伴焦虑抑郁的冠状动脉粥样硬化性心脏病介入治疗患者药物干预治疗的研究  

Therapeutic effects of drugs intervention therapy on CHD patients complicated with depression and anxiety treated with PCI

作　　者：李方江[1] 张凡[2] 徐涛[1] 赵久安[1] 王亚玲[1] 李跃[1] 袁桂莉[1] 

机构地区：[1]河北北方学院附属第一医院心血管内科,河北省张家口市075000 [2]河北北方学院附属第一医院病理科,河北省张家口市075000

出　　处：《河北医药》2009年第2期131-133,共3页Hebei Medical Journal

基　　金：河北省科学技术研究与发展指导计划项目(编号:072761560)

摘　　要：目的探讨心理药物干预对伴有焦虑抑郁症状冠状动脉粥样硬化性心脏病(冠心病)介入治疗患者的临床疗效。方法对入选的168例冠心病介入治疗患者,通过症状自评量表(SCL-90)、Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)的测评对SDS得分粗分大于41以及SAS得分粗分大于40,定为有抑郁和焦虑倾向,共59人入选。将入选患者随分为干预组36例,对照组23例。干预组在冠心病介入治疗后常规心内科治疗的基础上+抗精神药物+心理干预。对照组在冠心病介入治疗后常规心内科治疗基础上+安慰剂。2组治疗前后SAS、SDS、SCL-90评分,心绞痛分级和心电图ST段进行比较。结果(1)干预组不同时段SAS、SDS评分明显低于对照组(P<0.01)。(2)干预组治疗后SCL-90评分除躯体症状人际关系敌对性外其余评分高于治疗前(P<0.01)。(3)干预组治疗后与常模均值心理健康状况的差异无统计学意义(P>0.05)(除躯体症状、人际关系、敌对性)。(4)干预组治疗后总有效率高于对照组(P<0.05)。结论(1)冠心病介入治疗患者存在抑郁、焦虑、躯体化、人际关系、敌对性、精神病性等心理健康问题。(2)精神药物+心理干预可明显改善伴有焦虑抑郁症状的冠心病介入治疗患者心理健康水平。通过认知的改变,可以减轻负性情绪对躯体状态的影响,抑制已改变的病理生理过程,从而提高临床疗效。Objective To investigate the effect of drug intervention on CHD patients complicated with depression and anxiety treated with PCI. Methods 59 patients from 159 patients with CHD treated with PCI whose scores both SDS and SAS were more than 40. The 59 patients were randomly divide into intervention group（ n = 36） and control group n = 31） . The patients in intervention group, on the basis of routine therapy, were given anti-psychotropic drugs and psychological intervention, while the patients in control group, on the basis of routine therapy, were given placebo. The SAS, SDS, SCL-90 score, angina pectoris grade, ST segment of ECG were detected before and after treatment for both groups. Results As compared with those on admission, the SAS and SDS scores in intervention group at discharge time were significantly different（ P 〈 0.01）, while there were no significant differences in control group at three time paints （P 〉 0.05） . The total score, general mean score, the scores of depression, anxiety, phobia and SCL-90 were significantly lower than those of control group （ P 〈 0.01 ）. There was no significant difference in SAS and SDS scores in control group before and after treatment （ P 〈 0.05）, but there were significant differences between two groups. There were significant differences in obvious improvement rate and total effective rate between two groups （ P 〈 0.05 ）. Conclusion The CHD patients have the abnormal emotions of depression, anxiety, hostility, compulsive disorders, relationship disorder, somatoform disorder, phobias, paranoid, psychiatrics. Psychotropic drug and psychological intervention can improve the emotional health levels of the depressive and anxious CHD patients treated with PCI, and can increase clinical efficacy by decreasing negativity emotion effect on the body and inhibit the changed pathological and physiological process.

关 键 词：冠心病 经皮冠脉成形术 焦虑与抑郁 药物干预 

分 类 号：R749.42[医药卫生—神经病学与精神病学] R541.4[医药卫生—临床医学]