焦虑、抑郁对风心病患者预后及心肌电活动的影响

Effects of anxiety and depression on the prognosis and myocardial electrical activity of patients with rheumatic heart disease

目的 探讨焦虑、抑郁对风心病患者预后及心肌电活动的影响。方法 选择80例风心病患者作为研究对象。在手术前采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对患者焦虑、抑郁进行评分,并根据焦虑、抑郁严重程度分为轻度焦虑/抑郁组(对照组)与中重度焦虑/抑郁组(研究组),各40例。所有患者均行二尖瓣置换术,并在术后给予同质心理护理、饮食护理、口腔护理及相应的药物治疗。分析比较2组术后治疗效果以及手术前后焦虑和抑郁评分,血清IL-2、TNF-α水平,心肌电活动情况。结果 研究组术后心功能疗效(70.00%,28/40)明显低于对照组(95.00%,38/40)(P<0.05)。术前,研究组焦虑、抑郁评分均明显高于对照组(P<0.05);术后7 d、1个月2组焦虑、抑郁评分与术前比较均逐渐降低,但研究组仍明显高于对照组(P<0.05)。术前,研究组血清IL-2、TNF-α水平均明显高于对照组(P<0.05);术后7 d、1个月2组血清IL-2、TNF-α水平与术前比较均逐渐降低,但研究组仍明显高于对照组(P<0.05)。术前,研究组APA、OS、RP、Vmax均明显高于对照组(P<0.05);术后7 d、1个月2组APA、OS、RP、Vmax与术前比较均逐渐降低,但研究组APA、OS、RP、Vmax明显仍高于对照组(P<0.05)。结论 中重度焦虑/抑郁风心病患者术后心功能疗效改善明显低于轻度焦虑抑郁风心病患者,同时术后焦虑抑郁评分、血清炎症因子水平、心肌电活动改善情况差于轻度焦虑抑郁风心病患者,焦虑/抑郁情况影响风心病患者预后。

Objective To investigate the effects of anxiety and depression on the prognosis and myocardial electrical activity of patients with rheumatic heart disease. Methods A total of 80 patients with rheumatic heart disease were selected as the research subjects. The anxiety and depression of the patients were scored by the Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) before surgery, and they were divided into a mild anxiety/depression group(the control group) and a moderate to severe anxiety/depression group(the study group) according to the severity of anxiety and depression, each with 40 cases. All the patients underwent a mitral valve replacement, and were given the same psychological care, diet care, oral care and corresponding medications after operation. The postoperative treatment effects, anxiety and depression scores, serum IL-2 and TNF-α levels and the myocardial electrical activity before and after surgery were analyzed and compared between the two groups. Results The postoperative cardiac function in the study group(70.00%, 28/40) was significantly lower than that in the control group(95.00%, 38/40)(P <0.05). Before operation, the scores of anxiety and depression in the study group were significantly higher than those in the control group(P <0.05). On the 7th day and one month after operation, the scores of anxiety and depression in the two groups were gradually decreased, but the study group was still significantly higher than the control group(P<0.05). Before operation, the levels of serum IL-2 and TNF-α in the study group were significantly higher than those in the control group(P <0.05). On the 7th day and one month after operation, their levels in both groups were gradually decreased, but the study group was still significantly higher than the control group(P<0.05). Before operation, the levels of APA, OS, RP, and Vmax of the study group were significantly higher than those of the control group(P<0.05). On the 7th day and one month after operation, their levels in the two groups were gradually decreased, but the study group was still significantly higher than the control group(P<0.05). Conclusion The postoperative improvement of cardiac function in patients with rheumatic heart disease combined with a moderate to severe anxiety/depression is significantly lower than that in patients with a mild anxiety and depression, and their postoperative improvement of the anxiety/depression scores, serum inflammatory factor levels and myocardial electric activity is worse than that in patients with a mild anxiety/depression, indicating that anxiety/depression affects the prognosis of patients with rheumatic heart disease.