多种治疗手段在中、重度慢性阻塞性肺疾病合并焦虑或忧郁治疗中的应用及对比

Application and comparison of various treatment methods in the treatment of moderate and severe chronic obstructive pulmonary disease with anxiety or depression

目的对比不同治疗手段在中、重度慢性阻塞性肺疾病合并焦虑或忧郁患者中的应用效果。方法选取2017年1月~2019年11月景德镇市第一人民医院收治的150例中、重度慢性阻塞性肺疾病合并焦虑或忧郁患者,采用随机数字表法将其分为三组,每组各50例。A组患者采用原发疾病药物+心理疏导治疗,B组患者采用原发疾病药物治疗+精神类药物辅助治疗,C组患者采用心理疏导+原发疾病药物治疗+精神类药物辅助治疗。比较三组患者的临床疗效,比较三组患者治疗前、治疗6个月后的焦虑忧郁程度和肺功能。结果C组患者的临床总有效率(98.00%)高于A组(78.00%)和B组(82.00%),差异有统计学意义(P<0.05)。三组患者治疗前的汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评分比较,差异无统计学意义(P>0.05);C组患者治疗后的HAMA评分为(8.03±1.51)分,HAMD评分为(9.17±2.03)分,低于A组[(12.21±3.01)、(13.06±3.16)分]和B组[(11.62±2.26)、(11.21±2.54)分],差异有统计学意义(P<0.05)。三组患者治疗前的第1秒用力呼气容积(FEV1)、FEV1占预计值的比值(FEV1%)、FEV1占用力肺活量的比值(FEV1/FVC)比较,差异无统计学意义(P>0.05);C组患者治疗后的FEV1为(2.21±0.65)L,FEV1%为(53.74±7.93),FEV1/FVC为(58.55±6.64)%,高于A组[(1.78±0.38)L、(46.51±7.41)、(55.79±6.59)%]和B组[(1.89±0.49)L、(48.26±7.62)、(55.83±6.32)%],差异有统计学意义(P<0.05)。结论中、重度慢性阻塞性肺疾病合并焦虑或忧郁患者采用心理疏导+原发疾病药物+精神类药物辅助治疗效果较佳,能改善焦虑忧郁程度和肺功能,提高治疗效果,利于促进患者疾病恢复。

Objective To compare the application effect of various treatment methods in the treatment of moderate and severe chronic obstructive pulmonary disease with anxiety or depression.Methods From January 2017 to November 2019,150 patients with moderate or severe chronic obstructive pulmonary disease combined with anxiety or depression were selected from Jingdezhen First People's Hospital.They were divided into three groups by random number table method,50 cases in each group.Group A was treated with primary disease drugs+psychological counseling,group B was treated with primary disease drugs+adjuvant therapy with psychotropic drugs,group C was treated with psychological counseling+primary disease drugs+adjuvant therapy with psychotropic drugs.The clinical effect,anxiety and depression degree,lung function before and 6 months after treatment were compared among the three groups.Results The total clinical effective rate of group C(98.00%)was higher than that of group A(78.00%)and group B and(82.00%),the difference was statistically significant(P<0.05).There were no significant differences in Hamilton anxiety scale(HAMA)score and Hamilton depression scale(HAMD)score among the three groups before treatment(P>0.05).The HAMA score and HAMD score of group C after treatment were(8.03±1.51)points and(9.17±2.03)points,respectively,which were lower than those of group A([12.21±3.01],[13.06±3.16]points)and group B([11.62±2.26],[11.21±2.54]points),with statistically significant differences(P<0.05).There were no significant differences among the three groups in the forced expiratory volume at 1 second(FEV1),the ratio of FEV1 to the expected value(FEV1%),the ratio of FEV1 to the forced vital capacity(FEV1/FVC)(P>0.05).After treatment,FEV1 in group C was(2.21±0.65)L,FEV1%was(53.74±7.93),and FEV1/FVC was(58.55±6.64)%,higher than those in group A([1.78±0.38]L,[46.51±7.41],[55.79±6.59]%)and group B([1.89±0.49]L,[48.26±7.62],[55.83±6.32]%),with statistically significant differences(P<0.05).Conclusion Psychological counseling+primary disease drugs+adjuvant therapy with psychotropic drugs are effective in the treatment of moderate and severe chronic obstructive pulmonary disease with anxiety or depression,which can improve the degree of anxiety and depression and lung function,improve the treatment effect,and promote the recovery of patients'disease.