冠状动脉旁路移植术后患者焦虑抑郁状态危险因素研究

The risk factors of anxiety and depression in patients after coronary artery bypass graft in primary hospitals

目的:探讨三级医院冠状动脉旁路移植术(CABG)患者,术后焦虑抑郁状态及其相关危险因素。方法:应用前瞻性研究方法,采用综合性医院焦虑抑郁量表,对本院180例CABG患者围术期行心理测评,评价术后焦虑抑郁状态的发生率,根据术后是否存在焦虑状态或(和)抑郁状态将患者分为焦虑抑郁状态组(n=103例)和对照组(n=77),对可能影响因素进行多因素Logistic回归分析。结果:1CABG患者术后焦虑、抑郁状态的发生率分别为42.2%、39%,二者均有的占23.9%;2单因素分析:文化程度低、无固定工作、负性家庭生活事件、患者为家中主要经济来源、术前合并焦虑抑郁、术前脑卒中史、初发心绞痛或心肌梗死、术后刀口疼痛评分>6分及ICU停留时间长为术后出现焦虑抑郁的危险因素(P<0.05);3Logistic回归分析:文化程度(P=0.018)、负性家庭生活事件(P=0.046)、术前合并焦虑抑郁(P=0.023)、初发心绞痛或心肌梗死(P=0.038)是术后出现焦虑抑郁的独立危险因素。结论:在基层三级医院,CABG患者术后焦虑抑郁状态发病率比较高,应该重视围手术期焦虑抑郁状态的筛查,采取有针对性的干预,从而改善预后,提高手术质量。

Objective：To investigate the status and risk factors of anxiety and depression in patients who received coronary artery bypass graft （CABG） in a primary hospital. Methods： 180 patients underwent CABG were prospectively investigated using Hospital Anxiety and Depression Scale. Patients with anxiety and / or depression after CABG were defined as the study group （n = 103 ）, the other patients were included in the control group（ n = 77 ）. Chi-square test and t test was used to compare the difference between the two groups for category variables and continuous variables, respectively. Logistic regression was then used to explore the risk factors of anxiety and depression. Results：（1）The incidence of anxiety and depression, anxiety associated with depression of patients after CABG was 42. 2% （76 patients） ,39% （70 patients） and 23.9% （43 patients） ,respectively. （2）Univariate analysis showed, those in the study group were more likely to report lower education level, negative family events, preoperative anxiety or depression, stroke history, pain score 〉 6, initial onset of angina pectoris and longer ICU duration after operation, having no stable work, and being the main source of family income （ P 〈 0. 05 ）. than the control group. 3 Logistic regression revealed that lower education degree, negative family events, preoperative anxiety or depression, initial onset angina pectoris were independent risk factors of anxiety and depression in patients after CABG （P 〈 0. 05 ）. Conclusion：Patients after CABG surgery have higher incidence of anxiety and depression in primary hospitals. Measures should be taken to control the risk factors of anxiety and depression, and so can improve the quality of the procedure.