住院冠心病患者出院后的心理状况变化

Changes of psychological status after discharge in hospitalized patients with coronary artery disease

目的观察住院冠心病患者出院后焦虑和抑郁状况的动态变化。方法入选2007~2009年住院并经冠状动脉造影（CAG）确诊的冠心病患者1116例,在CAG或支架植入后2 d内选用Zung焦虑自评量表（SAS）和Zung抑郁自评量表（SDS）对入选患者进行心理测评。在患者出院后1年通知其门诊回访,再次进行SAS和SDS量表的测评。结果共有361例（32.3%）患者接受了门诊随访,收回有效问卷361份。平均随访时期为患者出院后（14.8±4.3）个月。回访时患者SAS、SDS标准分显著低于其住院时的基线值（P〈0.01）,但仍显著高于国内标准常模分值（P〈0.01）。焦虑和抑郁的症状患病率显著低于住院时各自的症状患病率（P〈0.01）,其严重程度也较住院时显著下降。女性患者、心肌梗死患者回访时的焦虑和抑郁症状患病率与住院时无显著差异。基线SDS评分、既往心肌梗死史与门诊随访依从性负相关。结论国人住院冠心病患者出院后1年焦虑和抑郁状况显著改善,但仍未恢复至正常人群水平;女性患者和心肌梗死患者在出院后1年焦虑和抑郁状况无显著改善。

Objective To explore the dynamic changes of psychological status after discharge in hospitalized patients with coronary artery disease（CAD）.Methods Between 2007 and 2009,1116 hospitalized patients with CAD diagnosed by coronary angiography（CAG） were recruited.The psychological status was investigated within 2 days after CAG or percutaneous coronary intervention（PCI） using Zung self-rating anxiety scale（SAS） and Zung self-rating depression scale（SDS）.One year after discharge,the subjects were called back to receive another SAS and SDS examination at the outpatient clinic.Results A total of 361（32.3%） patients were followed-up within（14.8±4.3）months after discharge and 361 effective questionnaires were obtained.SAS and SDS scores of the followed-up patients decreased significantly compared with those during hospitalization（P0.01）,which remained to be higher than those of the standardized SAS and SDS models（P0.01）.The incidence of anxiety and depression symptoms also significantly decreased compared with the baseline（P0.01）.The severity of anxiety and depression symptoms was significantly decreased as well.However,the incidence of anxiety and depression symptoms was not significantly different between during hospitalization and after discharge in female and the patients with myocardial infarction.The baseline SDS score and past medical history of myocardial infarction（MI） were negatively correlated with the follow-up compliance.Conclusion The anxiety and depression conditions of the hospitalized CAD patients are significantly improved one year after discharge,but which are still higher than those of Chinese standardized criteria.The anxiety and depression symptoms of female and MI patients at one year after discharge remained to be similar to those during hospitalization.