松弛疗法对埋藏式心律转复除颤器放电后继发情绪紊乱患者起搏器事件及情绪紊乱的干预效果研究

Effect of Relaxation Therapy on the Frequency of Pacemaker Adverse Events and Mental Conditions in Patients with Mental Disorders Following Implantable Cardioverter-defibrillator Discharges

目的探讨松弛疗法减少埋藏式心律转复除颤器(ICD)放电后继发情绪紊乱患者起搏器事件,及改善情绪紊乱的效果。方法选取2015年6—11月于昆明医科大学第一附属医院心内科住院及ICD门诊随访的患者60例为研究对象。采用随机数字表法分别将男性、女性患者分为试验组和对照组,各30例。对照组患者仅接受一般药物治疗;试验组另外同时接受松弛疗法,包括肌肉放松训练、想象放松训练、深呼吸放松训练、静默放松训练,2次/d,30 min/次,持续6个月。应用起搏器腔内图事件监测功能,记录两组试验前6个月及试验期间6个月内被标记的起搏器事件次数。分别于试验前及干预6个月后填写焦虑自评量表(SAS)、抑郁自评量表(SDS),评价患者情绪紊乱程度及干预效果。结果试验期间,对照组、试验组分别退出3、2例。对照组试验前6个月与试验期间6个月被标记的起搏器事件发生次数比较,差异无统计学意义(Z=-0.472,P=0.637);试验组试验期间6个月被标记的起搏器事件发生次数少于试验前6个月(Z=-3.172,P=0.002)。试验组试验前6个月与试验期间6个月被标记的起搏器事件发生次数变化值大于对照组(Z=-2.475,P=0.013)。试验组干预后情绪紊乱程度较对照组轻,干预效果优于对照组(P<0.05)。试验组情绪紊乱的干预效果与被标记的起搏器事件次数呈负相关(r_s=-0.702,P<0.001)。结论松弛疗法能够减少ICD放电后继发情绪紊乱患者起搏器事件的发生次数,并改善患者情绪紊乱状态。

Objective To investigate the effect of relaxation therapy on the frequency of pacemaker adverse events and mental conditions in patients with mental disorders following implantable cardioverter-defibrillator（ ICD） discharges. Methods We enrolled 60 patients（ 26 males and 34 females） who received inpatient or outpatient treatment in Department of Cardiology and follow-up services delivered by ICD treatment,First Affiliated Hospital of Kunming Medical University,from June and November 2015 and randomized them into the experimental group and control group with 30（ 13 males and 17 females） in each based on the male to female ratio. Both groups received conventional drug therapy,the experimental group additionally received relaxation therapy for 6 monthes,including muscle relaxation training,imagination relaxation training,deep breathing relaxation training,silent relaxation training,twice daily,30 min per time. The number of pacemaker adverse events occurred in the 6-month period before and during the intervention were recorded using the Patient-Triggered Event Records（ PTER）. Self-rating Anxiety Scale（ SAS） and Self-rating Depression Scale（ SDS） were filled before and after the intervention for assessing the mental disorders and intervention effect. Results During the intervention period,3 and 2 cases dropped out of the control group and the experimental group,respectively. The number of pacemaker adverse events occurred in the control group during the6-month period before the intervention was not significantly different from that occurred during the intervention period（ Z=-0. 472,P = 0. 637）. However,in the experimental group,the number of pacemaker adverse events occurred during the intervention period was less than that occurred in the 6-month period before the intervention（ Z =-3. 172,P = 0. 002）. The reduced number of pacemaker adverse events occurring in the 6-month period before and during the intervention period was more in the experimental group than that in the control group（ Z =-2. 475,P = 0. 013）. After intervention,the degree of mental disorders was milder in the experimental group than in the control group,indicating better intervention effect was achieved in the experimental group（ P〈0.05）. The intervention effect was negatively correlated with the number of pacemaker adverse events in the experimental group（ rs=-0. 702,P〈0. 001）. Conclusion Relaxation therapy can reduce the number of pacemaker adverse events occurred in patients with secondary mental disorders after ICD discharges and improve their mental conditions.