认知行为干预对老年冠心病患者心理健康与心血管危险因素的影响

Effect of cognitive-behavioral intervention on mental state and quality of life in elderly patients with coronary heart disease

将90例≥65岁伴焦虑、抑郁、吸烟、饮酒、血脂、血压、血糖、体重指数异常的冠心病患者,依就诊顺序随机分为两组（各45例）,分别行常规治疗（对照组）与常规治疗＋认知行为干预（CBT）（CBT组）.治疗1个月后,CBT组的各心身指标除健康状况问卷（SF-36）评分外均优于对照组（P＜0.05或＜0.01）,6个月后SF-36评分（85±16）、症状自评量表评分（104±4）、汉密顿焦虑量表评分（10±4）、汉密顿抑郁量表评分（12±3）、吸烟（0.6±0.2）支/d、饮酒（10.1±2.3）g/d、血压[收缩压（123±11）mm Hg（1 mm Hg=0.133 kPa）、舒张压（77±5）mm Hg]、空腹血糖[（4.2±2.6）mmol/L]、体重指数（22.5±0.5）,均显著优于对照组（P＜0.01）.提示结合CBT能显著提高冠心病患者心身健康和生存质量。

Ninety elderly patients with coronary heart disease were randomly divided into 2 groups：in study group （n = 45） the cognitive-behavioral intervention as well as conventional medical treatment were performed and in control group （ n = 45 ） only conventional treatment was given. Short Form-36 （ SF-36）,symptom checklist 90（SCL-90）, Hamilton anxiety scale（ HAMA）, Hamilton depression scale（ HAMD）were evaluated before and after intervention, the serum total cholesterol （TC）, triglyceride （TG）and body mass index （BMI）were measured, the smoking and drinking behaviors were recorded. After 6-month of intervention the smoking [（0. 6 ± 0. 2）cigarettes/d] and drinking [（10. 1 ± 2. 3）g/d] behaviors, the scores of SF-36 （85 ± 16）, SCL-90 （104 ±4）, HAMA （10 ±4） and HAMD （12 ±3）, the systolic blood pressure [（ 123 ± 11 ） mm Hg （ 1 mm Hg = 0. 133 kPa）], diastolic blood pressure [（77 ± 5 ） mm Hg], the fasting blood glucose [（4. 2 ± 2. 6 ） mmol/L] and BMI （ 22.5 ± 0. 5 ） in study group were significantly improved compared to control group （ P 〈 0. 01 ）. The results indicate that cognitive-behavioral intervention can improve the mental state and quality of life in elderly patients with coronary heart disease.