可疑冠心病患者行冠状动脉介入手术前后的心理状况调查

目的　了解可疑冠心病患者行冠状动脉介入手术前后的心理状况及影响因素。方法15 8例患者入选 ,术前 2 4h内及术后第 3天分别用 90项症状清单评价患者的心理状况。结果　 ( 1)术前躯体化、焦虑、恐怖等因子分高于常模 ,术后躯体化因子分仍高 ;( 2 )男性患者强迫、精神病性因子得分高于女性 ,而女性则恐怖因子分较高 ;( 3 )冠状动脉造影示冠状动脉正常者躯体化、强迫症状、人际关系敏感、恐怖、偏执、精神病性、总均分及阳性项目数等评分高于冠心病患者 ;( 4)手术后强迫症状、抑郁、焦虑、敌对、总均分、阳性症状均分得分较术前减低 ;( 5 )单纯行冠状动脉造影术者恐怖因子分 ( 1.3 4± 0 .3 8)高于同时行冠状动脉成形术及支架植入术者 ( 1.15± 0 .2 3 ,P <0 .0 5 ) ;( 6)详细谈话组阳性症状均分低于常规谈话组 (分别为 2 .46± 0 .3 7,2 .5 6± 0 .48,P =0 .0 2 ) ;( 7) 70岁以上的患者阳性症状均分 ( 2 .62± 0 .45 )高于 60岁以下 ( 2 .47± 0 .43 ,P <0 .0 5 )及 60～ 69岁组 ( 2 .45± 0 .40 ,P <0 .0 1)。结论　冠状动脉介入手术前后的心理症状是多因素共同作用的结果 ,其中手术的心理刺激是最重要的原因 ,女性、高龄以及合并的心理疾病所起的作用不容忽视 ,术前谈话时详细介绍手术并发症不会增加

Psychologic status and their influencing factors in patients suspected of coronary disease before and after coronary catheterization

OBJECTIVE: To study the psychologic status and their influencing factors in patients suspected of having coronary disease before and after coronary catheterization. METHODS: A hundred fifty-eight inpatients (125 men, 33 women, mean age 66.1 +/- 9.6 years) who underwent a scheduled coronary catheterization for the first time and fulfilled entry criteria were enrolled. All the patients were examined by Symptom Check List-90 (SCL-90), a standard self-report symptom inventory on present psychologic status, within 24 hours before the coronary catheterization (after the information consent) and the third day after the procedure. RESULTS: (1) Before coronary catheterization, factorial scores of somatization, anxiety and phobic anxiety were higher than norm (P < 0.05 or P < 0.01). After the procedure, only somatization score was higher (P < 0.01). (2) Men had higher scores on obsessive-compulsive and psychotism than women (P < 0.05 and P < 0.01, respectively), however, women had higher scores on phobic anxiety (P < 0.05). (3) Compared with patients having coronary disease, those with angiographically normal coronary arteries seemed to have higher scores of somatization, obsessive-compulsive, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotism, global severity index and positive symptoms (P < 0.05 or P < 0.01). (4) After the procedure, significantly decreases in obsessive-compulsive, depression, hostility, global severity index and positive symptom severity index (P < 0.05 or P < 0.01) were seen. (5) Patients merely underwent coronary angiography had higher score in phobic anxiety construct than those having had coronary angiography and percutaneous transluminal coronary angioplasty (1.34 +/- 0.38 vs 1.15 +/- 0.23, P < 0.05). (6) When compared with the degree of explanation under informed consent, specific risk was not informed mentioned, a higher score in positive symptom severity index was seen (2.56 +/- 0.48 vs 2.46 +/- 0.37, P = 0.02). (7) Higher score was seen on positive symptom severity index when patients aged 70 years or more (2.62 +/- 0.45) than those under 60 years old (2.47 +/- 0.43, P < 0.05) or between 60 and 69 years old (2.45 +/- 0.40, P < 0.01). CONCLUSIONS: Patients' psychologic symptoms before and after the coronary catheterization seemed to be related to many factors. The most important appeared one was coronary catheterization itself. Women, patients with angiographically normal arteries, those of 70 years old or more were more likely to have elevated psychologic distress. Detail information including specific risk regarding the procedure was not associated with the increase of psychological symptoms. The findings emphasized the importance of psychologic assessment and counseling for patient who had undergone a scheduled coronary catheterization.