2016年度某三级甲等综合医院精神科会诊的心内科住院患者资料分析

Consultation-liaison psychiatry service to the patients from cardiovascular department in a tertiary general hospital in 2016

目的 了解综合医院心内科住院患者的精神科联络会诊特点.方法 通过电子病历系统收集某三甲综合医院2016年1月1日至12月31日精神科会诊的心内科住院患者资料,共222例.采用SPSS 16.0统计学软件对会诊率、会诊原因、精神科诊断、干预建议、出院后门诊复诊比例等数据进行分析,影响因素分析采用Logistic回归分析.结果 2016年心内科为全院邀请精神科会诊最多的科室.心内科住院患者精神科会诊的比例为5.8％（237/4 097）.会诊中最常见的原因为难以解释或治疗效果不佳的躯体症状（29.7％,66/222）、焦虑症状的治疗（17.6％,39/222）、既往有焦虑或抑郁障碍病史（11.3％,25/222）、睡眠问题的治疗（10.8％,24/222）.精神科诊断为焦虑障碍（51.8％,115/222）、抑郁障碍（13.5％,30/222）、睡眠障碍（6.8％,15/222）、应激反应与适应障碍（5.4％,12/222）的患者比例较高.精神科的主要处理意见包括抗抑郁药（48.2％,107/222）、苯二氮革类药（41.9％,93/222）、生活方式调整（9.5％,21/222）、非苯二氮革类睡眠药（7.7％,17/222）.出院后在精神科门诊复诊比例为7.8％（17/217）,主要影响因素为出院带药是否有精神科相关药物[OR=4.356,95％CI（1.148～16.535）,P=0.031]、出院医嘱中是否有建议精神科复诊的内容[OR=4.888,95％CI（1.566～15.253）,P=0.006].结论 综合医院心内科住院患者对精神科会诊需求突出,其中以焦虑障碍最为常见,患者出院后精神科门诊复诊率低.

Objective To explore the characteristics of consultation-liaison psychiatry service of patients from cardiovascular department in general hospital. Methods 222 inpatients were enrolled from January 1, 2016 to December 31, 2016, who were referred to the consultation-liaison psychiatry service in a general hospital. These data were analyzed, including rate of conclusion, reasons for referral, psychiatric diagnosis, management suggestions and the rate of outpatient visits after discharge and its influencing factors. Results Among all departments of this hospital in 2016, the cardiovascular department took the largest proportion to require consultation-liaison psychiatry service, with the rate of 5.8% （237/4 097）. The principal reasons for psychiatric referral were unexplained physical symptoms or non-satisfactory therapy effect （29.7%, 66/222）, the treatment of anxiety symptoms （17.6%, 39/222）, having previous history of anxiety or depression （11.3%, 25/222）, the treatment of sleep problems （10.8%, 24/222）. Anxiety disorders （51.8%, 115/222）, depression disorder （13.5%, 30/222）, sleep disorders （6.8%, 15/222）, stress reaction and adjustment disorder （5.4%, 12/222） were the major psychiatric diagnose. The main management suggestions included antidepressants （48.2%, 107/222）, benzodiazepines （41.9%, 93/222）, adjustment of lifestyle （9.5%, 21/222） and non-benzodiazepine sleep drugs （7.7%, 17/222）. The rate of outpatient visits after discharge was 7.8% （17/217）, and the main influencing factors were： whether the psyehotropie medication given at discharge （0R=4.356, 95% C1 （ 1.148-16.535 ） , P=0.031 ） and suggestions for psychiatric revisits listed in discharge instruction（OR=4.888,95%Cl（1.566-15.253） ,P=0.006）. Conclusion The cardiology inpatients in general hospital have a prominent demand for psychiatric consultation, and anxiety disorder is the most common disease among them. The rate of outpatient visits after discharge is quite lower.