急性心肌梗死合并抑郁情绪患者治疗依从性分析

Analysis of therapeutic adherence of acute myocardial infarction patients combined with depression

目的：明确合并抑郁状态是否影响心肌梗死患者对改善其预后的医疗干预的顺应性.方法：入选我院2004-03/2007-02因急性心肌梗死住院的病例,在住院期间进行宣教,建议所有患者7~10项医疗干预措施,在心肌梗死后3~5 d使用Beck抑郁自评量表（BDI）的13项版本评估患者是否合并抑郁状态及其程度.对出院后存活的患者在急性心肌梗死后6 mo（n=132,男性78例）进行门诊或电话随访,使用治疗结果特异依从性研究积分（MOSSAS）的评分,让患者对7~10项医疗干预措施的坚持情况进行自我评分.结果：住院期间合并至少轻-中度抑郁状态的心肌梗死患者[BDI≥5,n=27（20.5%）]在随访期间能够坚持低脂饮食、缓减压力、按医嘱服药和获得社会支持的较少.而合并抑郁状态的糖尿病患者在饮食控制方面也较无抑郁状态的糖尿病患者差.结论：AMI后合并抑郁状态的患者对有利于改善预后的医疗干预的依从性较差.此结果可部分解释住院期间合并抑郁状态的心肌梗死患者的远期预后较差.

AIM：To medical interventions of reducing cardiac risk in patients after acute myocardial infarction（AMI）.METHODS：All AMI patients during 3 years（2004.3-2007.2） in our hospital were made clear about the advantages of medical interventions to reduce cardiac risk and were recommended to take 7-10 interventions.Three to five days after AMI,these patients were interviewed using the Beck Depression Inventory（BDI）-13 to assess symptoms of depression.Accessible survivors（n=132;78 men） were interviewed in out-patient department or by telephone 6 months later using the Medical Outcomes Study Specific Adherence Scale（MOSSAS） to measure self-reported adherence to the recommended medical interventions.RESULTS：Patients who were found in the hospital to have symptoms of at least mild to moderate depression [BDI-13 score≥5,n=27（20.5%）] reported lower adherence to low-fat diet,reducing stress,taking medications as prescribed,and obtaining social support 6 months later.Diabetic patients with depression were less likely to follow a diabetic diet than those without depression.CONCLUSION：Patients with depression following AMI are less likely to adhere to recommended medical interventions intender to reduce the risk of subsequent cardiac events.This finding could explain why depression in the hospital is related to poor long-term prognosis in patients after AMI.