脑卒中康复期的心理干预

目的探讨心理干预在脑卒中康复中的作用。方法选择2006-12～2007-12收治住院的180例脑卒中患者,入院1周后,用汉密顿焦虑量表(HAMA),汉密顿抑郁量表(HADA)通过问卷方式进行心理测验,对106例有显焦虑抑郁情绪的病人进行心理干预治疗和松弛训练,4周后再进行评定。结果治疗前后汉密顿焦虑量表分值与汉密顿抑郁量表分值均有统计学意义。结论心理干预在脑卒中康复中有明显的作用。     

心理干预对老年疾病患者焦虑和抑郁情绪的影响

目的探索心理干预对老年疾病患者焦虑和抑郁情绪的影响。方法以2010年2月-2012年8月在重庆市精神卫生中心老年科和重庆沙坪坝区人民医院治疗的100例老年疾病患者为研究对象,采用随机数字表法分为干预组和对照组各50例。两组均采用内科常规药物治疗,干预组在此基础上实施心理干预,并在入组时、心理干预后3个月、6个月时分别进行汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)评定。结果心理干预3个月和6个月后,干预组HAMD和HAMA总评分均低于对照组(P0.01)。结论心理干预可能有助于改善老年疾病患者的焦虑、抑郁情绪。     

黛力新联合心理干预对脑血管造影患者焦虑抑郁的疗效观察

目的 探讨黛力新联合心理干预对脑血管造影患者心理情绪的影响.方法 将80例行脑血管造影的患者随机分为黛力新联合心理干预组（药物治疗组）和心理干预组;分别采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）进行评定手术前后患者的焦虑、抑郁情况.结果 黛力新联合心理干预组的HAMA评分和 HAMD评分明显低于心理干预组.结论 黛力新联合心理干预可明显改善患者对脑血管造影术产生的焦虑和抑郁情绪,可作为辅助治疗措施.     

心理护理干预对主动脉夹层患者康复的意义

目的探讨心理护理对主动脉夹层患者情绪障碍的影响。方法将99例确诊为主动脉夹层的患者随机分为研究组50例和对照组49例。2组在行主动脉夹层腔内隔绝术前、术后均给予常规对症处理和常规护理,研究组在此基础上给予心理干预护理。护理前后均采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行心理状态评估。结果干预后第7天,研究组SAS和SDS评分均较干预前明显改善,与对照组比较差异有统计学意义(P0.05)。结论对主动脉夹层患者进行心理护理干预,能够有效的改善患者的焦虑、抑郁情绪,有助于患者康复。     

心理干预对恶性肿瘤患者焦虑、抑郁状态及生活质量的影响

目的 探讨心理干预对恶性肿瘤患者焦虑抑郁状态及生活质量的影响.方法 将205例恶性肿瘤患者随机分为对照组和心理干预组,对照组采用常规放疗、化疗及最佳支持治疗,心理干预组在常规治疗基础上对患者进行心理干预,治疗前后采用焦虑自评量表(SAS),抑郁自评量表(SDS)和EORTC-QLQ-C30量表对患者进行焦虑抑郁状态及生活质量的测定.结果 两组患者入院时SDS及SAS评分比较无统计学差异(P＞0.05),心理干预组第6周SDS及SAS评分均明显低于对照组,差异有统计学意义(P＜0.05),心理干预后可改善癌症患者生活质量,较干预前差异有统计学意义(P＜0.05).结论 心理干预能够改善恶性肿瘤患者焦虑抑郁情绪,提高生活质量,有利于患者的康复.     

心理行为干预对冠心病患者情绪障碍及遵医行为的影响

目的 观察心理行为干预对冠心病患者焦虑、抑郁情绪和遵医行为的影响.方法 将86例患者随机分为干预组43例和对照组43例,2组均给予冠心病常规治疗和护理,干预组同时给予心理行为干预,于治疗前和治疗后3个月应用焦虑自评量表(SAS)和抑郁自评量表(SDS)和自行设计遵医行为问卷进行评定.结果 干预前2组患者焦虑、抑郁评分差异无统计学意义(P＞0.05),3个月后2组患者情绪障碍均得到改善,干预组患者焦虑、抑郁评分显著低于对照组(P＜0.01);患者的遵医行为干预组较对照组明显提高(P＜0.01).结论 心理行为干预可以改善冠心病患者负性心理状态,提高患者遵医行为,有利于患者的康复.     

心理干预对急性心肌梗死患者焦虑抑郁的作用

目的心理干预对急性心肌梗死患者焦虑、抑郁情绪的影响。方法将82例急性心肌梗死患者随机分为干预组43例和对照组43例,在常规治疗基础上,干预组进行心理护理干预,对照组采用传统护理方法。2组均在入院后及治疗3周后分别采用焦虑自评量表(SAS)和抑郁自评量表(SDS)测试病人治疗前后的焦虑、抑郁程度。观察2组病人治疗前后焦虑、抑郁程度及医患依从性情。结果心理干预前干预组和对照组患者SAS、SDS评分无显著性差异(P>0.05);心理干预3周后干预组患者SAS、SDS评分与干预前比较差异有统计学意义(P<0.05),对照组差异无统计学意义(P>0.05);心理干预3周后干预组与对照组患者SAS、SDS评分比较差异有统计学意义(P<0.05)。结论心理干预有利于急性心肌梗死患者的身心健康,可有效缓解焦虑、抑郁情绪,提高临床疗效。     

心理干预对精神分裂症患者经期情绪障碍影响的研究

目的 了解精神分裂症患月经期的情绪障碍问题及心理干预时情绪障碍的影响，从而解决女性病人治疗中的疑难问题。方法 对我院126名住院的女性精神分裂症病人分别进行经期和非经期的焦虑自评量表SAS和抑郁自评量表SDS的测定，然后将126名病人随机分成干预组和对照组各63名，干预组进行2个月的心理干预，对照组不进行上述干预，其他治疗相同。第3个月再分别对两组病人进行经期和非经期的焦虑自评量表和抑郁自评量表的测定。结果 (1)精神分裂症病人经期SAS、SDS量表分均较非经期高，经统计学检验两差异显；(2)干预组经心理干预后无论经期还是非经期SAS、SDS量表分与对照组比较差异显；(3)干预组自身前后量表分比较差异显。结论 精神分裂症患月经期存在明显的焦虑、抑郁，易引起病情波动，针对女性病人内分泌变化进行心理干预有一定疗效。     

心理干预对癫患者焦虑抑郁情绪的影响

目的:探讨心理干预对癫患者焦虑抑郁情绪的影响。方法:对163例成人癫患者在抗癫治疗的同时实施为期3个月的心理干预;采用中文版Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)分别于干预前、干预后1个月和3个月进行评定。结果:163例癫患者实施心理干预后焦虑和抑郁情绪改善显著,并随干预时间延长而显著下降。与干预前比较,干预1周,SAS及SDS评分与干预前差异无统计学意义(P=0.469、0.272);干预1个月和3个月,SAS及SDS评分与干预前比较差异有显著统计学意义(F=15.196、16.207,P均<0.001)。结论:癫患者焦虑抑郁情绪明显;心理干预能够显著改善患者焦虑抑郁情绪;干预时间越长,效果越好。     

心理干预对恶性肿瘤患者家属心理障碍的作用

目的分析恶性肿瘤患者家属焦虑、抑郁状态的形成因素及心理干预对其的影响。方法对105名晚期恶性肿瘤患者家属根据其焦虑或抑郁症状给予心理干预,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)测评其治疗前后的症状变化。结果心理干预前后SAS分别为59.16±4.11、45.35±3.25(t=27.08,P<0.05),SDS分别为54.13±3.67、47.95±2.21(t=15.07,P<0.05),治疗后评定分值较治疗前明显下降,治疗后症状减轻。结论焦虑和抑郁症状是晚期恶性肿瘤患者家属不可忽视的心理问题,应引起医学界的重视。心理干预能够明显改善焦虑和抑郁症状。     

Antithrombotic treatment (argatroban vs. heparin) in coronary angioplasty in angina pectoris: effects on inflammatory, hemostatic, and endothelium-derived parameters

To evaluate the suitability of two anticoagulants (heparin vs. argatroban) as adjunctive drugs during and after elective conventional percutaneous transluminal coronary angioplasty, we compared the changes in inflammatory, hemostatic, and endothelium-derived markers in groups of patients with stable angina treated with the two drugs during percutaneous transluminal coronary angioplasty. Twenty-seven patients were randomly allocated to either group 1 (15 patients who received an empiric dose of heparin and aspirin as anticoagulant), or group 2 (12 patients who received an alternative regimen of argatroban and aspirin). Both drugs were administered as a bolus followed by continuous infusion for 96 hours during and after percutaneous transluminal coronary angioplasty. There were no differences in the inflammatory response induced by percutaneous transluminal coronary angioplasty in both groups, but the fibrinogen concentration significantly decreased during percutaneous transluminal coronary angioplasty in group 2. Decreased platelet counts and increased mean platelet volume were observed during percutaneous transluminal coronary angioplasty in both groups. The levels of prothrombin fragment 1+2 and thrombin antithrombin III complex increased markedly during percutaneous transluminal coronary angioplasty. Group 2 showed a more rapid return to the baseline levels of these two markers than group 1. Secondary fibrinolysis was evidenced by a steep increase of D-dimer after percutaneous transluminal coronary angioplasty in both groups. In contrast to the significant decrease in antithrombin activities during percutaneous transluminal coronary angioplasty in group 1, no marked change in these markers was found in group 2. Although the levels of von Willebrand factor and plasminogen activator inhibitor-1 showed essentially the same changes in both groups during and after percutaneous transluminal coronary angioplasty, more markedly increased levels of tissue type plasminogen activator and type plasminogen activator-plasminogen activator inhibitor-1 complex after percutaneous transluminal coronary angioplasty were found in group 1 than in group 2. While neither drug had any effect on the percutaneous transluminal coronary angioplasty-induced inflammatory response, argatroban may more effectively inhibit the generated thrombin and prevent antithrombin consumption during and after percutaneous transluminal coronary angioplasty.     

Effects of a behavioural intervention on quality of life and related variables in angioplasty patients: results of the EXhaustion Intervention Trial

OBJECTIVES: The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI). METHODS: Seven hundred ten patients were randomized into an intervention group and a usual care control group. The group intervention focused on stressors leading to exhaustion and on support of recovery. HRQL (measured by the MacNew questionnaire), exhaustion [measured by the Maastricht Questionnaire and the Maastricht Interview Vital Exhaustion (MIVE)], anxiety (measured by the State-Trait Inventory), and depression (measured by the structured clinical interview for DSM-IV) were assessed at intake and at 6 and 18 months. Presence of anginal complaints was assessed at 18 months. RESULTS: The intervention had a significant beneficial effect on all psychological factors except hostility and on the presence of anginal complaints. The effect of the intervention on exhaustion, as assessed by the MIVE, was modified by a previous history of coronary artery disease (CAD). Gender modified the effect of the intervention on exhaustion and on anxiety, the strongest effect being observed in women. CONCLUSIONS: The behavioural intervention improved HRQL and related psychological factors. Somatic comorbidity and a history of CAD limited the effect of the intervention.     

Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty: a prospective, randomized controlled study

A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty (PTCA) were randomly assigned to either an intervention or a control group. Subjects in the intervention group participated in a comprehensive behaviorally oriented program aimed at achieving significant long-term changes in risk factor-related lifestyle behavior. Assessments of lifestyle behaviors, psychological factors, biological risk factors, and rehabilitation as well as secondary prevention endpoints were carried out, at inclusion and after 12 months. Results showed that the intervention patients, as compared with controls, improved significantly on measures assessing smoking, exercise, and diet habits. These self-rated changes were confirmed by weight reductions and improved exercise capacity, as well as by between-group differences in subclinical chest pain during an exercise test. However, few effects were found on the different psychological variables, as well as on morbidity or return to work.     

同一机构2年期间冠状动脉旁路移植82例：治疗前后心理状态分析

背景：冠状动脉旁路移植作为一个负性事件可引起冠状动脉粥样硬化性心脏病患者的心理应激反应。 目的：观察冠状动脉旁路移植患者移植前后心理状态的变化,分析影响冠状动脉旁路移植患者心理变化的因素。 方法：选取2007-01/2009-06于新疆医科大学第五附属医院心外科行冠状动脉旁路移植的患者82例,具备正常的认知能力,无慢性精神疾病史,理解力正常,无失语,自愿接受心理评估。于移植前1 d、移植后出院前1 d分别用中国版90项症状自评量表SCL-90对患者心理状况进行评价。 结果与结论：冠状动脉旁路移植前总均分、阳性项目数、阳性症状均分、躯体化、抑郁、焦虑和恐怖因子分高于常模,人际关系敏感、偏执因子分低于常模,冠状动脉旁路移植后抑郁、焦虑较移植前高(P < 0.05~0.01);其共同特点为冠状动脉旁路移植患者移植前、后存在明显的抑郁、焦虑心理。结果提示,抑郁和焦虑会增加冠状动脉旁路移植过程中、移植后心血管事件的危险,故在移植前、后应常规对患者进行心理状态评估,合理进行干预,降低移植过程中并发症的发生,减少冠状动脉旁路移植后心血管事件的发生。 关键词：冠状动脉旁路移植;症状自评量表;抑郁;焦虑;心理干预     

Effects of a home-based intervention program on anxiety and depression 6 months after coronary artery bypass grafting: a randomized controlled trial

OBJECTIVE: The objective of this study was to evaluate the effects of a home-based intervention program (HBIP) on anxiety and depression 6 months after coronary artery bypass grafting (CABG). METHODS: In a prospective randomized controlled trial, 203 elective CABG patients were included. An HBIP structured for respondents in the intervention group was performed 2 and 4 weeks after surgery. Anxiety and depression symptoms were measured by the Hospital Anxiety and Depression Scale (HADS) in both patient groups before surgery, 6 weeks after surgery, and 6 months after surgery. RESULTS: A total of 185 patients completed the study: 93 patients in the intervention group and 92 patients in the control group. On 6-week and 6-month follow-ups, significant improvements in anxiety and depression symptoms were found in both groups. These improvements did not differ significantly between the groups. However, in a predefined subgroup of patients with anxiety and/or depression symptoms at baseline (n=65), improvement was significantly larger in the intervention group (n=29) than in the control group (n=36) after 6 months (P<.05). CONCLUSIONS: Patients experiencing high levels of psychological distress before CABG surgery benefited from a structured informational and psychological HBIP. Implementation of psychological screens of patients scheduled for CABG might serve to identify patients experiencing anxiety and/or depression. These patients could then be targeted to receive individualized HBIP.     

药物冠状动脉支架置入后延长氯吡格雷疗程：能降低血管的炎性反应吗？

背景：使用二磷酸腺苷受体阻断剂(氯吡格雷)对接受经皮冠状动脉介入患者术前进行预处理,可以减少术后患者的病死率和心肌梗死发生率。但冠状动脉介入后氯吡格雷疗程究竟需要持续多久仍是一个值得讨论的问题。 目的：观察不同疗程氯吡格雷干预经皮穿刺冠状动脉成形治疗冠状动脉粥样硬化性心脏病患者血浆C-反应蛋白水平的变化。 方法：选择48例冠状动脉粥样硬化性心脏病患者,在接受经皮冠状动脉介入治疗前1 d使用阿司匹林300 mg和氯吡格雷300 mg,之后联合使用阿司匹林100 mg/d和氯吡格雷75 mg/d治疗。术后24 h、1个月及6个月进行随诊。其中经皮穿刺冠状动脉成形后6个月复查患者被随机分为两组,一组接受12个月的氯吡格雷和阿司匹林联合治疗,另一组先接受3个月的联合治疗,后3个月仅接受阿司匹林治疗。所有患者在术前、术后即时以及随诊时抽取血样,用酶联免疫吸附法检测血清C-反应蛋白质量浓度。 结果与结论：术后血浆C-反应蛋白水平比术前升高,于术后24 h达高峰,之后又呈逐渐降低趋势。尽管接受了氯吡格雷预处理,经皮冠状动脉介入治疗后患者C-反应蛋白水平仍有所增高,说明无论术前预处理与否,术后都需要行抗炎治疗。延长氯吡格雷疗程能显著降低患者血浆C-反应蛋白水平,提示延长氯吡格雷疗程可以起到确切的抗炎作用,这可能对减低术后的心血管意外的风险性有一定作用。 关键词：氯吡格雷;C-反应蛋白;经皮冠状动脉介入治疗;医学植入物;支架     

Effects of a behavioural intervention on quality of life and related variables in angioplasty patients : Results of the EXhaustion Intervention Trial

Objectives

The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI).

Methods

Seven hundred ten patients were randomized into an intervention group and a usual care control group. The group intervention focused on stressors leading to exhaustion and on support of recovery. HRQL (measured by the MacNew questionnaire), exhaustion [measured by the Maastricht Questionnaire and the Maastricht Interview Vital Exhaustion (MIVE)], anxiety (measured by the State-Trait Inventory), and depression (measured by the structured clinical interview for DSM-IV) were assessed at intake and at 6 and 18 months. Presence of anginal complaints was assessed at 18 months.

Results

The intervention had a significant beneficial effect on all psychological factors except hostility and on the presence of anginal complaints. The effect of the intervention on exhaustion, as assessed by the MIVE, was modified by a previous history of coronary artery disease (CAD). Gender modified the effect of the intervention on exhaustion and on anxiety, the strongest effect being observed in women.

Conclusions

The behavioural intervention improved HRQL and related psychological factors. Somatic comorbidity and a history of CAD limited the effect of the intervention.     

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.