摘要
目的:观察抗焦虑药物治疗对冠心病患者合并焦虑障碍发生率的影响。方法:①选择2002-01/2004-09在北京大学深圳医院心内科及深圳市孙逸仙心血管医院心内科住院接受冠状动脉内支架植入术治疗的冠心病患者358例。患者对实验目的知情,并能积极配合检查。②焦虑障碍程度评估采用汉密顿焦虑量表犤包括心血管系统症状、呼吸系统症状、胃肠道症状、植物神经系统症状、躯体性焦虑(肌肉系统)症状、躯体性焦虑(感觉系统)症状、生殖泌尿系统症状、焦虑心境、紧张、害怕、失眠、认知功能、抑郁心境以及会谈时行为表现等14项症状。根据每项症状的严重程度将其界定为0～4分5个等级,0分为无焦虑症状,4分为症状极重。总分<7分为无焦虑症状,≥14分为肯定有焦虑症状,≥7分,<14分为可能有焦虑症状犦。评分在入院后3d内、冠状动脉介入治疗前进行。③经汉密顿焦虑量表评分确定有焦虑症状存在的冠心病患者160例。设汉密顿焦虑量表总分<7分的198例冠心病患者为单纯冠心病组,在对其实施冠状动脉血运重建手术后给常规药物治疗4周。④随机将汉密顿焦虑量表总分≥14分的冠心病患者160例分为2组:焦虑治疗组和焦虑对照组各80例。焦虑对照组与单纯冠心病组的治疗方法相同。焦虑治疗组在前两组治疗方案的基础上加用盐酸氟西汀,20mg/d,治疗4周。⑤所有患者于治疗4周末时接受第2次汉密顿焦虑量表评定,由相同的评定员以相同的方法进行。观察介入治疗及4周常规药物治疗前后各组患者临床症状缓解率及治疗4周后汉密顿焦虑量表评分的减分幅度,并观察盐酸氟西汀的不良反应。⑥计量和计数资料差异比较分别采用t检验和χ2检验。结果:冠心病患者258例均完成量表评估并进入结果分析。①治疗前临床症状发生率:单纯冠心病组的典型冠心病症状发生率高于合并焦虑组,但其差异不明显(P>0.05),而不典型性冠心病症状的发生率明显低于合并焦虑组(P<0.05)。②治疗4周后临床症状发生率:单纯冠心病组患者所有临床症状完全缓解。焦虑对照组患者典型冠心病症状缓解率同样达到100%,但不典型性冠心病症状的缓解率明显低于单纯冠心病组(P<0.05)。焦虑治疗组典型冠心病症状缓解率与焦虑对照组相近(P>0.05),非典型性冠心病症状及焦虑和抑郁心境缓解率明显高于焦虑对照组(P<0.05)。③汉密顿焦虑量表评分减分情况:经过4周干预治疗后,焦虑治疗组患者的汉密顿抑郁量表中躯体焦虑、精神焦虑因子评分及总分减分幅度明显高于焦虑对照组(12.4±2.6,11.8±2.8,23.1±3.0;2.7±1.5,3.0±1.7,6.2±3.2,P<0.05)。④氟西汀治疗4周,未见明显副作用。结论:①合并焦虑的冠心病患者不典型冠心病症状发生率明显高于未合并焦虑的冠心病患者。②冠状动脉介入血运重建治疗及术后药物治疗对无焦虑症状的单纯冠心病患者疗效确切;合并焦虑冠心病患者在介入治疗后依然存在的不典型冠心病症状是患者焦虑、抑郁等心理卫生问题躯体化的表现,对合并焦虑冠心病患者进行抗焦虑药物治疗可有效减少冠心病患者不典型冠心病症状发生率及焦虑障碍情况发生。
AIM： To observe the effect of anxiolytic intervention on the incidence of anxiety disorder in patients with coronary heart disease. METHODS：① Totally 358 inpatients with coronary heart disease treated in the Department of Cardiology at Beijing University Shenzhen Hospital and Shenzhen Sun Yat-Sen Cardiovascular Hospital from January 2002 to September 2004 were recruited. Informed consent was obtained from the patients who can accept examination actively. ② Hamilton Anxiety Scale （HAMA） was used to evaluate the level of anxiety disorder [ including cardiovascular symptoms, respiratory symptoms, gastrointestinal symptoms, vegetative nervous system symptom , somatic anxiety （muscular system）, somatic anxiety anxiety （sensory） symptoms, genitourinary symptoms, anxious moods , tensions, fears , insomnia, intellectual, depressed mood as well as behavior at interview and so on 14 symptoms. Each item was rated on a 5-point scale , ranging from 0 （not present） to 4 （severe）. Total points 〈 7 was not present ,≥14 points was sure to have anxiety symptoms ,≥7 points and 〈 14 points might have anxiety symptoms. The psychiatric diagnoses were established within 3 days after admittance to hospital and before the coronary revascularization . ③Totally 160 patients were diagnosed as anxiety symptoms by HAMA . The total scores of HAMA less than 7 points of 198 patients with coronary heart disease were set as only coronary heart disease group. 4-week routine medication treatment was given before coronary revascularization. ④Totally 160 patients with coronary heart disease with the total points ≥ 14 diagnosed by HAMA were randomly divided into 2 groups ： Anxiety treatment group （n=80） and anxiety control group （n=80）. The treatment methods in the anxiety control group and only coronary heart disease group were the same. 20 mg/d of fluoxertine hydrochloride was added in the anxiety control group for 4 weeks based on the methods in the prior two groups. ⑤ All the patients accepted the second evaluation by HAMA at the end of the fourth week with the same method by the same person. Release rate of clinical symptom of the patients in each group was observed at the treatment immediately, before and after the 4-week treatment, and the reduced amplitude of HAMA was also observed at 4 weeks after treatment as well as the adverse effect of fluoxertine hydrochloride.⑥ t test and analysis of variance were used to compare the difference of data. RESULTS： Totally 258 patients with coronary heart disease all complete the evaluation of the scale and entered the result analysis. ①Incidence of clinical symptom before treatment： incidence of clinical symptom in the only coronary heart disease was higher than that coronary heart disease with anxiety group , but the difference was not significant（P 〉 0.05）,while the incidence of atypical coronary heart disease in the only coronary heart disease group was significantly lower than that in the coronary heart disease with anxiety group （P 〈 0.05）.②Incidence of clinical symptom 4 weeks after treatment： all the clinical symptoms ameliorated in the patients in the only coronary heart disease group. Ameliorated rate of typical coronary heart disease in the anxiety control group reached 100%, but the ameliorated rate of atypical coronary heart disease was significantly lower than that in the only coronary heart disease group （P 〈 0.05）. Ameliorated rate of coronary heart disease symptom in the anxiety treatment group was similar to that in the anxiety control group （P 〉 0.05）. Ameliorated rate of atypical coronary heart disease symptom and anxiety and depression were significantly higher than that in the anxiety control group （P 〈 0.05）.③ Reduced condition of HAMA ： total score of somatic anxiety , mentalanxiety factor in the HAMA as well as the reduced amplitude of the patients in the anxiety treatment group was significantly higher than that in the axiety control group （12.4±2.6,11.8±2.8,23.1±3.0;2.7±1.5,3.0±1.7, 6.2±3.2,P 〈 0.05）. ④No significant adverse effect was found 4 weeks after treatment with fluoxertine hydrochloride. CONCLUSION： ①The incidence of atypical coronary heart disease of the patients with anxirty was significantly higher than those patients without anxiety. ②Coronary revascularization and medication treatment after operation have exact curative effect for the coronary heart disease patients without anxiety symptoms. Atypical coronary heart disease symptoms still exist after treatment in coronary heart disease patients with anxiety that is the somatic presentation of anxiety , depression and so on mental health , Anxiolytic intervention for the coronary heart disease patients with anxiety can effectively reduce the incidence of atypical coronary heart disease symptom and anxiety disorder in patients with coronary heart disease.
出处
《中国临床康复》
CSCD
北大核心
2005年第32期23-25,共3页
Chinese Journal of Clinical Rehabilitation
