中青年冠心病患者PCI术后心理状况及影响因素研究

Study on psychological status and influencing factors of young and middle-aged patients with coronary heart disease after PCI

目的探讨中青年冠心病患者经皮冠状动脉介入治疗术后心理状况及其影响因素.方法对200例行经皮冠状动脉介入治疗的中青年冠心病患者收集整理临床资料,采用焦虑自评量表、抑郁自评量表评定焦虑抑郁程度.比较术前1d及术后第1d、3d、7d各量表评分变化,将焦虑自评量表总分≥50分、抑郁自评量表总分≥50分中满足至少1项设为阳性组,反之设为阴性组,对其影响因素进行单因素分析和多因素logistics回归分析.结果本组患者经皮冠状动脉介入治疗术前1d焦虑自评量表、抑郁自评量表评分较高,术后第1d、3d、7d各量表评分均较术前1 d呈持续性下降(P<0.01).术后第7 d焦虑63例,抑郁35例,焦虑抑郁共病10例,其中阳性共88例,阴性共112例;单因素分析显示,阳性组与阴性组在职业、医疗费用来源、血管病变支数、病程、人际关系、术前焦虑或抑郁、并发症发生率、术后心功能分级方面比较差异有统计学意义(P<0.05或0.01);多因素logistics回归分析发现,职业、人际关系、血管病变支数、并发症、术后心功能分级是中青年冠心病患者经皮冠状动脉介入治疗术后发生焦虑、抑郁的独立危险因素(P<0.05或0.01).结论中青年冠心病患者经皮冠状动脉介入治疗术前易出现焦虑、抑郁情绪,术后上述不良情绪较术前有所缓解,但有部分患者仍然存在,其影响因素众多,医护人员应予以有针对性地心理干预,以提高患者的心理健康水平.

Objective To analyze the psychological status and influencing factors of young and middle-aged patients with coronary heart disease after PCI.Methods The general data of 200 young and middle-aged patients with coronary heart disease undergoing PCI were collected.The SDS and the SAS were used to assess the degree of depression and anxiety in patients.The changes of SAS and SDS scores were observed at 1 day before surgery and 1 day,3 days,7 days after surgery.Patients with SAS score not less than 50 points or SDS score not less than 50 points or both of the two were included into the positive group.Oth-erwise,the patients were included into the negative group.Univariate and multivariate regression analyses were performed to analyze the influencing factors.Results The SAS scores and SDS scores of young and middle-aged patients with coronary heart disease were significantly lower at 1d,3d and 7d after PCI than 1d before surgery(P<0.01).At 7 days after surgery,there were 63 cases of anxiety,35 cases of depression,10 cases of anxiety and depression,and a total of 88 positive cases,112 negative cases.Univariate analysis showed that,there were significant differences between the two groups in occupation,sources of medical expenses,number of vascular lesions,course of disease,interpersonal relationship,preoperative anxiety or depression,incidence of complications and postoperative grade of cardiac function(P<0.05 or 0.01).Multivariate logistics regression analysis showed that,occupation,interpersonal relationship,number of vascular lesions,incidence of complications and postoperative grade of cardiac function were risk factors for anxiety and depression after PCI in young and middle-aged patients with coronary heart disease(P<0.05 or 0.01).Conclusion Young and middle-aged patients with coronary heart disease are prone to anxiety and depression before percutaneous coronary intervention.The above-mentioned adverse emotions are relieved after surgery,but some patients still exist.There are many influencing factors,and medical personnel should provide targeted psychological intervention to improve the mental health of patients.