心脏急症与稳定性冠心病患者合并心理问题现状分析

目的 心脏急症患者、稳定性冠心病患者和冠状动脉造影阴性者合并心理疾患的比较.方法 对298例疑诊为冠心病的患者根据冠状动脉病变情况分为:急性冠状动脉综合征(ACS)组128例、稳定性冠心病组108例、阴性对照组62例.分别在入院冠状动脉造影前、冠状动脉造影后3 d、出院前1 d进行Zung抑郁自评量表(Zung self-rating depression scale,SDS)、Zung焦虑自评量表(Zung self-rating anxiety scale,SAS)、汉密尔顿抑郁量表(Hamilton depression rating scale,HRSD)进行评估.结果 ACS组患者入院时有抑郁症状和焦虑症状的患者分别占65.6%(84/128),78.9%(101/128);随着治疗的进行,抑郁和焦虑的比例明显下降,出院时分别占45.3%(58/128)和64.8%(83/128,P<0.05).入院时,稳定性冠心病患者的抑郁和焦虑的比例分别为18.5%(20/108)和26.9%(29/108),对照组分别为32.3%(20/62)和25.8%(16/62),两组患者抑郁、焦虑比例在治疗过程中并无明显变化(P>0.05).结论 心理问题和冠心病共存在心内科常见,在ACS中更为突出.对于稳定性冠心病和冠状动脉造影阴性的患者应注意心理因素的影响.

Emotional disorder in patients with acute or stable coronary heart disease

Objective To compare the incidence of emotional disorder in patients with acute or stable coronary heart disease. Methods A total of 298 patients with suspected coronary heart disease (CHD) were designed into three groups based on of coronary angiography results: acute coronary syndrome (ACS, n=128), stable angina pectoris (SAP, n=108) and non-CHD (n=62). All patients were evaluated by Zung Self-rating Depression Scale (SDS), Zung Self-rating Anxiety Scale(SAS) and Hamilton Depression Rating Scale (HRSD) for depression and anxiety before coronary angiography (CAG), 3 days after CAG, and 1 day before discharge. Results Incidences of depression and anxiety were significantly higher the ACS group (65.6% and 78.9% before CAG; 60. 9% and 70. 3% 3 days post CAG; 45.3%and 64. 8% before discharge) compared patients with SAP (18.5% and 26.9% before CAG; 17.6% and 28.7% 3 days post CAG; 15.7% and 26.9% before discharge, all P <0.05 vs. ACS) and non-CHD patients (32.3% and 25.8% before CAG; 27.4% and 24.2% 3 days post CAG; 29.0% and 30.6% before discharge, all P<0.05 vs. ACS) while the depression and anxiety incidences were similar between patients with SAP and non-CHD in this cohort (P>0.05). Conclusion Emotional disorder is common in patients with suspected heart diseases, especially in patients with ACS. Psychological distress of patients with suspected heart disease should be evaluated and treated.