冠心病患者介入术后焦虑抑郁情绪的变化及影响因素

Involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention

目的 探讨冠心病患者介入术后焦虑及抑郁情绪的变化特点及影响因素。方法选择2009年1月至2010年12月于天津市人民医院心内科行冠脉介入治疗的396例患者进行12个月的随访，在患者出院前及术后12个月使用HADS量表对焦虑及抑郁情绪进行量化评分，评价其变化特点，并使用Logistic回归分析影响情绪变化的因素。结果 介入术后的焦虑同性别（P=0．003）、年龄（P=0．004）及是否为急性心肌梗死（P=0．009）相关，抑郁同是否为急性心肌梗死（P〈0．001）相关。随访12个月，分别有76．3％的患者焦虑状态稳定，79．5％的患者抑郁状态稳定，多因素分析表明，焦虑情绪恶化同是否有心血管不良事件（OR：1．323，95％CI：1．026～1．705，P=0．031）、西雅图心绞痛评分（OR：O．870，95％CI：0．772～0．981，P=0．023）、出院前焦虑评分（OR：1．228，95％CI：1．053～1．432，P=0．009）相关，而抑郁程度恶化同出院前抑郁评分（OR：1．287，95％CI：1．072～1．545，P=0．007）相关。结论 冠心病患者介入术后12个月绝大部分焦虑及抑郁状态稳定，围手术期充分沟通、术后有效控制心血管事件发生，可以缓解患者的不良情绪，改善生活质量。

Objective To explore the involvement characteristics and influencing factors of anxiety and depression in patients after percutaneous coronary intervention （PCI）. Methods A total of 396 patients undergoing PCI were investigated between January 2009 and December 2010. All of them completed the Hospital Anxiety and Depression Scale （HADS） before discharge and at 12 months post-PCI. We evaluated the involvement characteristics and used Logistic regression to analyze the influencing factors of mood changes. Results The relevant factors of post-PCI anxiety were gender （ P = 0. 003 ） , age （ P = 0. 004） and acute myocardial infarction （ P = 0. 009 ） while depression was associated with acute myocardial infarction （ P 〈 0. 001 ）. A 12-month follow-up study showed that anxiety remained stable in 76.3% of patients while depression in 79. 5%. Multi-factor analysis showed that factors of presence of adverse cardiovascular events （ OR ： 1. 323, 95% CI： 1. 026-1. 705, P = 0.031 ） , Seattle angina score （ OR ：0. 870, 95%CI：0.772-0. 981, P = 0. 023） and anxiety scores at pre-discharge （ OR： 1. 228, 95% CI： 1. 053- 1. 432, P = 0. 009） were correlated with the deterioration degree of depression. And the factor associated with the deterioration of depression was the scores before discharge （OR： 1. 287, 95% CI： 1. 072 -1. 545, P = 0. 007 ）. Conclusion The levels of anxiety and depression remain stable in the majority of PCI patients at Month 12 post-PCI. Perioperative communication and effective control of postoperative cardiovascular events may ease a patient＇s negative emotions and improve their living quality.