冠心病患者焦虑抑郁的特点及药物干预价值

摘要

目的 探索冠状动脉粥样硬化性心脏病(冠心病,CHD)患者焦虑及抑郁的特点及药物干预的价值.方法 入选2015年3月~2017年3月以胸痛主诉住院的患者198例,根据冠状动脉(冠脉)造影或冠脉CT结果分为CHD组(84例)与非CHD组(114例).两组患者均于入院后行汉密尔顿焦虑量表(HAMA)与汉密尔顿抑郁量表(HAMD)评价患者焦虑与抑郁情况,同时将CHD组HAMA或HAMD大于7分的患者随机分为药物治疗组与非药物治疗组.药物治疗组在常规药物及心理疏导治疗基础上给予氟哌噻吨美利曲辛片(早上、中午各10.5 mg).4周后观察患者焦虑抑郁改善情况.结果 CHD组焦虑60.7%(51/84)及焦虑合并抑郁47.6%(40/84)患者比例明显高于非CHD患者,焦虑为41.2% (47/114),焦虑合并抑郁为31.6%(36/114),差异有统计学意义(P均＜0.05).CHD组患者的HAMA及HAMD高于非CHD组(P＜0.05).CHD组中HAMA或HAMD大于7分患者应用氟哌噻吨美利曲辛片4周后 HAMA及HAMD较治疗前明显下降(P均＜0.05),而非药物治疗组患者HAMD及HAMA较前无明显变化,差异无统计学意义(P均＞0.05).结论 以胸痛为主诉的CHD患者较非CHD患者更容易出现焦虑或焦虑合并抑郁,在心理疏导基础上给予药物治疗可以改善CHD患者的焦虑或抑郁.%Objective To investigate the characteristics of anxiety-depression and value of medicinal intervention in patients with coronary heart disease (CHD). Methods The patients hospitalized with chest pain (n=198) were chosen from Mar. 2015 to Mar. 2017, and divided, according to coronary CT results, into CHD group (n=84) and non-CHD group (n=114). The status of anxiety and depression were reviewed by using Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) in all patients after hospitalization. CHD was again divided, according to HAMA scores or HAMD scores above 7, into medicated group and non-mediated group. The medicated group was given flupentixol-melitracen tablets (10.5 mg in the morning and at noon) for 4 weeks on the base of routine drug therapy and psychological counseling. The improved conditions were observed after 4 weeks. Results The percentages of patients with anxiety was 60.7% (51/84) and those with anxiety complicated by depression was 47.6% (40/84) in CHD group, and percentages of patients with anxiety was 41.2% (47/114) and those with anxiety complicated by depression was 31.6% (36/114) in non-CHD group (all P<0.05). HAMA scores and HAMD scores were higher in CHD group than those in non-CHD group (P<0.05). HAMA scores and HAMD scores decreased significantly in medicated group after treatment for 4 weeks (all P<0.05), and HAMA scores and HAMD scores had no significant changes in non-medicated group (all P>0.05) after treatment. Conclusion CHD patients with chest pain are easily complicated by anxiety or anxiety complicated by depression. The drug therapy bases on psychological counseling can relieve anxiety and depression in CHD patients.