埋藏式心律转复除颤器患者心理障碍及其处理对策研究  

Research and therapeutic strategy on the psychological disturbances of patients with implantable cardioverter defibrillator

作　　者：李淑敏[1] 郭涛[1] 薛强[1] 郝应禄 刘中梅[1] 杨军[1] 韩明华[1] 赵玲[1] 华宝桐[1] 

机构地区：[1]昆明医学院第一附属医院心内科,云南昆明650032 [2]玉溪市第一人民医院心内科,云南玉溪653100

出　　处：《云南医药》2011年第3期270-275,共6页Medicine and Pharmacy of Yunnan

摘　　要：目的了解埋藏式心律转复除颤器(ICD)患者心理障碍的发病率,探讨心理障碍的病因与发病学机制,评价综合治疗即"拼盘治疗"的疗效。方法选取1998年5月～2009年5月在昆明医学院第一附属医院初次行ICD/CRT-D植入术并能完成随访的患者138例(男108例,女30例,平均年龄65.7岁),所有患者均接受中国生活事件量表(LES)、适应不良自评量表、防御方式问卷(DSQ)、症状自评量表(SCL-90)、社会支持评定量表(SSRS)、ICD与回避行为问卷、汉密尔顿抑郁量表(HRSD)和汉密尔顿焦虑量表(HAMA)进行心理状态评估,并选取昆明医学院部分在校研究生130例作为正常对照组,采用相同量表进行心理状态评估,与ICD患者进行对比分析。所有患者于术前1周和术后1周、1月、3月、6月及9月分别采用上述量表进行心理状态评估。随访病例中存在心理障碍的患者予以综合治疗即"拼盘治疗"并在治疗后1周、2周、4周、6周和10周再次进行心理状态评估,与此同时采用病情严重程度(SI)与疗效总评(GI)两项指标进行疾病严重程度和疗效评价。随访采用门诊复查、住院观察、电话随访及上门随访等方式进行,患者心理评估采用观察法、问卷法及半结构式晤谈法进行。结果 138例患者共完成随访834例次,ICD患者的心理健康状况较差存在心理障碍58例(42.03%),明显高于正常对照组差异具有显著统计学意义,其中以焦虑、惊恐发作、睡眠障碍、适应不良、幻影放电和抑郁为主要表现。本研究表明以SCL-90作为ICD患者是否出现心理障碍的衡量指标,其中以躯体化、焦虑与恐怖是最有意义的预测因子;应用HRSD作为抑郁的评判指标,ICD患者抑郁状态以焦虑/躯体化、绝望感、睡眠障碍、迟缓和认知障碍作为预测指标;应用HAMA作为焦虑的评判指标,ICD患者焦虑状态中精神性与躯体性症状具有同等重要的意义,均是其发生的有力预测因素Objective The study was designed to understand the rate of psychological disturbances in patients with implantable cardioverter defibrillator（ICD）retrospectively,to explore the etiological factors and psychopathogenesis and to evaluate the therapeutic effect of standard educational interventions program and comprehensive therapy likewise called＂combination therapy＂.Methods The study enrolled 138 patients（108 male,30 female,mean age of 65.7 years）,who accepted and received a medical or physical examination after the implantation of ICD CRT-D in The First Affiliated Hospital of Kunming Medical College during May 1998～May 2009.All patients were assessed by life event scale of China（LES）,maladaptation self-rating scale,defense style questionnaire（DSQ）,symptom checklist 90（SCL-90）,social support rating scale（SSRS）,avoidance behaviors of ICD,Hamilton depression rating scale for depression（HRSD） and Hamilton anxiety scale（HAMA）.A part of post-graduates（130persons） in the Kunming Medical College selected as the control group（heath persons） were appraised in the same ways.Both of results were compared after data were collected.ICD recipients were randomly divided into two groups.The one received a set of experimental educational interventions about health and the other one received a series of comprehensive educational interventions related to ICD.Psychological assessment of all operation-patients were executed 1 week before and 1 week,1 month,3 months,6 months and 9months after implantation.Among all patients except operation-patients without shock in the former study,patients who suffered with psychological disturbances accepted a comprehensive therapy likewise called＂combination therapy＂and psychological assessment of such patients were carried out 1 week,2weeks,4weeks,6weeks and 10weeks after treatment.Severity of illness（SI） and global improvement（GI） were thought as index suggesting severity of diseases and therapeutic effect at the same time.Out-patient clin

关 键 词：埋藏式心律转复除颤器 心理障碍 综合治疗 

分 类 号：R541.7[医药卫生—心血管疾病] R749.05[医药卫生—内科学]