焦虑障碍并发急性下壁心肌梗死1例
|
摘要
目的分析焦虑障碍病人并发急性心肌梗死医疗措施。方法对六安市第二人民医院2017年12月收治的1例焦虑障碍病人并发急性心肌梗死病例进行回顾分析。结果病人因"睡眠差、心发急、诸多躯体不适感2个月,加重15 d"入院,诊断:焦虑障碍。给予常规抗焦虑治疗16 d,病人情绪仍不稳定,并突然出现心急、烦躁不安、胸闷、胸痛,经动态监测心电图、急诊冠脉造影示:病人右冠脉中段闭塞;之后行经皮冠状动脉介入治疗(PCI)术,病人胸闷、胸痛症状消失;然焦虑依然明显,转入精神科予以"草酸艾司西酞普兰、阿普唑仑"等治疗,病情好转出院。2周后随访,病人病情平稳。结论焦虑障碍可增加急性心肌梗死不良事件发生率;关注病人的精神状态及病情变化,有助于鉴别诊断,降低病人住院期间的意外发生。
Objective To analyze and to explore the medical measures of the disease.Methods A case report of acute myocardial infarction in a patient with anxiety disorder admitted to Lu'an Second People's Hospital in December 2017 was retrospectively analyzed.Results The patient was admitted to hospital for "poor sleep,impatience,and other various physical discomfort for 2 months,aggravated for 15 days",then diagnosed as anxiety disorder.After routine anti-anxiety treatment for 16 days,the patient's mood was still unstable,and developed sudden impatience,irritability,chest tightness,and chest pain.Dynamic monitoring of electrocardiogram and emergency coronary angiography showed middle occlusion of the right coronary artery.After the treatment of percutaneous coronary intervention(PCI),the patient's symptoms of chest tightness and chest pain disappeared,but the anxiety was still obvious.The patient was then transferred to the psychiatric department and treated with Oxacin oxalic acid and Alprazolam.Later the condition was improved and the patient was discharged.The follow-up two weeks later showed that the patient's condition was stable.Conclusions Anxiety disorders can increase the incidence of adverse events in acute myocardial infarction.Concern on the patient's mental state and changes in the condition can help differential diagnosis and reduce accidents during hospitalization.
Objective To analyze and to explore the medical measures of the disease.Methods A case report of acute myocardial infarction in a patient with anxiety disorder admitted to Lu'an Second People's Hospital in December 2017 was retrospectively analyzed.Results The patient was admitted to hospital for "poor sleep,impatience,and other various physical discomfort for 2 months,aggravated for 15 days",then diagnosed as anxiety disorder.After routine anti-anxiety treatment for 16 days,the patient's mood was still unstable,and developed sudden impatience,irritability,chest tightness,and chest pain.Dynamic monitoring of electrocardiogram and emergency coronary angiography showed middle occlusion of the right coronary artery.After the treatment of percutaneous coronary intervention(PCI),the patient's symptoms of chest tightness and chest pain disappeared,but the anxiety was still obvious.The patient was then transferred to the psychiatric department and treated with Oxacin oxalic acid and Alprazolam.Later the condition was improved and the patient was discharged.The follow-up two weeks later showed that the patient's condition was stable.Conclusions Anxiety disorders can increase the incidence of adverse events in acute myocardial infarction.Concern on the patient's mental state and changes in the condition can help differential diagnosis and reduce accidents during hospitalization.
引文
[1] 侯晓平,缪京梨,周云飞,等.住院老年心血管疾病患者的情感障碍调查[J].中华老年多器官疾病杂志,2009,8(3):269-270.
[2] 马秀虎.老年心血管疾病伴发焦虑情绪的调查与分析[J].中国社区医师,2014,30(20):16-17.
[3] 郝伟,于欣.精神病学[M].7版.北京:人民卫生出版社,2013:131-132.
[4] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2014:220-221.
[5] 高传发,马礼坤,李家宝,等.年轻急性心肌梗死的临床特点和预后分析[J].安徽医药,2014,18(11):2163-2165.
[6] 应优优,李浙成,胡智星,等.焦虑抑郁与冠心病发生的关系研究[J].中华老年心脑血管病杂志,2015,17(7):762-763.
[7] 严明.舒必利的临床不良反应[J].中国民康医学,2010,22(5):577-579.
[8] ROEST AM,ZUIDERSMA M.Myocardial infarction and generalised anxiety disorder:10-year follow-up[J].Br J Psychiatry,2012,200(4):324-329.
[9] 黄曾艳,梁东辉.急性冠脉综合征与焦虑抑郁状态相关性的研究进展[J].广东医学,2015,36(22):3552-3554.
[10] 张焱,周勇杰.伴不同焦虑和(或)抑郁障碍的冠心病患者心率变异性情况及舍曲林的应用效果[J].广东医学,2017,38(14):2219-2223.
[11] 谢芳,李高飞.西酞普兰对冠心病合并焦虑抑郁患者HAMA SDS评分的影响[J].重庆医学,2015,44(18):2512-2514.
[2] 马秀虎.老年心血管疾病伴发焦虑情绪的调查与分析[J].中国社区医师,2014,30(20):16-17.
[3] 郝伟,于欣.精神病学[M].7版.北京:人民卫生出版社,2013:131-132.
[4] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2014:220-221.
[5] 高传发,马礼坤,李家宝,等.年轻急性心肌梗死的临床特点和预后分析[J].安徽医药,2014,18(11):2163-2165.
[6] 应优优,李浙成,胡智星,等.焦虑抑郁与冠心病发生的关系研究[J].中华老年心脑血管病杂志,2015,17(7):762-763.
[7] 严明.舒必利的临床不良反应[J].中国民康医学,2010,22(5):577-579.
[8] ROEST AM,ZUIDERSMA M.Myocardial infarction and generalised anxiety disorder:10-year follow-up[J].Br J Psychiatry,2012,200(4):324-329.
[9] 黄曾艳,梁东辉.急性冠脉综合征与焦虑抑郁状态相关性的研究进展[J].广东医学,2015,36(22):3552-3554.
[10] 张焱,周勇杰.伴不同焦虑和(或)抑郁障碍的冠心病患者心率变异性情况及舍曲林的应用效果[J].广东医学,2017,38(14):2219-2223.
[11] 谢芳,李高飞.西酞普兰对冠心病合并焦虑抑郁患者HAMA SDS评分的影响[J].重庆医学,2015,44(18):2512-2514.