the present study was to compare the patient＇s psychologic status between transradial approach and transfemoral approach percutaneous coronary catheterizations. Methods A total of 198 inpatients （105 transfemoral, 93 transradial） underwent scheduled first time coronary catheterizations were enrolled. All patients were studied by symptom SCL-90 on present psychologic status 24 hours before and 24-48 hours after coronary catheterizations. Results Age, sex, weight, smokers, employment, educational background, marriage status, family relations, family history of cardiovascular disease, income and medical insurance status were similar between the two groups. There was also no difference in diabetes, hypertension history as well as coronary heart disease confirmed by coronary catheterization between the 2 groups. Compared with the status before the procedure, factorial scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, global severity index and total positive symptoms were significantly reduced after percutaneous coronary catheterizations （1.50±0.51 vs. 1.64±0.53, 1.50 ±0.48 vs. 1.67 ±0.55, 1.28 ±0.41 vs. 1.38 ± 0.49, 1.42±0.43 vs. 1.55±0.53, 1.38±0.41 vs. 1.58±0.54, 1.32±0.35 vs. 1.44±0.41, 1.38± 0. 34 vs. 1.49 ± 0. 42, and 23.08 ± 17. 30 vs. 27.72 ± 18.79, respectively, P all 〈 0. 05 ）. Scores on somatization, depression and positive symptom severity index were significantly lower in patients received transradial coronary catheterizations than those received transfermoral coronary catheterization approach （1.52 ±0.51 vs. 1.62 ±0.53, 1.43 ±0.54 vs. 1.54 ±0.43 and 2.36 ±0.66 vs. 2.50 ±0.43, respectively, P all 〈 0. 05 ）. Conclusion Patients＇ psychologic status improved significantly after pe

关 键 词：精神卫生 自我评价(心理学) 冠状血管造影术 血管成形术 经腔 经皮冠状动脉 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]