冠心病患者经皮冠状动脉介入术后焦虑抑郁现状及影响因素分析
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摘要
目的:研究冠心病患者经皮冠状动脉介入(PCI)术后焦虑抑郁现状,并分析其影响因素。方法:此项横断面观察性研究的对象选自2016年9月至2017年8月,于首都医科大学附属北京安贞医院行PCI治疗的冠心病患者。采用自制量表、医院焦虑抑郁量表对患者进行一般情况调查及心理测评。使用Logistic回归分析冠心病患者PCI治疗术后焦虑抑郁的影响因素。结果:入选了250例行PCI治疗且血运成功的术后患者,平均年龄为(64±5)岁。其中,有焦虑症状的患者37. 6%、有抑郁症的患者29. 6%、有焦虑合并抑郁症状的患者12. 4%。多因素分析,居住地(农村,OR=2. 092,95%CI:1. 243～3. 520,P=0. 005)、付费方式(自费/新农合,OR=2. 464,95%CI:1. 279～4. 745,P=0. 007)、月收入低(<3 000元,OR=2. 931,95%CI:1. 527～5. 626,P=0. 001)及合并糖尿病(OR=2. 600,95%CI:1. 355～4. 988)是PCI术后患者焦虑的危险因素;女性(OR=2. 086,95%CI:1. 186～3. 669)、文化程度低(小学及以下,OR=5. 603,95%CI:1. 567～20. 025,P=0. 008)、婚姻状况(离异/丧偶,OR=3. 459,95%CI:1. 569～7. 628,P=0. 002)、居住地(农村,OR=2. 085,95%CI:1. 202～3. 617,P=0. 009)是PCI术后患者抑郁的危险因素。结论:PCI治疗术后患者焦虑、抑郁的患病率较高。农村、自费/新农合、月收入低(<3 000元)或合并糖尿病的患者在PCI术后易出现焦虑情绪;女性、文化程度低(小学及以下)、离异/丧偶或农村的患者在PCI术后易出现抑郁情绪。医务人员在治疗这部分患者躯体疾病的同时,应更多关注其心理状况,及早识别不良情绪的发生并积极进行有效的干预。
Objective: To investigate the status of anxiety and depression in patients after percutaneous coronary intervention( PCI) and analyze the risk factors of anxiety and depression. Methods: This survey was a cross-sectional observation. The subjects were patients with coronary artery disease who underwent PCI,selected from the Capital Medical University Beijing Anzhen Hospital from September 2016 to August 2017. Self-designed scale and Hospital Anxiety and Depression Scale were respectively used to survey the general data and psychological state of patients. Logistic regression was used to analyze the influencing factors of anxiety and depression in patients after PCI. Results: There are 250 patients with successful PCI enrolled,with an average age of( 64 + 5) years. Of these,37. 6% had anxiety symptoms and 29. had anxiety symptoms. Regression equation showed that residence( rural area,OR = 2. 092,95% CI: 1. 243-3. 520,P = 0. 005),mode of payment( self-funded/new rural cooperative medical system,OR = 2. 464,95% CI: 1. 279-4. 745,P = 0. 007),low monthly income( < 3 000 yuan,OR = 2. 931,95% CI: 1. 527-5. 626,P = 0. 001) and diabetes mellitus( OR =2. 600,95% CI: 1. 355-4. 988) were anxiety risk factors for post-PCI patients; women( OR = 2. 086,95% CI:1. 186-3. 669),low educational level( primary school and below,OR = 5. 603,95% CI: 1. 567-20. 025,P =0. 008),marital status( divorce/widow,OR = 3. 459,95% CI: 1. 569-7. 628,P = 0. 002) and residence( rural,OR = 2. 085,95% CI: 1. 202-3. 617,P = 0. 009) were depression risk factors for post-PCI patients. Conclusions: The prevalence of anxiety and depression after PCI is high. Rural,self-funded/new rural cooperative medical system,low monthly income( < 3 000 yuan) or diabetes mellitus patients are prone to anxiety after PCI; female,low educational level( primary school and below),divorced/widowed or rural patients are prone to depression after PCI. Medical staff should pay more attention to the psychological condition of these patients,identify the occurrence of bad emotions early and carry out effective intervention actively.
Objective: To investigate the status of anxiety and depression in patients after percutaneous coronary intervention( PCI) and analyze the risk factors of anxiety and depression. Methods: This survey was a cross-sectional observation. The subjects were patients with coronary artery disease who underwent PCI,selected from the Capital Medical University Beijing Anzhen Hospital from September 2016 to August 2017. Self-designed scale and Hospital Anxiety and Depression Scale were respectively used to survey the general data and psychological state of patients. Logistic regression was used to analyze the influencing factors of anxiety and depression in patients after PCI. Results: There are 250 patients with successful PCI enrolled,with an average age of( 64 + 5) years. Of these,37. 6% had anxiety symptoms and 29. had anxiety symptoms. Regression equation showed that residence( rural area,OR = 2. 092,95% CI: 1. 243-3. 520,P = 0. 005),mode of payment( self-funded/new rural cooperative medical system,OR = 2. 464,95% CI: 1. 279-4. 745,P = 0. 007),low monthly income( < 3 000 yuan,OR = 2. 931,95% CI: 1. 527-5. 626,P = 0. 001) and diabetes mellitus( OR =2. 600,95% CI: 1. 355-4. 988) were anxiety risk factors for post-PCI patients; women( OR = 2. 086,95% CI:1. 186-3. 669),low educational level( primary school and below,OR = 5. 603,95% CI: 1. 567-20. 025,P =0. 008),marital status( divorce/widow,OR = 3. 459,95% CI: 1. 569-7. 628,P = 0. 002) and residence( rural,OR = 2. 085,95% CI: 1. 202-3. 617,P = 0. 009) were depression risk factors for post-PCI patients. Conclusions: The prevalence of anxiety and depression after PCI is high. Rural,self-funded/new rural cooperative medical system,low monthly income( < 3 000 yuan) or diabetes mellitus patients are prone to anxiety after PCI; female,low educational level( primary school and below),divorced/widowed or rural patients are prone to depression after PCI. Medical staff should pay more attention to the psychological condition of these patients,identify the occurrence of bad emotions early and carry out effective intervention actively.
引文
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[13]王翠,谭丞宏,杨文笔,等.PCI术后患者焦虑抑郁状态及影响因素调查[J].遵义医学院学报,2017(3).
[14]Moser DK,Dracup K.Role of spousal anxiety and depression in patients'psychosocial recovery after a cardiac event[J].Psychosom Med,2004,66(4):527-532.
[15]王群,钱晨光,袁琦.北京市社区老年人抑郁及焦虑的影响因素与心脑血管患病关系的调查[J].心肺血管病杂志,2017(3).
[16]陈慧,李笑葳,马淑梅.经皮冠状动脉介入治疗术后患者合并情绪障碍的现况调查[J].实用药物与临床,2011,14(2):121-123.
[17]原天岗,肖传实,赵永忠.我国综合医院精神卫生服务模式初探[J].中国医院管理,2002,22(12):23-24.Yuan TG,Xiao CS,Zhao YZ.Mental health service model in general hospitals in China[J].Chin Hosp Manag,2002,22(12):23-24.
[18]崔明,张玉山.对综合医院住院患者焦虑及抑郁状况的临床分析[J].中华精神科杂志,2000,33(2):99-99.
[2]Cohen BE,Edmondson D,Kronish IM.State of the art review:Depression,stress,anxiety,and cardiovascular disease[J].Am Heart J,2015,28:1295-1302.
[3]Zhang P.Study of anxiety/depression in patients with coronary heart disease after percutaneous coronary intervention[J].Cell Biochem Biophys.2015,72(2):503-507.
[4]Goldstein B I,Carnethon M R,Matthews K A,et al.Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease:a scientific statement from the American Heart Association[J].Circulation,2016,132(10):965-986.
[5]Tully P J,Baune B T.Anxiety and the effects on cardiovascular disease[M].Cardiovascular Diseases and Depression.Springer International Publishing,2016.
[6]Zigmond A S,Snaith R P.The hospital anxiety and depression scale[J].Acta Psychiatrica Scandinavica,1983,67(6):361.
[7]孙振晓,刘化学,焦林瑛,等.医院焦虑抑郁量表的信度及效度研究[J].中华临床医师杂志(电子版),2017,11(2):198-201.
[8]Phillips MR,Zhang J,Shi Q,et al.Prevalence,treatment,and associated disability of mental disorders in four provinces in China during 2001-05:an epidemiological survey[J].Lancet,2009,373(9680):2041-2053.
[9]Lee S,Tsang A,Huang Y Q,et al.The epidemiology of depression in metropolitan China[J].Psychol Med,2009,39(5):735-747.
[10]Gu G,Zhou Y,Zhang Y,et al.Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment[J].Bmc Psychiatry,2016,16(1):259.
[11]Maruyama N,Ashley K B,Casasnovas C,et al.Psychiatric care of the patient with diabetes[M].Springer International Publishing,2017.
[12]Delewi R,Vlastra W,Rohling WJ,et al.Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory.Int J Cardiol,2017,228:926-930.
[13]王翠,谭丞宏,杨文笔,等.PCI术后患者焦虑抑郁状态及影响因素调查[J].遵义医学院学报,2017(3).
[14]Moser DK,Dracup K.Role of spousal anxiety and depression in patients'psychosocial recovery after a cardiac event[J].Psychosom Med,2004,66(4):527-532.
[15]王群,钱晨光,袁琦.北京市社区老年人抑郁及焦虑的影响因素与心脑血管患病关系的调查[J].心肺血管病杂志,2017(3).
[16]陈慧,李笑葳,马淑梅.经皮冠状动脉介入治疗术后患者合并情绪障碍的现况调查[J].实用药物与临床,2011,14(2):121-123.
[17]原天岗,肖传实,赵永忠.我国综合医院精神卫生服务模式初探[J].中国医院管理,2002,22(12):23-24.Yuan TG,Xiao CS,Zhao YZ.Mental health service model in general hospitals in China[J].Chin Hosp Manag,2002,22(12):23-24.
[18]崔明,张玉山.对综合医院住院患者焦虑及抑郁状况的临床分析[J].中华精神科杂志,2000,33(2):99-99.