摘要
目的对基层医院急性冠脉综合征(ACS)患者合并焦虑状态的相关因素进行临床分析,探讨早期识别及干预焦虑状态对ACS患者预后的影响。方法选取2012年6月—2014年1月在绍兴市人民医院就诊并住院的ACS患者450例,其经汉密尔顿焦虑量表(HAMA)评定后,确定非焦虑患者298例(非焦虑组),伴焦虑患者152例(焦虑组);将伴焦虑组患者按照随机数字表法分为焦虑A亚组(75例)和焦虑B亚组(77例)。分析非焦虑组和焦虑组一般临床资料。焦虑A亚组在冠心病常规治疗基础上予以心理干预,焦虑B亚组在常规治疗基础上予以心理干预的同时联合舍曲林片和劳拉西泮片药物干预。抗焦虑治疗1个月后,对两亚组再次进行HAMA评分;并对两亚组进行12个月的随访,记录主要不良心血管事件(MACE)发生率。结果 ACS伴焦虑的发病率为33.8%。多因素Logistic回归分析结果显示,性别、年龄、丧偶、胸痛、高血压病史、糖尿病病史、合并慢性病种类是影响ACS患者发生焦虑的因素(P<0.05)。焦虑A亚组治疗前后HAMA评分比较,差异无统计学意义(t=1.875,P=0.052);焦虑B亚组治疗后HAMA评分低于治疗前(t=2.382,P=0.018);两亚组治疗前HAMA评分比较,差异无统计学意义(t=0.096,P=0.321);治疗后,焦虑B亚组HAMA评分低于焦虑A亚组(t=2.084,P=0.039)。焦虑A亚组MACE发生率为34.7%(26/75),高于焦虑B亚组的13.0%(10/77)(χ2=7.909,P=0.005)。Kaplan-Meier分析显示随访12个月时,两亚组无事件生存率比较,差异有统计学意义(χ2=13.563,P<0.001)。结论女性、高龄、丧偶、胸痛、高血压、糖尿病、患多种慢性病是ACS合并焦虑状态的影响因素,心理干预联合药物治疗可更有效地改善ACS患者焦虑症状,并可明显降低MACE的发生率,患者预后较好。
Objective To make clinical analysis on the related factors of patients with acute coronary syndrome （ ACS） and anxiety in primary hospitals and to explore the influence of early identification and anxiety intervention on the prognosis of ACS patients. Methods We enrolled 450 patients who were admitted into Shaoxing People′s Hospital from June 2012 to January 2014. According to the results of HAmA assessment,we assigned 298 patients into non -anxiety group and assigned 152 patients into anxiety group. Using random number table method,we further divided the anxiety group into anxiety subgroup A（n=75）and anxiety subgroup B（n=77）. The general clinical data of the two groups were analyzed. Subgroup A and subgroup B were administrated with conventional treatment of coronary heart diseases and mental intervention;subgroup B was also administrated with sertraline tablets and lorazepam tablets. One month after treatment, the two subgroups were undertaken with HAmA assessment again. We made one - year follow - up visits on the two subgroups, during which the incidence rates of major adverse cardiac events（ mACE） were recorded. Results The morbidity of ACS combined with anxiety＆amp;nbsp;was 33. 8%. The multivariate Logistic regression analysis showed that gender,age,death of spouse,chest pain,history of hypertension,history of diabetes,the combination of chronic diseases were influencing factors for anxiety in ACS patients（ P〈0. 05）. The HAmA score of subgroup A after treatment was not significantly different from that before treatment（ t=1. 875,P=0. 052）;the HAmA score of subgroup B after treatment was lower than that before treatment（t=2. 382,P=0. 018）;before treatment,the two subgroups were not significantly different in HAmA score （ t = 0. 096, P = 0. 321 ）;after treatment, subgroup B was lower than subgroup A in HAmA score（t=2. 084,P=0. 039）. The mACE incidence rate of subgroup A was 34. 7%（26/75）,higher than that of subgroup B which was 13. 0%（10/77）（χ2 =7. 909,P=0.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第26期3137-3141,共5页
Chinese General Practice
基金
浙江省卫生厅适宜技术成果转化项目(2012ZHB022)
关键词
急性冠状动脉综合征
焦虑
心理治疗过程
药物疗法
联合
Acute coronary syndrome
Anxiety
Psychotherapeutic process
Drug therapy, combination
