心脏早搏患者伴焦虑抑郁的治疗及其对生活质量的影响

The treatment and quality of life in premature beats patients with anxiety and depression symptoms

目的观察评价无器质性心脏早搏患者焦虑抑郁情况及抗抑郁药物治疗及其对患者生活质量的影响。方法无器质性心脏早搏伴焦虑抑郁患者212例完全随机分为观察组和对照组，各106例，2组均给予美托洛尔，每次25—50mg，2次／d。观察组同时给予氟西汀20～40mg，1次／d（72例）或氟哌噻吨美利曲辛（34例），1片／次，早晨及中午各服1次，疗程2个月。治疗前后分别观察2组临床症状、心电图及焦虑自评量表（SAS）和抑郁自评量表（SDS）评分的变化，并采用“中国心血管病人生活质量评定问卷”进行生活质量评估。结果观察组SAS、SDS评分治疗后与治疗前比较，差异有统计学意义[SAS：（39±9）分比（52±10）分；SDS：（39±10）分比（58士11）分；P〈0．01]，而对照组治疗前后比较差异无统计学意义（P〉0．05）；观察组治疗后的SAS、SDS评分与对照组治疗后比较，差异有统计学意义[SAS：。（39±9）分比（534-10）分；SDS：（39±10）分比（58±9）分；P〈0．01]。对照组治疗后心悸、胸闷、气促、胸痛症状的改善率分别为30．2％（32／106）、42．6％（43／101）、46．O％（23／50）、48．6％（17／35），观察组改善率分别为84．9％（90／106）、95．9％（93／97）、96．4％（53／55）、92。l％（35／38），2组比较差异均有统计学意义（均P〈0．01）。观察组心脏早搏的临床疗效为84．0％（89／106），亦明显高于对照组的53．8％（57／106）。观察组“中国心血管病人生活质量评定问卷”的得分与对照组比较，差异有统计学意义（P〈0．01）。结论心脏早搏患者伴有焦虑抑郁障碍，应用抗焦虑抑郁药物治疗能有效缓解患者的临床症状、减少早搏的发生，同时能够改善患者的生活质量。

Objective To observe and assess the psychological disorders such as anxiety and depression in arrhythmic patients without organic heart disease as well as clinical efficacy and the quality of life with pharmacother apy using antidepressants. Methods Two hundred and twelve patients with premature beats but without organic heart disease were randomly assigned to the observation group and control group with 106 patients in each group. All the patients were given with metoprolol and fluxetine or deanxit and metoprolol separately. The clinical signs,electro cardiograph （ ECG）, dynamic electrocardiogram （ DCG）, selfrating anxiety scale （SAS） and Self rating Depres sion Scale（SDS）score were observed before treatment and 2 months after treatment. The Evaluation of Chinese ques tionnaire of quality of life in patients with cardiovascular disease was adopted to evaluate patients＇ quality of life. Results Compared to pre treatment,the observation group＇s SAS, SDS score decreased significantly[ SAS： （39 ± 9） vs （52 ± 10） ;SDS： （39 ±10） vs （58± 11 ） ;P 〈 0. 01 ], however there were no significant changes in control group （P 〉0. 05）. Compared with control group, the observation group＇s SAS, SDS score decreased significantly [ SAS ： （39 ± 9） vs （53 ± 10） ; SDS： （ 39 ± 10） vs （58 ± 9） ; P 〈 0. 01 ]. The clinical improvement rate of observa tion group＇s symptoms regarding chest pain,thorax suffocation and breath hard were respectively 84.9%, 95.9%, 96. 4% and 92. 1% ,which were significantly higher than control group＇s 30. 2%, 42. 6%, 46. 0% and 48.6% （ P 〈 0. 01 ）. The effective rate of observation group＇s premature beats was 84. 0% （ 89/106）, which was also signifi candy higher than control group＇s 53.8 % （57/106）. The observation group＇ s score of Evaluation of Chinese ques tionnaire of quality of life in patients with cardiovascular disease were significantly higher than that of control group （P 〈 0. 01 ）. Conclusions The patients with premature beats who suffer from sustained cardiovascular symptom are often accompanied by psychological disorders of anxiety and depression. The quality of life in patients with premature beats with anxiety and depression can also be improved.