冠状动脉旁路移植术患者手术前后抑郁发生情况研究

Depression before and after operation in coronary artery bypass grafting patients

目的观察研究冠状动脉旁路移植(CABG)术患者在术前、术后抑郁发生和变化情况。方法患者分为体外循环下CABG(ONCAB)组和非体外循环下CABG(OPCAB)组,在手术前一周内、术后3个月和术后半年进行Beck抑郁问卷(BDI)的自我测评。结果术前抑郁的发生率为49．2％,其中中重度抑郁为24．6％,在术后有下降,但仍然有26．7％的抑郁存在;术前总分值大于5．77分,呈现抑郁状态,术后有改善,分别为4．12和3．06分;在术后不同时间,抑郁组的评分虽有所减少,但仍相对较高(术后3个月、6个月分别为14．18和12．76,无明显抑郁组为4．07和23．06);术后抑郁组离开原工作岗位者居多(继续工作情况分别为16％和21％,而无明显抑郁组为25％和30％)、心绞痛发生相对较多(术后3个月和6个月分别为12％、15％,无明显抑郁组为5％和24％)、女性比例逐渐增加(术后3个月和6个月分别为23％和27％,无明显抑郁组为16％和18％);OPCAB与ONCAB两组之间比较手术前后抑郁评分差异无统计学意义。结论CABG术患者在术前有不同程度的抑郁存在;手术后抑郁状态随时间延长有明显改善;术前抑郁可能预测患者术后抑郁的发生情况;ONCAB和OPCAB两组之间在术后不同时间点抑郁评分值差异无统计学意义。

Objective To investigate the presence of depression in coronary artery bypass grafting （CABG） patients before and after the operation. Methods A questionnaire survey was conducted among 72 CABG patients, 21 of which, aged 65.30 ＋ 1.15, underwent on-pump coronary artery bypass grafting （ONCAB） and 51 of which, aged 63.70 ＋ 0. 22, underwent off-pump CAB （OPCAB）, using Beck Depression Inventory （BDI） one day before, and 3 and 6 months after the operation. Results Depressive disorders occurred in 49. 2% of the patients preoperatively and 26. 7% of the patients 6 months after the operation. The mean pre-operative BDI score was 5.77, and the post-operative BDI scores 3 and 6 months after operation were 4. 12 and 3.06 respectively. At different pest-operative time points the BDI scores of the depressive group were all lower than those of the non-depressive group, however, there was still a trend of lowering of BDI scores in the latter group. There were more patients who failed to resume their original work and more patients with angina and hypertension in the depression group. The proportion of females after operation was higher in the depression group. There was no significant difference in BDI score between the ONCAB and OPCAB groups both pre- and post-operatively. Conclusion Depression at different degrees exists before CABG and can be improved post-operatively. Pre-operative BDI score is predictor of postoperative psychological outcome.