认知行为治疗对急性心肌梗死介入手术病人焦虑与抑郁及心率变异性的影响  

EFFECTS OF COGNITIVE BEHAVIORAL THERAPY ON ANXIETY,DEPRESSION AND HEART RATE VARIABILITY IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR ACUTE MYOCADIAL INFARCTION

作　　者：林雪竹[1] 刘桂芝[2] 周杰[3] 

机构地区：[1]青岛大学护理学院,山东青岛266021 [2]青岛大学附属医院质量管理评价部 [3]青岛大学附属医院预防保健科

出　　处：《齐鲁医学杂志》2016年第4期481-483,485,共4页Medical Journal of Qilu

基　　金：青岛市科技发展计划项目(Kzd-07)

摘　　要：目的探讨认知行为治疗对急性心肌梗死介入手术病人情感异常及心率变异性的影响及临床意义。方法拟行介入手术治疗的急性心肌梗死住院病人78例,随机分为观察组和对照组,各39例。两组均给予常规治疗护理,在此基础上,对照组给予病人一般心理护理,观察组根据认知行为治疗方法给予病人个体化的心理护理,出院后4周观察两组病人的焦虑抑郁评分和心率变异性指标的变化情况。结果入院时,两组病人焦虑、抑郁评分及心率变异性各指标差异无统计学意义（P〉0.05）。出院后4周,两组焦虑、抑郁得分与入院时比较,差异有统计学意义（t=5.20~23.80,P〈0.01）;两组心率变异性指标与入院时比较,差异亦有显著性（t=-27.20~17.50,P〈0.01）;观察组焦虑抑郁评分显著低于对照组（t=10.51、7.15,P〈0.01）,心率变异性指标中的低频（LF）显著低于对照组,NN间期标准差（SDNN）、RR间期平均值标准差（rMSSD）、相邻NN之差〉50ms的个数占总窦性心搏个数的百分比（PNN50）、高频（HF）指标显著高于对照组,差异有显著性（t=-20.60~15.30,P〈0.01）。结论对急性心肌梗死介入手术病人进行系统的认知行为治疗,可以有效改善病人焦虑、抑郁情绪以及心率变异性。Objective To assess the effects of cognitive behavioral therapy on anxiety,depression and heart rate variability（HRV）and its clinical value in patients with acute myocardial infarction（AMI）undergoing percutaneous coronary intervention（PCI）. Methods A total of 78 AMI patients scheduled for PCI were evenly randomized to observation group and control group.Conventional therapy and nursing were offered to patients in both groups,and moreover,those in the observation group were given individualized mental nursing based on cognitive behavioral therapy.Four weeks after discharge,the scores of anxiety,depression and heart rate variability index were observed. Results On admission,the differences in scores of anxiety,depression,and heart rate variability index between the two groups were not statistically significant（P〉0.05）.Four weeks after discharge,the diffe-rences in scores of anxiety and depression were significant compared with that on admission in both groups（t=5.20-23.80,P〈0.01）,and HRV index showed significant differences as well（t=-27.20-17.50,P〈0.01）.Compared with the control group,the scores of anxiety and depression were significantly lower in the observation group（t=10.51,7.15;P〈0.01）,and the LF index of heart rate variability was significantly lower,whereas the SDNN,rMSSD,PNN50,and HF index were significantly higher（t=-20.60-15.30;P〈0.01）. ConclusionSystemic cognitive behavioral therapy,for patients with acute myocardial infarction undergoing percutaneous coronary intervention,can effectively improve patients＇ anxiety,depression and heart rate variability.

关 键 词：认知行为治疗 急性心肌梗死 心率变异性 焦虑 抑郁 

分 类 号：R473.5[医药卫生—护理学]