自体骨髓干细胞移植治疗心肌梗死患者心理状态调查分析

Mental status of myocardial infarction patients undergoing autologous bone marrow stem cell transplantation

目的:当前自体骨髓干细胞移植治疗心肌梗死技术进展很快,但对于患者的心理问题关注不足,无法准确评估患者围手术期的应激程度。文章调查采用自体骨髓干细胞移植治疗心肌梗死患者的心理状况。方法:抽取急性心肌梗死患者41例,均行经皮冠状动脉介入治疗+标准药物治疗+经冠脉注入自体骨髓单个核细胞治疗。对41例患者进行心理问题调查,用症状自评量表SCL-90和社会支持评定量表对患者进行问卷调查,并与国内常模进行比较。SCL-90量表每个症状的评分计1～5级,1级没有症状,5级极严重;社会支持评定量表评分越高,社会支持越高。分析影响患者的心理健康因素、心理健康水平与社会支持的相关性。结果:自体骨髓干细胞移植患者SCL-90量表的9项因子中,躯体化、强迫、焦虑、敌对性、恐怖、精神病性6项指标评分均高于国内常模(P<0.01);人际关系敏感、抑郁评分低于国内常模(P<0.01);惟有偏执评分与常模差异无显著性意义(P>0.05)。41例自体骨髓干细胞移植心肌梗死患者的社会支持评分为25.32～45.52分,平均(36.92±8.91)分。将社会支持评分高于36.92分的23例患者设定为高社会支持得分组,低于36.92分的18例设定为低社会支持得分组,低社会支持得分组患者的躯体化、强迫、人际关系、抑郁、焦虑、恐怖、偏执等症状因子评分明显高于高社会支持得分组(P均<0.05)。结论:采用干细胞移植的心肌梗死患者常常存在明显的心理问题,表现为不同程度的抑郁、焦虑等身心症状。在进行躯体疾病治疗的同时,应配合以疏导为主的心理治疗,消除不良心理因素的影响。

OBJECTIVE： The technique of myocardial infarction treated by autologous bone marrow stem cell transplantation develops rapidly presently, but medical staffs usually pay little attention to patients＇ psychosomatic disorder status and cannot judge the stress extent around the period of operations exactly. This study served to investigate the psychosomatic disorder status of patients with myocardial infarction treated by autologous bone marrow stem cell transplantation. METHODS： A total of 41 patients with acute myocardial infarction, who had been subjected to percutaneous coronary intervention ＋ standard medication ＋ autologous bone marrow stem cell transplantation through coronary artery, were selected. The psychosomatic disorder status of the 41 patients was investigated using questionnaires of symptom checklist-90 （SCL-90） and social support rate scale （SSRS）, and compared with national norm. Every symptom of SCL-90 scale contained 1-5 grades： grade 1 represented no symptom, and grade 5 indicated severe symptom. As for the SSRS, the higher score suggested a high social support. The correlation of mental health and mental health status that influenced patients to social support was analyzed. RESULTS： Among the 9 factors of SCL-90, the scores of somatization, compulsion, anxiety, hostility, consternation and psychiatric state were higher, but interpersonal relation sensitivity, depression were lower in patients compared with national norms （P 〈 0.01）. No significant difference in paranoia was found between patients and norms （P 〉 0.05）. The score of social support was （25.32-45.52） points, averagely （36.92±8.91） points. Patients having above 36.92 points of social support served as a high social support group （n=23）, and those having below 36.92 points as a low social support group （n=18）. The scores of somatization, compulsion, interpersonal relation, depression, anxiety, consternation and paranoia were significantly greater in the low social support group than in the high social support group （P〈 0.05）. CONCLUSION： Patients with myocardial infarction treated by autologous bone marrow stem cell transplantation often have mental disorders, with the presence of depression and anxiety. Doctors should treat patients＇ not only physical illness but also mental disorders, so as to remove the influence of adverse mental factors on health.