慢性心力衰竭患者心身症状综合征、焦虑抑郁状态和影响因素分析

Psychosomatic symptom syndrome,anxiety,depression and influence factors in patients with chronic heart failure

目的观察慢性心力衰竭(CHF)患者心身症状综合征(PSS)、焦虑和抑郁的发生情况和相关影响因素。方法选取2018年5月至2020年1月于秦皇岛第一医院心内科门诊就诊的371例CHF患者为研究对象,应用心身症状量表、焦虑自评量表和抑郁自评量表对CHF患者进行问卷调查,将PSS作为因变量,心功能分级、焦虑、抑郁、年龄及学历作为自变量进行Logistic回归分析。结果PSS、焦虑和抑郁评分异常分别为74.39%、34.77%和46.36%。其中女性心力衰竭患者PSS发生率明显高于男性(P<0.05)。临床常见的PSS是睡眠障碍、心前区不适、心慌、心悸、乏力、情绪低落,以及头晕(女性)、愤怒或冲动(男性)等。Logistic回归分析结果显示,抑郁(OR=3.92,95%CI:0.883~8.145,P<0.01)、焦虑(OR=1.11,95%CI:1.034~1.200,P=0.005)和心功能分级(OR=1.08,95%CI:1.018~1.145,P=0.011)是PSS的危险因素。结论慢性心力衰竭患者心身症状综合征发生率高于焦虑、抑郁,抑郁、焦虑、心功能分级是心身症状综合征发生的危险因素。

Objective To observe the incidence and influence factors of psychosomatic symptom syndrome(PSS),anxiety,depression in patients with chronic heart failure(CHF).Methods CHF patients(n=371)were chosen from Department of Cardiology in the First Hospital of Qinhuangdao City from May 2018 to Jan.2020.A survey was conducted in all patients by using Psychosomatic Symptom Scale(PSSS),Self-Rating Anxiety Scale(SAS)and Self-Rating Depressive Scale(SDS).PSS was taken as a dependent variable and NYHA classification of heart function,anxiety,depression,age and education background were taken as independent variables in a Logistic regression analysis.Results The proportion of abnormal scores of PSS was 74.39%,that of SAS were 34.77%and that of SDS were 46.36%.The incidence rate of PSS was significantly higher in female CHF patients than that in male ones(P<0.05).The symptoms of PSS including dyssomnia,precordial discomfort,flustered,palpitation,hypodynamia,depressed mood,dizziness(female)and anger or irritation(male)were common in clinical practice.The results of Logistic regression analysis showed that depression(OR=3.92,95%CI:0.883~8.145,P<0.01),anxiety(OR=1.11,95%CI:1.034~1.200,P=0.005)and NYHA classification(OR=1.08,95%CI:1.018~1.145,P=0.011)were risk factors of PSS.Conclusion The incidence rate of PSS is higher than that of anxiety or depression in CHF patients,and depression,anxiety and NYHA classification of heart function are risk factors of PSS.