冠心病患者经皮冠状动脉介入术后焦虑及抑郁情绪心理干预的研究

Psychological intervention of anxiety and depression in CHD patients with PCI

目的探讨心理干预对冠心病经皮冠状动脉介入(PCI)术后合并焦虑抑郁情绪的患者反复疑病就医和主要心脏事件(MACE)发生率的影响。方法将2005年1月至2007年5月在河北省沧州市中心医院心内科住院行PCI术后合并焦虑抑郁情绪的患者210例[约占同期PCI术患者的29.8%(210/704)],随机分为对照组(98例)和心理治疗组(112例)进行对照研究,对治疗组进行系统规范的强化性心理干预2个月,比较两组2个月前后心理评估分数的变化。并对两组患者同时随访观察6个月至2.5年,观察两组患者临床疑病就医率和MACE事件发生率的差异性;随访阶段治疗组心理辅导不间断,以维持巩固治疗组患者的心理健康状态。结果PCI术后2个月治疗组患者经过强化性心理干预后,心理评估分数明显低于对照组(焦虑41.13±4.15比51.71±4.18,抑郁45.04±4.12比56.88±4.01,P<0.04);术后随访6个月至2.5年,治疗组临床疑病就医率显著低于对照组(45.56%比79.51%,P<0.01),MACE发生率明显低于对照组(11.60%比20.41%,P<0.05)。结论心理干预能有效地纠正负性情绪,使PCI术后患者反复疑病就医率和MACE发生率明显降低。如果能够大规模对PCI术后患者进行心理干预,将大大减少这些患者的疑病就医和MACE发生,从而减少其不必要的医疗费用,以有效地使用医疗资源。

Objective To explore the effect of psychological intervention of repeatedly hypochondriacal hospitalization and the occurrences of MACE in patients with anxiety and depression after percutaneous coronary intervention （PCI）. Methods Two hundred and ten patients [ who are 29. 8% share in the totally Post-PCI patients in the same phase （210/704）] with coronary heart disease （CHD） who were treated with PCI from January 2005 to May 2007 were randomly divided into the control group （ n = 98 ） and the psychological intervention group （n = 112）. Patients in the psychological intervention group underwent standard systemic psychological intervention. Psychological evaluation was perfol^ned for both groups 2 month after PCI. In order to enhance patients＇psychological status, patients in the intervention group continued to receive psychological intervention during follow up visits which lasted between 0. 5 to 2. 5 years. The difference in hypochondriacal hospital visit rate and the occurrence of MACE were also studied during the follow-up. Results After standard systematic psychological intervention for 2 months after PCI, the psychological evaluation scores of patients in the intervention group was significantly lower than those in the control group and （ P 〈 0. 04 ） their post-PCI clinical events rate was also lower then that of the control during follow-up （P 〈 0. 01 ）. The MACE rate in the psychological intervention group was significantly lower than that of the control （ P 〈 0. 05 ）. Conclusions Psychological intervention can effectively reduce post-PCI negative mood which can decrease the incidence of repeatedly hypochondriacal hospital visit rate and the incidence of MACE. Effective psychological intervention can not only reduce unnecessary hospitalization expense, but also can free up limited hospital resources for more urgent medical needs.