先天性心脏病外科修补术后患儿心理行为研究

目的 探讨先天性心脏病(CHD)患儿的心理行为状况,并对照研究外科修补手术与介入封堵治疗对CHD患儿心理行为的影响.方法 应用Aehenbach儿童行为量表分别对79例行外科修补手术和82例介入治疗的CHD患儿在术前和术后1年进行心理行为检测.选取80名与CHD患儿一般特征相匹配的健康儿童为对照组.结果 CHD儿童术前心理行为异常检出率及心理行为总粗分均显著高于对照组(P＜0.01),心理行为粗分均值亦高于对照组(P＜0.05).男孩主要表现为抑郁、交往不良、体诉、社会退缩、违纪及攻击方面,女孩主要表现为抑郁、社会退缩、体诉、违纪方面.术后1年测试,男、女二治疗组心理行为总粗分分别显著低于治疗前(P＜0.01),男、女二介入组总粗分与对照组比较差异无统计学意义;外科组男孩术后总粗分及攻击行为粗分分别高于介入组(P＜0.05),外科组女孩术后心理行为总粗分及抑郁、社会退缩和违纪行为粗分分别高于介入组(P＜0.05).心理行为因子异常检出率与病程呈正相关,病程越长检出率越高.结论 CHD患儿存在着明显的心理行为问题,宜早期治疗.与介入治疗相比,外科修补术后较长时间内患儿仍存有明显的心理行为问题,应引起更多重视.

The mental and behavioral performance in children with congenital heart diseases treated by surgical repair

Objective The aim of this study was to compare the postoperative mental and behavioral conditions between children with congenital heart diseases (CHD) treated with surgical procedures or interventional therapy.Methods One hundred and sixty-one children suffering CHD with no associated structural cardiac anomalies were divided into two groups:the surgical group (n=79) and interventional group (n=82).One year after the above-mentioned treatments,Achenbach Child Behavior Checklist (CBCL) edited by Xu Tao-yuan in 1992 was performed on these children.Eighty healthy children with the similar common characteristics as those with CHD were enrolled into the control group.Results The abnormal rates of the boys and girls with CHD were significantly higher than that in the control group (P＜0.01).The behavioral abnormities of boys included depression,social flinch,physical complaints,aggression and violating rules;whereas the behavioral abnormities of girls includeel depression,social flinch,physical complaints and violating rules,which were both significantly different from those in the control group.The total postoperative cursory marks of patients in the interventional and surgical groups were significantly lower than the pre-operative marks (P＜0.05).The total postoperative cursory marks and marks of assault of the boys in the surgical group were both significantly higher than those in the interventional group (P＜0.05).The total postoperative cursory marks and the marks of depression,social flinch,violate rules of girls in the surgical group were all significantly higher than those in the interventional group (P＜0.05).The abnormal rates of mentality and behavior correlated positively with the course of disease.Conclusions CHD significantly affected the mentality and behavior of the children.It should draw our attention that more postoperative mental and behavioral problems can be noted in children undergoing surgical procedures than in those accepting interventional therapy in a relatively long period.