术前心理疏导对于冠心病首次与多次PCI患者睡眠质量、心理的作用

Effects of preoperative psychological counseling on sleep quality and mental condition in CHD patients undergoing first and repeated PCI

目的:研究术前心理疏导对于多次与首次行PCI的冠心病(CHD)心绞痛患者的睡眠质量、心理的作用。方法:选择本院2016年6月至2017年6月收治的首次接受PCI的49例CHD患者为首次PCI组,以同期收治的≥2次PCI治疗的49例CHD患者为多次PCI组。两组均于术前接受有针对性的专业心理疏导。观察比较两组术前后心理、睡眠质量、血浆N末端B型利钠肽前体(NT-proBNP)等临床指标。结果:与首次PCI组比较,多次PCI组术前焦虑自评量表[SAS,(50.18±8.79)分比(54.21±8.92)分]、抑郁自评量表[(55.78±9.36)分比(59.98±9.41)分]、匹兹堡睡眠质量指数问卷评分[PSQI,(12.74±2.73)分比(15.96±2.81)分]、冠脉Gensini积分[(89.16±6.12)分比(96.73±6.36)分]、左室舒张末内径[(58.71±5.12)mm比(64.38±5.19)mm]、左室收缩末内径[(45.87±3.25)mm比(49.92±3.29)mm]、血浆NT-proBNP水平[(612.15±11.28)ng/ml比(639.87±11.34)ng/ml]、心绞痛发作程度评分[(5.18±0.56)分比(5.92±0.58)分]均显著升高,P<0.05或<0.01。与术前比较,术后两组上述指标、心绞痛发作次数和发作时间均显著降低,P<0.05或<0.01。术后除了多次PCI组SAS和PSQI评分仍显著高于首次组外,两组其余指标差异均无显著性,P均>0.05。结论:多次PCI患者术前上述临床指标均较首次PCI患者严重。术前心理疏导能够有效缓解心理压力,提高睡眠质量;且术前心理疏导和PCI能够使得多次PCI患者获得与首次PCI者相似的疗效。

Objective：To study effects of preoperative psychological counseling on sleep quality and mental condition in patients with CHD undergoing first and repeated PCI.Methods：A total of 49 CHD patients with angina pectoris,who received first PCI treated in our hospital from Jun 2016 to Jun 2017,were enrolled as first PCI group.Another49 CHD patients with angina pectoris,received PCI for twice or more were regarded as repeated PCI group.Both groups received targeted professional psychological counseling before PCI.Psychological state,sleep quality,plasma level of N terminal pro brain natriuretic peptide（NT-proBNP）etc.were observed and compared between two groups before and after PCI.Results：Compared with first PCI group before PCI,there were significant rise in scores of self-rating anxiety scale[SAS,（50.18±8.79）scores vs.（54.21±8.92）scores],self-rating depression scale[（55.78±9.36）scores vs.（59.98±9.41）scores]and Pittsburgh sleep quality index[PSQI,（12.74±2.73）scores vs.（15.96±2.81）scores],coronary Gensini score[（89.16±6.12）scores vs.（96.73±6.36）scores],left ventricular end-diastolic dimension[（58.71±5.12）mmvs.（64.38±5.19）mm],left ventricular end-systolic dimension[（45.87±3.25）mm vs.（49.92±3.29）mm],plasma NT-proBNP level[（612.15±11.28）ng/ml vs.（639.87±11.34）ng/ml]and angina onset degree score[（5.18±0.56）scores vs.（5.92±0.58）scores]in repeated PCI group,P〈0.05 or0.01.Compared with before PCI,there were significant reductions in above indexes,angina onset times and duration in two groups after PCI,P〈0.05 or0.01.There were no significant difference in above indexes after PCI between two groups except postoperative SAS and PSQI score of repeated PCI group still significantly higher than those of first PCI group,P〉0.05 all.Conclusion：Preoperative above clinical indexes of repeated PCI group are more severe than those of first group.Preoperative psychological counseling can effectively alleviate mental pressure,improve sleep quality of patients,and joint PCI can obtain similar therapeutic effect in repeated PCI patients as those of first PCI patients.