术前抑郁、焦虑状况与冠状动脉旁路移植术后心血管事件发生的关系

Relationship between Depression,Anxiety and Cardiac Events after Coronary Artery Bypass Grafting

目的:前瞻、序列、对比研究我科行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的患者术后1年抑郁、焦虑的状况以及心血管事件的发生率。方法:2005年10月至2006年8月,以我科连续行择期CABG术的69例患者为对象,分别在术前1周内、术后出院前1天、术后1年使用ZUNG氏抑郁自评量表和焦虑自评量表进行抑郁、焦虑状态评分,同时随访术后1年的心血管事件的发生率。结果:术前24例(34.8%)存在抑郁焦虑状态,出院前33例(47.8%)存在抑郁焦虑状态,术后1年随访时10例(14.5%)存在抑郁焦虑状态。术后1年随访时共有6例(8.7%)患者发生心血管病事件,其中5例再次入院。术前存在抑郁焦虑的患者与不存在抑郁焦虑的患者相比:术后住院时间延长[(19±8)dvs.(16±6)d,P=0.003],容易出现伤口并发症(3/24vs.0/45,P=0.039),出院前和术后12月随访时不良情绪的发生率较高(分别为75%vs.33%,P=0.001;29%vs.7%,P=0.017);随访时存在抑郁焦虑的患者与不存在抑郁焦虑的患者相比:术前和术后发生心律失常更多见(3/10vs.2/59,P=0.019;6/10vs.2/59,P=0.000),术中移植血管桥数量较多[(3.5±0.5)vs.(3.0±0.9),P=0.049],术后住院时间较长[(24±11)天vs.(16±6)天,P=0.001],术前存在抑郁焦虑状态比例较高(7/10vs.3/59,P=0.026),发生心血管事件较多(3/10vs.3/59,P=0.036)。结论:行冠状动脉旁路移植术术前不良情绪会导致术后恢复减慢,而术前不良情绪、病情重、术后随访发生心血管事件可能与术后1年的抑郁焦虑状态有关系,需要引起重视。

Objective： To prospectively investigate the presence of depression, anxiety symptoms and cardiac events after coronary artery bypass grafting （ CABG ） . Methods： Sixty nine patients who received scheduled CABG were selected consecutively and their depression and anxiety symptoms were assessed with the Self-rating Depression Scale （ SDS ） and Self-rating Anxiety Scale （ SAS ） before operation, before discharge and 1 year after operation. And cardiac events were also investigated one year after operation. Results： Twenty four patients （34. 8% ） had depression and/or anxiety symptoms before CABG, 33 patients （47. 8% ） had depression and/or anxiety symptoms before discharge, and 10 patients （ 14. 5% ） had depression and/or anxiety symptoms one year after operation. Six patients （8.7% ） had cardiac events, and 5 patients were redmitted. Depression and anxiety symptoms before operation might lead to prolonged length of stay [ （ 19 ±8） days vs. （ 16 ±6） days, P =0. 003], more wound complications （3/24 vs. 0/45, P=0. 0391, and higher rates of bad emotions before discharge （75% vs. 33%, P =0. 001 ） and one year after operation （ 29% vs. 7%, P = 0. 017 ） . Those patients with depression and/or anxiety symptoms one year after operation （N= 10） had more preoperative arhythmia （3/10 vs. 2/59, P =0. 019） and more postoperative arhythmia （6/10 vs. 2/59; P =0. 000）, more blood vessel grafted [ （3.5 ±0. 5） vs. （3.0 ±0. 9）, P=0. 049], longer stay in hospital [ （24 ± 11 ） days vs. （ 16 ± 6） days, P =0. 001 ） ], higher rate of anxiety before operation （7/10 vs. 3/59, P = 0. 026） and more cardiac events in follow-up （3/10 vs. 3/59, P = 0. 036） . Conclusion： Preoperative bad emotions may delay postoperative recovery. Preoperative bad emotions, serious pathogenetic condition, and cardiac events followed can lead to depression and/or anxiety symptoms one year after operation. Much attention should be paid to this phenomenon.