不同时间点心脏移植等待者的焦虑和抑郁状态分析

Anxiety and depression status among patients waiting for heart transplantation surgery at different time points

目的探讨心脏移植等待者在不同时间点的焦虑和抑郁状态的变化。方法93例受者在2013年3月至2014年3月间在复旦大学附属中山医院心外科登记要求进行心脏移植手术，由1名固定的精神科医生在患者等待移植期间进行汉密尔顿抑郁量表（HAMD，17项）和汉密尔顿焦虑量表（HAMA）的评估。等待者中有36例最终入院接受心脏移植手术，在入院后每周进行2次HAMD和HAMA的评估直至手术。结果93例等待者初次访谈的HAMD和HAMA得分分别为（13．1±3．8）分和（14．2±4．6）分，其中18例（19．4％）存在中度抑郁症状；31例（33．3％）存在中度焦虑症状，14例（14．1％）存在严重焦虑症状。最终接受心脏移植手术的36例患者中，初次访谈的HAMD和HAMA得分分别为（14．5±3．8）分和（16．0±4．9）分。31例入院后访谈的HAMD和HAMA得分分别为（13．2±3．8）分和（16．2±4．4）分，其中7例（19．4％）存在中度抑郁症状；16例（44．4％）存在中度焦虑症状，9例（25．0％）存在严重焦虑症状。入院前后HAMD得分的差异有统计学意义（t=3．383，P=0．002）。入院后首次和第2次HAMD和HAMA得分的差异也有统计学意义（t=14．024，P=0．000；t=2．786，P=0．009）。对14例进行了3次评估的患者的HAMD和HAMA得分进行重复方差分析，差异均有统计学意义（F=5．626，P=0．034；F=4．568，P=0．020），并且HAMD的得分呈线性趋势（F=8．273，P=0．013）。结论入院后等待心脏移植患者的抑郁症状有所缓解。在住院等待期间，患者的焦虑症状起先会略微下降，随后显著上升，但抑郁症状会持续下降。

Objective Although heart transplantation surgery has become more common, little is known about the psychological status of patients waiting for a heart transplant. Method Ninetythree patients registered for heart transplantation from March 2013 to March 2014 in a large general hospital in Shanghai were assessed by a psychiatrist using the Hamilton Depression Scale （17 items） and the Hamilton Anxiety Scale. Out of them 36 were preoperatively admitted to the Cardiac Surgery Department. The scales were assessed repeatedly at the 1st day, 3rd day, 7th day, 10th day and so on until the operation took place. Result The mean scores of HAMD and HAMA of 93 patients in the waiting list were separately 13.11 ± 3.81 and 14. 20 ± 4. 57. Among them 18（19. 4%） were classified as moderately depressed, 31 （33. 3 % ） had moderately anxious symptoms, and 14 （14. 1%） had severe anxious symptoms. Thirty-six patients were preoperatively admitted to hospital. Their mean scores of HAMD and HAMA were separately 13.19 ± 3. 82 and 16. 17 ±4. 35. Among them 7（19. 4%） were classified as moderate depression at the time of admission, 16 （44. 4%） had moderately anxious symptoms and 9 （25.0%） had severe anxious symptoms. The scores of HAMD had significant difference （t = 3. 383, P = 0. 002） before and after admission. Paired t test was separately conducted to analyze the first assessment and the 3rd-day assessment of HAMA and HAMD total scores after admission of all the inpatients. The results showed the scores were statistically different （for HAMA, t = 2. 786, P = 0. 009 ; for HAMD, t = 14. 024,P = 0. 000）. Repeated ANOVA was used to analyze the recipients who had three assessments. The results had statistical difference （for HAMA, F = 4. 568, P = 0. 020; for HAMD, F = 5. 626, P = 0. 034） and the difference of HAMD score at different time points had a linear trend （F = 8.273, P = 0.013）. Conclusion After hospital admission, the depression symptoms will be significantly alleviated. When waiting for the transplant in the hospital, the anxiety symptoms alleviate slightly in three days and then aggravate significantly. The depression symptoms alleviate slightly continuously.