心理因素对老年弥漫性食管痉挛的影响及抗焦虑抑郁治疗研究  

The effects of psychosomatic factors on elder diffuse esophageal spasm and antianxiety/antidepressant treatment

作　　者：王霞[1] 陈玉龙[2] 王晖[1] 蒋楠[1] 林秀英[1] 张筱凤[1] 

机构地区：[1]杭州市第一人民医院消化内科,浙江杭州310006 [2]郑州大学第一附属医院消化内科,河南郑州450052

出　　处：《实用医院临床杂志》2015年第6期20-23,共4页Practical Journal of Clinical Medicine

摘　　要：目的观察心理因素对老年弥漫性食管痉挛(diffuse esophageal spasm,DES)的影响和抗焦虑抑郁治疗效果。方法采用汉密尔顿焦虑、抑郁量表评估52例老年DES患者和40例健康志愿者的心理状态,食管测压检测食管运动功能。DES患者随机分两组,A组:钙通道阻断剂,B组联合抗焦虑抑郁剂,治疗前后评估食管下段括约肌压力(lower esophageal sphincter,LES)、心理状态和消化道症状。结果 DES患者焦虑抑郁状态评分显著高于健康对照组,80.8%(42/52)的患者存在焦虑抑郁状态,DES患者和对照组LES压力分别为(35.4±16.3)mm Hg和(19.8±9.6)mm Hg(P<0.05),食管收缩幅值分别为(137.3±65.6)mm Hg和(88.4±42.3)mm Hg,DES患者消化道症状主要表现为胸痛(76.9%),吞咽困难(65.4%),呕吐(30.8%)。A组治疗4周总有效率为61.5%,停药2周后有效率为34.6%;B组治疗2周消化道症状即缓解,4周总有效率为84.6%,停药2周后有效率仍为84.6%。两组焦虑抑郁状态和食管测压在治疗4周较治疗前均明显改善(P<0.05),A组停药后2周与治疗前差异无统计学意义,B组停药后2周与治疗前有差异有统计学意义。结论食管压力升高和心理异常在DES发病中起重要作用,抗焦虑抑郁治疗可有效缓解DES症状和焦虑抑郁状态。Objective To investigate the effect of psychosomatic factors on elder diffuse esophageal spasm（ DES） and curative effect of antianxiety/antidepressant treatment. Methods Fifty-two patients and 40 healthy volunteers were studied. Esophageal manometry and psychological testing were performed. The patients with DES were randomly divided into A or B group. The group A was treated with calcium antagonist while the group B was treated with calcium antagonist and antidepressants. The esophageal stress states,psychological states and gastrointestinal symptoms were compared before and after treatment. Results The anxiety depression score in the patients with DES was significantly higher than that in the healthy volunteers. In the DES patients,80. 8%（ 42 /52） had symptoms of anxiety depression. LES pressure in the DES patients and healthy volunteers were 35. 4 ± 16. 3 and 19. 8 ± 9. 6 mm Hg,respectively（ P〈0. 05）. The contraction amplitudes in the DES patients and healthy volunteers were 137. 3 ± 65. 6 and 88. 4 ± 42. 3 mm Hg,respectively. The main symptoms of DES patients were chest pain（ 76. 9%）,dysphagia（ 65. 4%） and vomiting（ 30. 8%）. After treatment for 4weeks,the total effective rate in the group A was 61. 5%,and the rate was 34. 5% after 2 weeks of stopping drug. In the group B,the digestive tract symptoms were immediately relieved after treatment for 2 weeks and the total effective rate was 84. 6% after treatment for4 weeks. The rate was still 84. 6 after 2 weeks of stopping drug. The states of anxiety depression and esophageal pressure were significantly improved after 4 week treatment in the both groups（ P〈0. 05）. There was no obvious difference in the situation in the group A between 2 weeks of stopping drug and before treatment. However,there was significant different in the situation in the group B between2 weeks of stopping drug and before treatment. Conclusion The increased esophageal pressure and psychological abnormality play an important role in the DES episode. Psychos

关 键 词：弥漫性食管痉挛 心理因素 焦虑 抑郁 

分 类 号：R749.72[医药卫生—神经病学与精神病学] R571.2[医药卫生—临床医学]