心力衰竭患者心理因子与中医证候分型的相关性

Correlation between psychological factors of patients with heart failure and syndrome diagnosis in traditional Chinese medicine

目的探讨心力衰竭患者心理因子与其中医辨证分型之间的相互关系，以指导临床护理人员应用中西医心理护理知识给予干预。方法在中医心血管病专家的指导下对218例心力衰竭住院患者进行中医证候诊断，采用心理健康临床症状自评量表（SCL-90）对各中医证候分型患者进行调查，比较本组患者与国内常模的SCL-90评分并分析中医证候分型与SCL-90评分的相关性。结果与中国成人常模相比，心肺气虚证心力衰竭患者SCL-90各因子中躯体化（1．70±0．55）分、人际关系敏感（1．44±0．39）分、恐怖（1．47±0．53）分、焦虑（1．57±0．45）分、偏执（1．28±0．42）分，差异均有统计学意义（t分别为3．73，-3．48，2．80，2．58，-2．27；P〈0．05）；气阴两亏证心力衰竭患者躯体化、强迫症状、焦虑、恐怖、抑郁、精神病性因子评分与国内常模比较，差异均有统计学意义（t分别为7．23，4．38，4．27，4．21，3．16，2．04；P〈0．05）；气虚血瘀证心力衰竭患者躯体化、人际关系敏感、偏执、敌对、恐怖、焦虑因子评分与国内常模比较，差异均有统计学意义（P〈0．05）；心肾阳虚证心力衰竭患者躯体化、人际关系敏感、焦虑、敌对、恐怖、强迫症状因子评分与国内常模比较，差异均有统计学意义（P〈0．05）；阳虚水泛证心力衰竭患者躯体化、强迫症状、敌对、人际关系敏感、焦虑、恐怖、偏执因子评分与国内常模比较，差异均有统计学意义（P〈0．05）；痰饮阻肺证心力衰竭患者躯体化、强迫症状、人际关系敏感、焦虑、偏执、恐怖、敌对因子评分与国内常模比较，差异均有统计学意义（P〈0．05）。结论临床护理人员可根据患者不同中医证候诊断、不同心功能分级，给予相应干预，对恢复并保持良好心态配合治疗，提高患者生活质量具有十分重要的意义。

Objective To explore the correlation between the psychological factors of patients with heart failure and syndrome diagnosis in traditional Chinese medicine so as to promote clinical nursing staff to adopt treatment with psychological nursing knowledge of traditional Chinese and Western medicine. Methods With mental health clinical feedback form （SCL-90）, we surveyed 218 hospitalized patients with heart failure, and diagnosed the syndrome of patients with traditional Chinese medicine under the guidance of experts, then analyzed the correlation between them. Results Among patients with Qi deficiency of heart and lung, the score of somatization, interpersonal sensitivity, anxiety, terror, paranoia factor was （ 1.70 ± 0.55 ）, （ 1.44 ± 0.39）, （ 1.47 ±0. 53 ）, （ 1.57 ±0. 45 ）, （ 1.28 ±0. 42）, significantly different with that of Chinese healthy adult （ t = 3.73, - 3.48,2.80,2.58, - 2.27, respectively ; P 〈 0.05 ）. There was significantly different between patients with Qi and Yin deficiency and Chinese healthy adult in the score of somatization, obsessive symptoms, anxiety, fear, depression, psychotic factors （t = 7.23,4.38,4.27,4.21,3.16,2.04, respectively; P 〈 0.05 ）. Patients with Qi deficiency and blood stasis, heart and kidney Yang deficiency, Yang deficiency with edema syndrome, and phlegm obstructing lung, compared with Chinese healthy adult, significant differences were found in the score of somatization, obsessive symptoms, hostility, interpersonal sensitivity, anxiety, terror, paranoid factors （P 〈 0.05 ）. Conclusions It is very important for clinical nursing staff to provide psychological care for patients with heart failure. According to the different syndrome diagnosis and cardiac function classification, it is helpful to restore and maintain a good mentality so as to improve patients＇ quality of life.