抗心绞痛联合抗焦虑-抑郁药物治疗心绞痛伴焦虑抑郁症状的疗效

Effects of anti-angina treatment combined with anti-anxiety-depression drug on patients with angina accompanied by anxiety-depression symptoms

目的评价心绞痛伴有焦虑和抑郁症状的冠状动脉性心脏病患者给予常规抗心绞痛治疗的同时加用抗焦虑-抑郁药物治疗的临床疗效。方法按照前瞻性、随机化、多组比较的设计。依据躯体症状及自评量表的评分,将106例确诊为心绞痛伴焦虑抑郁症状的患者按照随机数字表分为3组:联合治疗组入选36例,完成随访33例;抗心绞痛组入选39例,完成随访36例;抗焦虑抑郁组31例,完成随访29例。联合治疗组:予异舒吉注射液20mg和冠心宁注射液(成分为丹参、川芎)静脉滴注,盐酸氟西汀20mg或氟哌噻吨美利曲辛片1片口服;有睡眠障碍者口服盐酸多塞平。抗心绞痛组:静脉用药同联合治疗组,但不予盐酸氟西汀及盐酸多塞平口服。抗焦虑抑郁组:口服盐酸氟西汀及盐酸多塞平,给予参芪注射液(成分为党参、黄芪)静脉滴注。观察3组患者心绞痛的改善程度、心电图变化以及住院天数。结果联合治疗组的抗心绞痛治疗总有效率为81.8%,显著高于抗心绞痛组的61.1%和抗焦虑抑郁组的48.3%(P值均<0.05)。联合治疗组的心电图改善总有效率为75.8%,显著高于抗心绞痛组的50.0%和抗焦虑抑郁组的34.5%(P值均<0.05)。联合治疗组的住院天数显著短于抗心绞痛组及抗焦虑抑郁组(P值均<0.01),而抗心绞痛组与抗焦虑抑郁组的差异无统计学意义(P>0.05)。结论心绞痛伴焦虑抑郁症状患者在常规抗心绞痛治疗的同时联合抗焦虑抑郁药物治疗能更有效地缓解患者的临床症状,并且缩短住院天数。

Objective To evaluate the effects of anti-angina treatment combined with anti-anxiety-depression drug on patients with angina accompanied by anxiety-depression symptoms.Methods This was a prospective,randomized and comparative study of multi-group.According to the score of somatization symptom and self rating scale,106 patients diagnosed as angina accompanied with anxiety-depression symptoms were randomly divided into 3 groups.There were 36 cases in combining therapy group and follow-up was accomplished in 33 cases.There were 39 cases in angina treatment group and follow-up was accomplished in 36 cases.There were 31 cases in anxiety-depression treatment group and follow-up was accomplished in 29 cases.Combined therapy group：Isosorbide dinitrate（20 mg） and Guanxinning zhusheye（ingredients：salvia miltiorrhiza and szechwan lovage rhizome） were intravenously injected.Fluoxetine hydrochloride（20 mg） or flupentixol and melitracen（1 tablet） were taken orally each day.Doxepin was given orally if sleep disorder existed.Angina group：only intravenous injection of isosorbide dinitrate and Guanxinning zhusheye.Anxiety-depression group：Fluoxetine hydrochloride and doxepin were taken orally,and Shenqi Fuzheng zhusheye（ingredients：codonopsis pilosula and mongolion mildetch root） was intravenously injected.The relief of angina,electrocardiogram and hospital days were compared between different groups.Results The effective rate for the treatment of angina in the combined therapy group was 81.8%,which was significantly higher than those in angina group（61.1%） and anxiety-depression group（48.3%,P0.05）.The cardiogram improvement rate in the combined therapy group was 75.8%,which was better than those in angina group（50.0%） and anxiety-depression group（34.5%,P0.05）.Hospital days in the combined therapy group were significantly less than those in the other two groups（P0.01）;and there was no significant difference between angina group and anxiety-depression group（P0.05）.Conclusion For the patients with angina accompanied with anxiety-depression symptoms,routine therapy for angina combined with medication therapy for anxiety-depression can effectively relieve clinical symptoms and reduce hospital stay.（Shanghai Med J,2012,35：874-876）