抑郁对冠状动脉旁路移植术后患者远期预后的影响

摘要

目的 总结冠状动脉旁路移植手术前后患者抑郁发生比例,探讨抑郁对术后远期预后的影响.方法 选取2009年5月至2010年2月期间345例冠状动脉旁路移植手术患者,其中男221例,女124例;平均年龄(61.5±7.8)岁.根据ZUNG抑郁自评量表(SDS)测定结果,将患者分为抑郁组(84例)和非抑郁组(261例),比较两组手术前、后抑郁的发生比例.随访24个月,观察抑郁对主要不良心血管事件(MACE)发生比例的影响,进行两组间无MACE、死亡生存分析,并行Cox多因素分析.结果 345例患者中,抑郁组女性患者比例、体质量指数、既往高血压、脑血管疾病等基线指标均高于非抑郁组,差异有统计学意义(P＜0.05).患者术后抑郁较术前明显增高(40.9％对24.3％,P＜0.05).随访24个月,抑郁组总MACE发生比例明显高于非抑郁组(16.5％对5.2％,P＜0.01),其中心肌梗死发生比例及再次血运重建率较非抑郁组患者增高(6.8％对2.1％,6.6％对1.6％,P＜0.05).两组患者24个月累积病死率(3.3％对1.6％,P=0.315)差异无统计学意义.Kaplan-Meier生存分析曲线显示,抑郁组患者24个月的无MACE生存率显著低于非抑郁组患者(P＜0.001);死亡生存分析,两组患者差异无统计学意义(P =0.309).Cox多因素分析结果显示,抑郁症、左心室射血分数、既往心肌梗死是CABG患者术后24个月内MACE发生的独立危险因素.结论 冠状动脉旁路移植手术前后均有较高比例的患者存在不同程度抑郁,术后抑郁发生比例明显高于术前;冠状动脉旁路移植术后,抑郁组患者总MACE的发生比例明显高于非抑郁组患者,术后抑郁是MACE发生的危险因素,影响远期预后.%Objective To investigate the incidence of depression of coronary artery bypass grafting before and after surgery in patients with coronary heart disease and the impact of depression on patients undergoing coronary artery bypass grafting.Methods 345 patients treat with CABG were divided into depression and non depression groups based on Serf-rating depression scale(SDS).Compare the change of different degree of depression occurrence rate before and after surgery.All patients were followed up for 24 months after procedure for the occurrence major adverse cardiovascular events(MACE),then make the non MACE survival analysis and Cox regression.Results Baseline data of BMI(body mass index) and history of hypertension,cerebrovascular disease was statistically significant difference between groups.Depression in patients after CABG was significantly higher than that before procedure(40.9％ vs 24.3％,P ＜0.05).The MACE rate was significantly higher in patients with post-procedure depression than that in patients without depression(16.5％ vs 5.2％,P ＜0.01),and the incidences of myocardial infarction and target lesion revascularization were also significantly higher in depression patients than in non-depression patients(6.8％ vs 2.1％,6.6％ vs 1.6％,P ＜ 0.05).There was no significant difference on accumulative mortality between two groups(3.3％ vs 1.6％,P =0.315).The survival analysis curve of Kaplan-Meier show the incidences of non MACE survival rate was significantly lower in depression patients than in non-depression patients (P ＜0.001).There was no significant difference on death survival analysis(P =0.309).Depression,old myocardial infarction and LVEF(left ventricular ejection fraction)were independent risk factors for MACE.Conclusion The proportion was higher in patients with post-procedure and pre-procedure who have different degree of depression,the MACE rate was significantly higher in patients with postprocedure depression than in patients without depression.Depression is dangerous factors for prognosis of patients with coronary artery bypass grafting.