初发急性心肌梗死患者创伤后应激障碍现状及危险因素探究

Status and risk factors of post-traumatic stress disorder in patients with first-onset acute myocardial infarction

目的探讨初发急性心肌梗死患者创伤后应激障碍(post-traumatic stress disorder,PTSD)现状及危险因素。方法选取2017年1月至2018年2月本院收治的266例初发急性心肌梗死患者为研究对象,根据发病后60d的创伤后应激障碍量表平民版(PTSD checklist-civilian version,PCL-C)评分将其分为PTSD组和无PTSD组,比较两组患者的基线资料、人格特征与反刍思维,采用多因素Logistic回归分析探讨初发急性心肌梗死患者发生PTSD的独立影响因素。结果全部患者的PCL-C总分为(39.6±7.9)分,其中再体验、回避、高警觉症候群的条目评分分别为2.30、2.29、2.42分。共有85例(32.0%)患者被诊断为PTSD,纳入PTSD组,其余181例患者纳入非PTSD组。PTSD组患者的高血压比例、神经质评分、侵入性反刍评分均显著高于非PTSD组(均P<0.05),年龄、内外向评分、主动反刍评分均显著低于非PTSD组(均P<0.05)。多因素Logistic回归分析结果显示,神经质评分、侵入性反刍评分升高是初发急性心肌梗死患者发生PTSD的独立危险因素(均P<0.05),而年龄增长是其独立保护因素(均P<0.05)。结论近1/3的初发急性心肌梗死患者存在PTSD,以警觉性增高症候群表现最为严重,神经质评分与侵入性反刍评分升高是初发急性心肌梗死患者发生PTSD的独立危险因素,而年龄增长是其独立保护因素。

Objective To study the status and risk factors of post-traumatic stress disorder (PTSD) in patients with first-onset acute myocardial infarction (AMI).Method 266 patients with first-onset AMI from January 2017 to February 2018 were enrolled the study and divided into PTSD group and non-PTSD group according to PTSD checklist-civilian version (PCL-C) at 60 days after onset. Baseline data,personality characteristics and rumination were compared between two groups.Multivariate Logistic regression analysis was used to investigate the independent influencing factors of PTSD in patients with primary AMI.Result The total score of PCL-C in all patients was (39.6±7.9) points.The average scores of item of re-experience,avoidance and high alertness syndrome were 2.30, 2.29 and 2.42 points respectively.A total of 85 patients (32.0%) were diagnosed with PTSD and classified as PTSD group,while the remaining 181 patients were classified as non-PTSD group.The proportion of hypertension,neuroticism score and intrusive rumination score in PTSD group were significantly higher than those in non-PTSD group,while age,extraversion score and active rumination score were significantly lower than those in non-PTSD group (all P > 0.05).Multivariate Logistic regression analysis showed that increased neuroticism score and intrusive rumination score were the independent risk factors for PTSD in patients with first-onset AMI (all P < 0.05),and increased age was an independent protective factor (P < 0.05).Conclusion Nearly one third of first-onset AMI patients suffer from PTSD,and high alertness syndrome is the most serious.Increased neuroticism score and invasive rumination score were the independent risk factors for PTSD in patients with first-onset AMI,while increased age is an independent protective factor.