急诊冠状动脉支架植入术后患者反刍性沉思水平对临床预后的影响

Effects of rumination on clinical outcomes of patients after emergency coronary stent implantation

目的探讨急诊冠状动脉支架植入术后患者反刍性沉思水平对临床预后的影响。方法选择2014年1月-2016年1月宁波大学医学院附属医院收治的急诊冠状动脉支架植入术后患者100例，采用事件相关反刍性沉思问卷（ERRI）、SAS、SDS和健康相关的生存质量（SF．36）进行调查。根据ERRI问卷2个维度评分分别将患者分为〈15分组和≥15分组，共4组，其中A组为目的性反刍性沉思维度评分≥15分的患者（n=46），B组为目的性反刍性沉思维度评分〈15分的患者（n：54），C组为侵人性反刍性沉思维度评分〈15分的患者（n=42），D组为侵人性反刍性沉思维度评分≥15分的患者（n=58）。观察患者入院时和术后18个月时反刍性沉思水平对临床预后的影响。结果A、B、C、D组反刍性沉思水平平均得分分别为（21．57±2．48）、（10．82±2．47）、（11．26±1．82）、（20．81±2．09）分。入院时，A组患者SAS（38．27±5．89）分，SDS（37．91±6．32）分，均低于B组“值分别为6．330、6．557；P〈0．01）；术后18个月时，A组患者左室射血分数（75．38±7．29）％，SF．36评分（72．58±8．81）分，均高于B组，差异有统计学意义0值分别为2．334、5．352；P〈0．05）；A组患者发生心肌梗死1例，B组3例，差异无统计学意义（X^2=0．121，P〉0．05）。入院时，C组患者SAS（38．71±5．92）分，SDS（37．65±6．72）分，均低于D组0值分别为5．222、6．324；P〈0．01）；术后18个月时，C组患者左室射血分数（75．42±7132）％，SF-36评分（71．95±8．94）分，均高于D组，差异有统计学意义“值分别为2．748、4．371；P〈0．05）；C组患者发生心肌梗死1例，D组3例，差异无统计学意义（X^2=0．035，P〉0．05）。结论目的性反刍性沉思降低、侵入性反刍性沉思水平升高不利于冠状动脉支架植入术后患者左室功能恢复，并降低患者生活质量。

Objective To investigate the effect of rumination on the prognosis of patients after emergency coronary stent implantation. Methods A total of 100 patients with coronary stent implantation in the Affiliated Hospital of Medical School of Ningbo University from January 2014 to January 2016 were prospectively collected and investigated using Event Related Rumination Inventory （ERRI）, SAS, SDS and SF-36. According to the purposeful rumination on admission, patients were assigned into A group （purposeful rumination t〉 15, n=46） or B group （purposeful rumination 〈 15, n=54）. Moreover, according to the invasive rumination on admission, patients were assigned into C group （invasive rumination 〈 15, n=42） and D group （invasive rumination ≥ 15, n=58）. The effect of rumination on clinical outcomes of patients were compared at admission and 18 months after operation. Results The rumination＇s average scores of A, B, C and D groups were （21.57 ± 2.48）, （10.82 ± 2.47）, （11.26 ± 1.82）, and （20.81 ± 2.09）. At admission, SAS and SDS scores of patients in A group were （38.27 ± 5.89） and （37.91 ± 6.32）, which were both lower than B group （t=6.330, 6.557; P 〈 0.01）. At 18 months after operation, left ventricular ejection fraction and SF-36 score of patients in A group were （75.38 ±7.29） % and （72.58± 8.81）, which were both significantly higher than B group （t=2.334, 5.352; P 〈 0.05）. There was 1 case of myocardial infarction in A group and 3 cases in B group, with no statistically significant difference between two groups （ X 2=0-121, P 〉 0.05）. At admission, SAS and SDS scores of patients in C group were （38.71 ± 5.92） and （37.65 ±6.72）, which were both lower than D group （t=5.222, 6.324; P〈 0.01）. At 18 months after operation, left ventricular ejection fraction and SF-36 score of patients in C group were （75.42 ±7.32） % and （71.95 ±8.94）, which were both significantly higher than D group （t=2.748, 4.371 ; P 〈 0.05）. There was 1 case of myocardial infarction in C group and 3 cases in D group, with no statistically significant difference between two groups （ X 2=0-035, P 〉 0.05）. Conclusions The decrease of purposeful rumination and the increase of invasive rumination are not conducive to the recovery of left ventricular function, and decrease the quality of life in patients with coronary artery stent implantation.