应激源强度对心肌梗塞患者主要不良心血管事件、血清学标记物和心理情绪的影响

摘要

目的:观察心理应激源强度对心肌梗塞(AMI)患者急性期主要心血管事件(用以评定心理应激源强度)、血清学标记物和心理情绪指标影响.方法:近年住院的AMI患者115例,在病情平稳后,进行"生活事件量表"和"心脏病患者心理状态问卷"评估,同时还观察他们的主要心血管事件和血清学标记物等相关指标.结果:115例AMI患者发病前平均心理应激源值为(67.49±15.53)分,据此被区分为:低应激源组(≤67.49分,62例),高应激源组(＞67.49分,53例).与低应激源组比较,AMI急性期高应激源组的平均合并症数目[(0.72±0.25)个/例∶(1.86±0.43)个/例]、严重心律失常发生率(46.77%∶86.79%)、急性左心衰竭发生率(19.35%∶39.62%)、心源性休克发生率(3.23%∶18.87%)和死亡率(1.61%∶11.32%) 均明显升高(P<0.05～0.01);血糖浓度[(7.27±2.32) mmol/L∶(14.48±4.60) mmol/L]、淋巴细胞计数[(3.19±0.83) 109/L∶(4.65±1.26) 109/L]、C反应蛋白质[(1.33±0.28) μg/L∶(1.79±0.56) μg/L]和肌酸激酶[(128.45±27.35) U/L∶(164.96±31.52) U/L]浓度均明显升高(P<0.05～0.01);心脏射血分数和血管再通率均明显降低,而平均住院时间和住院花费均明显升高(P<0.05～0.01);心理指标的无能为力感[(1.69±0.49)分∶(2.13±0.56)分]、沮丧感[(1.58±0.35) 分∶(1.77±0.46) 分]和社交障碍感[(1.62±0.37) 分∶(1.84±0.48) 分]维度评分均明显升高,而自主健康感维度评分[(1.75±0.49) 分:(1.41±0.40) 分]则明显降低(P<0.05～0.01).结论:急性心肌梗塞患者高心理应激源组遭遇生活事件刺激量大,住院期间各类合并症增加,疗效差,花费高、情绪低落,心理干预不容忽视.%Objective: To observe the effects of strength of psychological stressors on major adverse cardiovascular e-vents (MACE) , serologic markers, and emotional indexes in patients with acute myocardial infarction (AMI). Methods: A total of 115 AMI patients were evaluated by life events scale (LES, for evaluate strength of psychological stressors) and heart patients psychological questionnaire (HPPQ), when the patients' conditions turn steady. Their MACE and serologic markers were observed and analyzed. Results: Mean strength of psychological stressors of the 115 AMI patients was (67. 49± 15. 53) scores before onset of AMI, and they were divided into low stressor group (≤ 67. 49 scores, n=62) and high stressor group (＞67. 49 scores, n=53). Compared with low stressor group, the mean number of complications [ (0.72 ±0.25) /case vs. (1.86 ±0.43) /case], incidence rates of severe arrhythmia (46. 77％ vs. 86. 79％), acute left heart failure (19. 35％ vs. 39. 62％), cardiogenic shock (3. 23％ vs. 18. 87％) and mortality (1. 61％ vs. 11. 32％) significantly increased; the count of lymphocytes [ (3. 19±0. 83) 109/L vs. (4. 65± 1.26) 109/L], concentrations of blood glucose [ (7.27 ± 2.32) mmol/L vs. (14. 48±4. 60) mmol/L], C —reactive protein [ (1. 33±0. 28) μg/L vs. (1. 79±0. 56)μg/L] and creatine kinase [ (128. 45±27. 35) U/L vs. (164. 96± 31. 52) U/L] significantly increased; the cardiac ejection fraction and rate of revascularization were significantly lower, average stay and cost on hospitalization were significantly higher; scores of dimensions of feelings of helpless [(1. 69± 0. 49) scores vs. (2. 13±0. 56) scores], frustration [(1. 58 ± 0. 35) scores vs. (1. 77±0. 46) scores] and human communication disorders [ (1. 62±0. 37) scores vs. (1. 84±0. 48) scores] significantly increased, and score of dimension of self—awareness of health [ (1. 75±0. 49) scores vs. (1. 41±0. 40) scores] significantly decreased in high stressor group, P＜0. 05 ～ 0.01 all. Conclusion: Patients with acute myocardial infarction and high strength psychological stressor have more complications during admission, poor therapeutic effect, more cost, and poor emotion; thus, mental intervention could not be ignored.