综合医院急诊胸痛患者的心理状态及临床特征  

The mental state and characteristics of patients with chest pain in the emergency department of general hospitals

作　　者：贺建华[1] 李丛佳[1] 王文化[2] 白树功[1] 朱红岩[1] 那润萍[1] 刘欣[1] 

机构地区：[1]首都医科大学附属北京安贞医院,北京100029 [2]北京市心血管疾病防治办公室,北京100029

出　　处：《中国心理卫生杂志》2010年第12期893-896,共4页Chinese Mental Health Journal

摘　　要：目的：评估胸痛患者的心理状态，分析描述非心源性胸痛（non—cardiacchestpain，NCCP）的临床特征。方法：横断面研究。收集胸痛为主诉连续就诊的急诊患者711人，采用汉密顿焦虑量表（HamiltonAnxietyRatingScale，HAMA）和汉密顿抑郁量表（HamiltonDepressionRatingScale-17，HAMD一17）评估患者心理状态，比较NCCP与心源性胸痛的临床特点。结果：共231例同意合作的胸痛患者入选，年龄19～79岁，男性106。其中182例为NCCP，49例为有器质性心脏病者（心源性胸痛组）。胸痛患者焦虑抑郁平均分均高于正常界值（HAMA得分≥14；HAMD一17得分≥8），以焦虑症状更明显，NCCP组有明显焦虑症状的患者比例高于心源性胸痛组（64．3％VS．57．1％，P〈0．01）。与心脏病患者相比，NCCP组年龄较小[（48．1±11．7）岁VS．（55．5±10．0）岁，P〈0．01]，≤45岁者较多（37．9％VS．16．3％，P〈0．01），胸痛发作时更易出现死亡恐惧（59．3％VS．40．8％）、害怕（69．8％VS．34．7％）、失控感（31．9％VS．10．2％）、过度换气（37．4％VS．16．3％）和手脚麻木（37．4％VS．14．3％）等伴随症状（Ps〈0．05）；伴随症状成组出现（／〉4个）的比例更高（29．7％VS．10．2％，P〈0．01），发作时心电图正常、病程〉16月者更多（49．5％VS．30．6％，P〈0．05）。结论：急诊胸痛患者焦虑症状明显，其中大多数为非心源性胸痛，主要临床特征为年龄较轻、心电图正常、发作时常有特征性伴随症状，或特征性伴随症状成组出现。Objective： To evaluate the mental state and delineate characteristics of patients with chest pain in the emergency department of general hospital. Methods ： This cross-sectional study was performed in the emergency department （ED） of an urban tertiary care hospital. Totally 711 consecutive patients complaining of chest pain were enrolled in the study. The mental states of patients were assessed with the Hamilton Anxiety Rating Scale { HAMA} and Hamilton Depression Rating Scale-17 { HAMD-17） . Results： A total of 231 patients presented to the ED with chest pain participated in the study, including 106 males and 125 females, aged 19 -79 years. Among them, 182 patients were confirmed without any heart disease, diagnosed with non-cardiac chest pain （ NCCP ）, and 49 were confirmed with heart disease. The patients with chest pain had higher scores of HAMA and HAMD-17, especially HAMA. The NCCP group had higher proportion of the patients whose HAMA scores were t〉 14 than the heart disease group （64. 3% vs. 57. 1%, P 〈0. 01 } . The patients in NCCP group were younger than patients with cardiac disease[ （48.1 ±11.7） vs. （55.5 ＋10.0）, P〈0.01）], and more ofthem were≤ 45 years （37.9%vs. 16. 3%, P 〈0. 01 } . The attacks of chest pain with NCCP were more frequently accompanied by the presence of some specified symptoms than patients with cardiac disease： fear of dying { 59. 3 % vs. 40. 8 % }, fear { 69. 8 % vs. 34. 7 % } , feeling out of control （31.9 % vs. 10. 2% ） , overventilation {37.4 % vs. 16. 3 % ） , numbness of limbs {37.4 % vs. 14. 3 % ）, and were more likely appeared in a group of these items at least four than cardiac disease patients {29.7 % vs. 10. 2 %, P 〈0. 01 } . The electrocardiology （ ECG} of NCCP patients during chest pain attack were normal, and the NCCP group had higher proportion of the patients whose disease course were t〉 6 month than the heart disease group （ 49. 5% vs. 30. 6%, P 〈 0.05 } . Conclusion： Patients presenting with chest pain

关 键 词：胸痛 焦虑 抑郁 急诊医学 横断面研究 

分 类 号：R749.92[医药卫生—神经病学与精神病学]