全科医师在非体外循环冠状动脉旁路移植术后患者焦虑抑郁倾向干预中的作用

Effect of medical intervention by general practitioners on anxiety and depression in patients after off-pump coronary artery bypass graft

目的探讨全科医师在非体外循环冠状动脉旁路移植术(OPCABG)后患者焦虑抑郁倾向干预中的作用。方法选取2013年6月至2016年6月在首都医科大学附属北京安贞医院心脏外科就诊的OPCABG术后随诊患者288例为研究对象。按照预计能否规律接受全科医师治疗(每月在社区卫生服务中心或乡村卫生站就诊次数≥1次)分为全科组(51例)和对照组(237例),比较2组术后出院前、术后3、6和12个月医院焦虑抑郁表自测评分及自觉手术效果满意程度评分。结果对照组患者中11例于术后6个月随访后失访,整体随访率为96.2%(277/288)。2组患者术后出院前、术后12个月的焦虑、抑郁自测评分和自觉手术效果满意程度评分差异均无统计学意义(均P>0.05)。术后3、6个月全科组焦虑、抑郁自测评分低于对照组,自觉手术效果满意评分高于对照组[术后3个月:(6.6±1.9)分比(7.4±1.7)分、(6.0±2.6)分比(6.9±2.1)分、(4.8±1.4)分比(4.3±1.2)分;术后6个月:(5.2±1.8)分比(6.9±2.0)分、(4.7±2.4)分比(5.1±2.3)分、(6.1±2.0)分比(5.0±2.1)分],差异均有统计学意义(P<0.05或P<0.01)。结论在分级诊疗原则指导下,全科医师的干预可以更好地缓解OPCABG术后患者的焦虑及抑郁倾向,有利于提高患者的心脏手术后自觉手术效果满意度。

Objective To evaluate the effect of medical intervention by general practitioners on anxiety and depression in patients after off-pump coronary artery bypass graft （OPCABG）. Methods A total of 288 patients who had OPCABG from June 2013 to June 2016 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University were enrolled. According to whether the patients would go for regular treatments provided by general practitioners in community health center or rural health station, they were divided into GP group（51 cases） and control group（237 cases）. Scores of the Hospital Anxiety and Depression Scale and self-satisfaction of surgical effect were analyzed before discharge and 3, 6, 12 months after surgery. Results Eleven patients in control group were lost to follow-up 6 months after surgery, the total follow-up rate was 96. 2% （277/288）. There were no significant differences of anxiety, depression and self-satisfaction scores between groups before discharge and 12 months after surgery（ P 〉 O. 05 ）. At 3, 6 months after surgery, anxiety and depression scores in GP group were significantly lower and self-satisfaction score was significantly higher than those in control group [ 3 months： （6.6±1.9）scores vs （7.4 ±1.7）scores, （6.0±2.6）scores vs （6.9 ±2.1）scores, （4.8 ±1.4）scores vs （4. 3 ± 1.2） scores ; 6 months after operation ： （5.2 ± 1.8 ） scores vs （6. 9 ±2.0） scores, （4.7 ±2.4） scores vs （5.1 ±2.3）scores, （6.1±2.0）scoresvs （5.0 ±2.1）scores（P〈0.05 orP〈0.01）. Conclusion Underthe guidance of graded diagnosis and treatment principle, general practitioner intervention can alleviate anxiety and depression tendency in patients after OPCABG and improve the satisfaction of surgical operation.