急性心肌梗死病人情感障碍的调查
作者：刘虹 徐庆科 管军 徐莉
单位：刘虹(青岛市人民医院心内科 青岛 266001)；徐庆科(青岛大学医学院附属医院心内科)；管军(青岛市人民医院心内科 青岛 266001)；徐莉(青岛市人民医院心内科 青岛 266001)
关键词：心肌梗死；抑郁症；心理疗法
齐鲁医学杂志000310 [摘要] ①目的 探讨情感障碍对急性心肌梗死(AMI)病人的影响。②方法 根据抑郁自评量表(SDS)评分,把147例AMI病人分为伴有抑郁症组和不伴有抑郁症组;伴有抑郁症组病人再随机分为治疗组和对照组,对治疗组进行干预治疗,治疗前后分别进行SDS评分,对照组不进行心理干预治疗。③结果 147例AMI病人中伴有抑郁症者57例,占38.1%;伴有抑郁症的AMI病人病死率为12.5%,明显高于不伴有抑郁症的病人(2.2%)，差异有显著性(χ2=5.58,P<0.05);通过对伴有抑郁症组进行心理及药物干预治疗,明显降低了AMI的病死率。④结论应高度重视AMI后的情感障碍,及早进行心理疏导和药物干预,降低病死率。
, 百拇医药
[中图分类号] R395.1 [文献标识码] A [文章编号] 1008-0341(2000)03-0179-02
EMOTIONAL DISORDER OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
LIU Hong, XU Qingke, GUAN Jun, et al
Department of Cardiology, Peoples Hospital of Qingdao, Qingdao 266001
[ABSTRACT] Objective This study was designed to investigate the mood disorder of 147 patients with acute myocardial infarction (AMI). Methods The AMI patients were divided into depression group and without depression group by self depression scale(SDS). The patients with depression were divided into two groups by random, the control and treatment group. The treatment group was scored by SDS before and after treatment. The control group was not treated. Results Fifty-seven (38.1%) patients with depression, the death rate was 12.5% and significantly higher than that of the patients without depression(χ2=5.58,P<0.05). The death rate of AMI with depression significantly decreased by using psychotherapy and drug treatment. Conclusion There are many AMI patients with depression. A clinician should pay great attention to mood disorder of AMI patients and apply psychotherapy and drug as soon as possible to decrease the death rate.
, 百拇医药
[KEY WORDS] myocardial infarction; depression; psychotherapy
抑郁症是急性心肌梗死(AMI)后的常见问题,也是决定预后的重要因素之一[1,2]。我们对147例AMI病人情感障碍进行了调查,以探讨情感障碍对AMI病人的影响,现将结果报告如下。
1 资料和方法
1.1 对象和分组
AMI病人147例,男92例,女55例;年龄48～71岁,平均(60.0±5.7)岁。均为住院病人,心电图和心肌酶谱变化均符合AMI标准。既往伴高血压36例,糖尿病18例,住院30d中伴发缺血性脑卒中9例。梗死部位:下壁66例(其中3例伴正后壁梗死,15例伴右室梗死),前壁72例,高侧壁9例,有15例为再发梗死。治疗遵从AMI一般治疗原则,有并发症者对症治疗。AMI病人入院后30d内在病情稳定后用抑郁自评量表(SDS)进行测定,按其评分结果分为两组,AMI不伴有抑郁症组和伴有抑郁症组。将AMI伴有抑郁症组病人再随机分为治疗组和对照组。
, 百拇医药
1.2 治疗方法
治疗组病人由专职精神科医生进行干预,其内容包括心理疏导配合抗抑郁药物(赛乐特、百忧解等)治疗,干预治疗前及干预治疗后分别进行SDS评分。对照组未进行心理干预治疗。
2 结 果
147例AMI病人入院30d内SDS评分结果表明,不伴有抑郁症病人91例,住院30d内死亡2例,病死率为2.2%,其中1例死于心室颤动,1例死于高度房室传导阻滞;伴有抑郁症者56例,占38.1%,有7例在住院30d内死亡,其中3例死于心室颤动,1例死于高度房室传导阻滞,2例死于心力衰竭,1例死于心脏破裂。AMI伴有抑郁症病人病死率为12.5%,明显高于不伴有抑郁症者(χ2=5.58,P<0.05)。治疗组28例病人进行干预治疗前后SDS评分分别为56.25±9.14和35.35±5.39(t=10.45,P<0.01),对照组SDS评分分别为52.27±6.11和49.05±7.21(t=1.89,P>0.05).对照组28例病人住院期间死亡6例,病死率为21.4%;而治疗组28例病人仅有1例死亡,病死率为3.6%,明显低于对照组(χ2=4.08,P<0.05),与AMI不伴有抑郁症病人的病死率接近。
, 百拇医药
3 讨 论
AMI是心血管疾病中最严重的疾病之一,是威胁人类健康的大敌。情感障碍是干扰和阻碍AMI病人康复并影响其生活质量最常见和最严重的伴发症之一[3,4]。我们的研究发现,AMI后伴发抑郁症病人较AMI不伴有抑郁症者病死率明显增高。原因可能为:①抑郁症病人遵医嘱率显著低于非抑郁症病人;②抑郁症病人对慢性心脏疾病的应对机制不良;③抑郁症病人恶性室性心律失常的发生率高;④在心电图显示心肌缺血程度相同的情况下,抑郁症病人更易体验到心绞痛,且持续时间延长,这可能与抑郁症病人体内β-内啡肽反应迟钝或缺如有关[5]。AMI后伴发抑郁症的早期诊断和心理干预治疗可以降低病死率,本文结果表明，AMI后伴发抑郁症病人经心理干预治疗后的病死率接近于AMI后不伴发抑郁症病人的病死率。抑郁症病因的多样性解释,反映了医学模式的生物-心理-社会导向,但更为迫切的关注焦点是抑郁症的症状识别、早期诊断和及早的心理干预治疗。故心内科医生应重视AMI后的情感障碍,将其提高到与躯体症状同等重要的地位,及早进行心理疏导和药物干预,以减少病人的痛苦,降低病死率。
, 百拇医药
作者简介 刘虹,女,1965年9月生，主治医师
参考文献
1，Aromaa A,Raitasalo R,Impivaara O, et al.Depression and cardiovascular diseases[J]. Acta Psychiatr Scand,1994,377(Suppl):77
2，Wasserthiel-Smoller S, Applegate WB, Berge K, et al. Change in depression as a precursor of cardiovascular events: SHEP Cooperative Research Group (systolic hypertension in the elderly)[J]. Arch Intern Med,1996,156(5):553
, 百拇医药
3，Carney RM,Saunders RD,Freedland KE, et al. Association of depression with reduced heart rate variability in coronary artery disease[J]. Am J Cadiol, 1995,76(8):562
4，Carney RM, Freedland KE, Eisen SA, et al. Major depression and medication adherence in elderly patients with coronary artery disease[J].Health Psychol, 1995,14(1):88
5，Ladwig KH,Roll G,Breithardt G, et al.Post-infarction depression and incomplete recovery 6 months after acute myocadial infarction[J]. Lancet, 1994,343(888):20
(2000-03-06收稿 2000-06-05修回), http://www.100md.com
单位：刘虹(青岛市人民医院心内科 青岛 266001)；徐庆科(青岛大学医学院附属医院心内科)；管军(青岛市人民医院心内科 青岛 266001)；徐莉(青岛市人民医院心内科 青岛 266001)
关键词：心肌梗死；抑郁症；心理疗法
齐鲁医学杂志000310 [摘要] ①目的 探讨情感障碍对急性心肌梗死(AMI)病人的影响。②方法 根据抑郁自评量表(SDS)评分,把147例AMI病人分为伴有抑郁症组和不伴有抑郁症组;伴有抑郁症组病人再随机分为治疗组和对照组,对治疗组进行干预治疗,治疗前后分别进行SDS评分,对照组不进行心理干预治疗。③结果 147例AMI病人中伴有抑郁症者57例,占38.1%;伴有抑郁症的AMI病人病死率为12.5%,明显高于不伴有抑郁症的病人(2.2%)，差异有显著性(χ2=5.58,P<0.05);通过对伴有抑郁症组进行心理及药物干预治疗,明显降低了AMI的病死率。④结论应高度重视AMI后的情感障碍,及早进行心理疏导和药物干预,降低病死率。
, 百拇医药
[中图分类号] R395.1 [文献标识码] A [文章编号] 1008-0341(2000)03-0179-02
EMOTIONAL DISORDER OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
LIU Hong, XU Qingke, GUAN Jun, et al
Department of Cardiology, Peoples Hospital of Qingdao, Qingdao 266001
[ABSTRACT] Objective This study was designed to investigate the mood disorder of 147 patients with acute myocardial infarction (AMI). Methods The AMI patients were divided into depression group and without depression group by self depression scale(SDS). The patients with depression were divided into two groups by random, the control and treatment group. The treatment group was scored by SDS before and after treatment. The control group was not treated. Results Fifty-seven (38.1%) patients with depression, the death rate was 12.5% and significantly higher than that of the patients without depression(χ2=5.58,P<0.05). The death rate of AMI with depression significantly decreased by using psychotherapy and drug treatment. Conclusion There are many AMI patients with depression. A clinician should pay great attention to mood disorder of AMI patients and apply psychotherapy and drug as soon as possible to decrease the death rate.
, 百拇医药
[KEY WORDS] myocardial infarction; depression; psychotherapy
抑郁症是急性心肌梗死(AMI)后的常见问题,也是决定预后的重要因素之一[1,2]。我们对147例AMI病人情感障碍进行了调查,以探讨情感障碍对AMI病人的影响,现将结果报告如下。
1 资料和方法
1.1 对象和分组
AMI病人147例,男92例,女55例;年龄48～71岁,平均(60.0±5.7)岁。均为住院病人,心电图和心肌酶谱变化均符合AMI标准。既往伴高血压36例,糖尿病18例,住院30d中伴发缺血性脑卒中9例。梗死部位:下壁66例(其中3例伴正后壁梗死,15例伴右室梗死),前壁72例,高侧壁9例,有15例为再发梗死。治疗遵从AMI一般治疗原则,有并发症者对症治疗。AMI病人入院后30d内在病情稳定后用抑郁自评量表(SDS)进行测定,按其评分结果分为两组,AMI不伴有抑郁症组和伴有抑郁症组。将AMI伴有抑郁症组病人再随机分为治疗组和对照组。
, 百拇医药
1.2 治疗方法
治疗组病人由专职精神科医生进行干预,其内容包括心理疏导配合抗抑郁药物(赛乐特、百忧解等)治疗,干预治疗前及干预治疗后分别进行SDS评分。对照组未进行心理干预治疗。
2 结 果
147例AMI病人入院30d内SDS评分结果表明,不伴有抑郁症病人91例,住院30d内死亡2例,病死率为2.2%,其中1例死于心室颤动,1例死于高度房室传导阻滞;伴有抑郁症者56例,占38.1%,有7例在住院30d内死亡,其中3例死于心室颤动,1例死于高度房室传导阻滞,2例死于心力衰竭,1例死于心脏破裂。AMI伴有抑郁症病人病死率为12.5%,明显高于不伴有抑郁症者(χ2=5.58,P<0.05)。治疗组28例病人进行干预治疗前后SDS评分分别为56.25±9.14和35.35±5.39(t=10.45,P<0.01),对照组SDS评分分别为52.27±6.11和49.05±7.21(t=1.89,P>0.05).对照组28例病人住院期间死亡6例,病死率为21.4%;而治疗组28例病人仅有1例死亡,病死率为3.6%,明显低于对照组(χ2=4.08,P<0.05),与AMI不伴有抑郁症病人的病死率接近。
, 百拇医药
3 讨 论
AMI是心血管疾病中最严重的疾病之一,是威胁人类健康的大敌。情感障碍是干扰和阻碍AMI病人康复并影响其生活质量最常见和最严重的伴发症之一[3,4]。我们的研究发现,AMI后伴发抑郁症病人较AMI不伴有抑郁症者病死率明显增高。原因可能为:①抑郁症病人遵医嘱率显著低于非抑郁症病人;②抑郁症病人对慢性心脏疾病的应对机制不良;③抑郁症病人恶性室性心律失常的发生率高;④在心电图显示心肌缺血程度相同的情况下,抑郁症病人更易体验到心绞痛,且持续时间延长,这可能与抑郁症病人体内β-内啡肽反应迟钝或缺如有关[5]。AMI后伴发抑郁症的早期诊断和心理干预治疗可以降低病死率,本文结果表明，AMI后伴发抑郁症病人经心理干预治疗后的病死率接近于AMI后不伴发抑郁症病人的病死率。抑郁症病因的多样性解释,反映了医学模式的生物-心理-社会导向,但更为迫切的关注焦点是抑郁症的症状识别、早期诊断和及早的心理干预治疗。故心内科医生应重视AMI后的情感障碍,将其提高到与躯体症状同等重要的地位,及早进行心理疏导和药物干预,以减少病人的痛苦,降低病死率。
, 百拇医药
作者简介 刘虹,女,1965年9月生，主治医师
参考文献
1，Aromaa A,Raitasalo R,Impivaara O, et al.Depression and cardiovascular diseases[J]. Acta Psychiatr Scand,1994,377(Suppl):77
2，Wasserthiel-Smoller S, Applegate WB, Berge K, et al. Change in depression as a precursor of cardiovascular events: SHEP Cooperative Research Group (systolic hypertension in the elderly)[J]. Arch Intern Med,1996,156(5):553
, 百拇医药
3，Carney RM,Saunders RD,Freedland KE, et al. Association of depression with reduced heart rate variability in coronary artery disease[J]. Am J Cadiol, 1995,76(8):562
4，Carney RM, Freedland KE, Eisen SA, et al. Major depression and medication adherence in elderly patients with coronary artery disease[J].Health Psychol, 1995,14(1):88
5，Ladwig KH,Roll G,Breithardt G, et al.Post-infarction depression and incomplete recovery 6 months after acute myocadial infarction[J]. Lancet, 1994,343(888):20
(2000-03-06收稿 2000-06-05修回), http://www.100md.com