心理疏导对扩张型心肌病合并心力衰竭伴焦虑抑郁患者的影响  

Influence of psychological counseling on DCM patients with HF complicated anxiety and depression

作　　者：李靖[1] 钱茜[1] 秦娴[2] 陈英[2] 杨军[2] LI Jing;QIAN Xi;QIN Xian;CHEN Ying;YANG Jun(Department of Nursing,Second People′s Hospital of Wuxi City,Wuxi,Jiangsu,214002,China)

机构地区：[1]无锡市第二人民医院护理部,江苏无锡214002 [2]无锡市第二人民医院心内科,江苏无锡214002

出　　处：《心血管康复医学杂志》2021年第3期251-254,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究心理疏导对扩张型心肌病(DCM)合并心力衰竭(HF)伴焦虑抑郁患者的疗效。方法:126例DCM合并HF(NYHA分级II-IV级)伴焦虑抑郁患者被随机均分为常规治疗组和心理疏导组(在常规治疗组基础上加用心理疏导)。观察比较两组入院与出院时的汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、左房内径(LAD)、左室舒张末期(LVEDd)、LVEF、血清NT-proBNP水平、平均住院时间、HF治疗总有效率和死亡率。结果:与常规治疗组比较,心理疏导组总有效率(77.7%比93.4%)显著升高,P=0.011;与常规治疗组出院时比较,心理疏导组出院时HAMA评分[(19.3±1.6)分比(12.8±1.1)分]、HAMD评分[(19.7±2.6)分比(12.2±2.9)分]、LVEDd[(72.50±6.08)mm比(68.75±6.44)mm]、血清NT-proBNP[(1921.7±218.5)mg/dl比(1538.2±239.3)mg/dl]和平均住院时间[(11.6±2.8)d比(9.2±2.5)d]均显著降低,LVEF[(30.77±3.56)%比(34.18±5.98)%]显著升高,P均<0.01。两组死亡率无显著差异,P=0.676。结论:心理疏导结合常规抗心衰药物治疗能够显著抑制扩张型心肌病患者神经内分泌的过度激活,逆转心室重构,改善心功能,疗效显著优于单纯常规药物治疗。Objective:To study therapeutic effect of psychological counseling(PC)on patients with dilated cardiomyopathy(DCM)complicated heart failure(HF),anxiety and depression.Methods:A total of 126 DCM patients with HF(NYHA class II~IV),anxiety and depression were randomly and equally divided into routine treatment group and PC group(received PC based on routine treatment group).Scores of Hamilton rating scale for anxiety(HAMA),Hamilton rating scale for depression(HAMD),left atrial diameter(LAD),left ventricular end-diastolic dimension(LVEDd),LVEF and serum level of N terminal pro brain natriuretic peptide(NT-proBNP)at admission and discharge,mean hospital stay,total effective rate of HF and HF mortality were observed and compared between two groups.Results:Compared with routine treatment group,total effective rate of PC group(77.7%vs.93.4%)significantly rose in PC group,P=0.011;Compared with routine treatment group at discharge,there were significant reductions in scores of HAMA[(19.3±1.6)scores vs.(12.8±1.1)scores],HAMD[(19.7±2.6)scores vs.(12.2±2.9)scores],LVEDd[(72.50±6.08)mm vs.(68.75±6.44)mm],serum NT-proBNP level[(1921.7±218.5)mg/dl vs.(1538.2±239.3)mg/dl]and mean hospital stay[(11.6±2.8)d vs.(9.2±2.5)d],and significant rise in LVEF[(30.77±3.56)%vs.(34.18±5.98)%]in PC group,P<0.01 all.There was no significant difference in mortality between two groups,P=0.676.Conclusion:Psychological counseling combined routine anti-HF drugs can significantly inhibit overactivation of neuroendocrine,reverse ventricular remodeling,improve cardiac function in DCM patients.And the therapeutic effect is significantly better than that of routine pure medication.

关 键 词：心肌病 扩张型 焦虑 抑郁 

分 类 号：R542.209[医药卫生—心血管疾病]