初发急性心肌梗死患者创伤后应激障碍现状及危险因素探究
|
摘要
目的探讨初发急性心肌梗死患者创伤后应激障碍(post-traumatic stress disorder,PTSD)现状及危险因素。方法选取2017年1月至2018年2月本院收治的266例初发急性心肌梗死患者为研究对象,根据发病后60 d的创伤后应激障碍量表平民版(PTSD checklist-civilian version,PCL-C)评分将其分为PTSD组和无PTSD组,比较两组患者的基线资料、人格特征与反刍思维,采用多因素Logistic回归分析探讨初发急性心肌梗死患者发生PTSD的独立影响因素。结果全部患者的PCL-C总分为(39.6±7.9)分,其中再体验、回避、高警觉症候群的条目评分分别为2.30、2.29、2.42分。共有85例(32.0%)患者被诊断为PTSD,纳入PTSD组,其余181例患者纳入非PTSD组。PTSD组患者的高血压比例、神经质评分、侵入性反刍评分均显著高于非PTSD组(均P <0.05),年龄、内外向评分、主动反刍评分均显著低于非PTSD组(均P <0.05)。多因素Logistic回归分析结果显示,神经质评分、侵入性反刍评分升高是初发急性心肌梗死患者发生PTSD的独立危险因素(均P <0.05),而年龄增长是其独立保护因素(均P <0.05)。结论近1/3的初发急性心肌梗死患者存在PTSD,以警觉性增高症候群表现最为严重,神经质评分与侵入性反刍评分升高是初发急性心肌梗死患者发生PTSD的独立危险因素,而年龄增长是其独立保护因素。
Objective To study the status and risk factors of post-traumatic stress disorder(PTSD) in patients with first-onset acute myocardial infarction(AMI). Method 266 patients with first-onset AMI from January 2017 to February 2018 were enrolled the study and divided into PTSD group and non-PTSD group according to PTSD checklist-civilian version(PCL-C) at 60 days after onset.Baseline data, personality characteristics and rumination were compared between two groups. Multivariate Logistic regression analysis was used to investigate the independent influencing factors of PTSD in patients with primary AMI. Result The total score of PCL-C in all patients was(39.6±7.9) points. The average scores of item of re-experience, avoidance and high alertness syndrome were 2.30,2.29 and 2.42 points respectively. A total of 85 patients(32.0%) were diagnosed with PTSD and classified as PTSD group, while the remaining 181 patients were classified as non-PTSD group. The proportion of hypertension, neuroticism score and intrusive rumination score in PTSD group were significantly higher than those in non-PTSD group, while age, extraversion score and active rumination score were significantly lower than those in non-PTSD group(all P > 0.05). Multivariate Logistic regression analysis showed that increased neuroticism score and intrusive rumination score were the independent risk factors for PTSD in patients with first-onset AMI(all P < 0.05), and increased age was an independent protective factor(P < 0.05). Conclusion Nearly one third of first-onset AMI patients suffer from PTSD, and high alertness syndrome is the most serious. Increased neuroticism score and invasive rumination score were the independent risk factors for PTSD in patients with first-onset AMI, while increased age is an independent protective factor.
Objective To study the status and risk factors of post-traumatic stress disorder(PTSD) in patients with first-onset acute myocardial infarction(AMI). Method 266 patients with first-onset AMI from January 2017 to February 2018 were enrolled the study and divided into PTSD group and non-PTSD group according to PTSD checklist-civilian version(PCL-C) at 60 days after onset.Baseline data, personality characteristics and rumination were compared between two groups. Multivariate Logistic regression analysis was used to investigate the independent influencing factors of PTSD in patients with primary AMI. Result The total score of PCL-C in all patients was(39.6±7.9) points. The average scores of item of re-experience, avoidance and high alertness syndrome were 2.30,2.29 and 2.42 points respectively. A total of 85 patients(32.0%) were diagnosed with PTSD and classified as PTSD group, while the remaining 181 patients were classified as non-PTSD group. The proportion of hypertension, neuroticism score and intrusive rumination score in PTSD group were significantly higher than those in non-PTSD group, while age, extraversion score and active rumination score were significantly lower than those in non-PTSD group(all P > 0.05). Multivariate Logistic regression analysis showed that increased neuroticism score and intrusive rumination score were the independent risk factors for PTSD in patients with first-onset AMI(all P < 0.05), and increased age was an independent protective factor(P < 0.05). Conclusion Nearly one third of first-onset AMI patients suffer from PTSD, and high alertness syndrome is the most serious. Increased neuroticism score and invasive rumination score were the independent risk factors for PTSD in patients with first-onset AMI, while increased age is an independent protective factor.
引文
[1]Cone JE,Li J,Kornblith E,et al.Chronic probable PTSD in police responders in the world trade center health registry ten to eleven years after 9/11[J].Am J Ind Med,2015,58(5):483-493.
[2]Krakow BJ,Ulibarri VA,Moore BA,et al.Posttraumatic stress disorder and sleep-disordered breathing:a review of comorbidity research[J].Sleep Med Rev,2015,24:37-45.
[3]吴仁利,马骏,谈清明,等.乙型肝炎患者5项结果及心理状态分析[J].转化医学电子杂志,2016,3(7):84-85.
[4]解芙艳,马艳华,高娃.社区老年慢性病患者的抑郁状况及其对抑郁情绪认知情况的调查[J].转化医学电子杂志,2015,2(10):46-47.
[5]陆秀琴,邹圣强,杨聪,等.耐多药结核病患者身心状况和应对方式现状调查及对策[J].中国医学前沿杂志(电子版),2015,7(8):45-47.
[6]Guler E,Schmid JP,Wiedemar L,et al.Clinical diagnosis of posttraumatic stress disorder after myocardial infarction[J].Clin Cardiol,2009,32(3):125-129.
[7]Singh A,Agrawal S,Gargya S,et al.Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting[J].Int J Crit Illn Inj Sci,2017,7(2):84-90.
[8]Sumner JA,Kubzansky LD,Elkind MS,et al.Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women[J].Circulation,2015,132(4):251-259.
[9]Perkins-Porras L,Joekes K,Bhalla N,et al.Reporting of Posttraumatic Stress Disorder and Cardiac Misconceptions Following Cardiac Rehabilitation[J].J Cardiopulm Rehabil Prev,2015,35(4):238-245.
[10]Wiedemar L,Schmid JP,Müller J,et al.Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction[J].Heart Lung,2008,37(2):113-121.
[11]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会,等.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[12]Sheng QH,Hsu CC,Li JP,et al.Combining fragmented QRSand TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction[J].J Zhejiang Univ Sci B,2018,19(5):349-353.
[13]吴鑫,陈龙,戴文杰,等.创伤后应激障碍症状阳性者的人格特征与创伤后应激障碍预后的关系[J].中国心理卫生杂志,2017,31(4):268-273.
[14]Li H,Wang L,Shi Z,et al.Diagnostic utility of the PTSDChecklist in detecting ptsd in Chinese earthquake victims[J].Psychol Rep,2010,107(3):733-739.
[15]王学义,马文有.艾森克人格问卷简式量表中国版对神经症的测试研究[J].河北精神卫生,2002,15(1):13-15.
[16]周宵,伍新春,安媛媛,等.事件相关反刍量表在地震后青少年群体中的适用性研究[J].中国临床心理学杂志,2017,25(6):1001-1006.
[17]刘瑛,陈宝坤,俞平,等.创伤后应激障碍评估量表综述[J].国际精神病学杂志,2015,42(1):114-118.
[18]梁冰,梁晶冰,邢姿,等.人格特征对急性心肌梗死所致创伤后应激障碍的影响[J].海南医学,2016,27(19):3146-3148,3149.
[19]Edmondson D,Cohen BE.Posttraumatic stress disorder and cardiovascular disease[J].Prog Cardiovasc Dis,2013,55(6):548-556.
[20]徐向东,吕淑云,张莉,等.突发群体事件后社区居民创伤后应激障碍及抑郁症的相关因素[J].中国心理卫生杂志,2014,28(4):241-247.
[21]Chung MC,Berger Z,Rudd H.Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction[J].Psychiatry Res,2007,152(2-3):243-252.
[22]Aidman EV,Kollaras-Mitsinikos L.Personality dispositions in the prediction of posttraumatic stress reactions[J].Psychol Rep,2006,99(2):569-580.
[23]Stevanovi?A,Fran?i?kovi?T,Vermetten E.Relationship of early-life trauma,war-related trauma,personality traits,and PTSD symptom severity:a retrospective study on female civilian victims of war[J].Eur J Psychotraumatol,2016,7:30964.
[24]Stockton H,Hunt N,Joseph S.Cognitive processing,rumination,and posttraumatic growth[J].J Trauma Stress,2011,24(1):85-92.
[25]伍新春,周宵,王文超,等.关于创伤后应激障碍与创伤后成长的辩证认识--基于整合-比较的视角[J].北京师范大学学报(社会科学版),2018(2):41-50.
[2]Krakow BJ,Ulibarri VA,Moore BA,et al.Posttraumatic stress disorder and sleep-disordered breathing:a review of comorbidity research[J].Sleep Med Rev,2015,24:37-45.
[3]吴仁利,马骏,谈清明,等.乙型肝炎患者5项结果及心理状态分析[J].转化医学电子杂志,2016,3(7):84-85.
[4]解芙艳,马艳华,高娃.社区老年慢性病患者的抑郁状况及其对抑郁情绪认知情况的调查[J].转化医学电子杂志,2015,2(10):46-47.
[5]陆秀琴,邹圣强,杨聪,等.耐多药结核病患者身心状况和应对方式现状调查及对策[J].中国医学前沿杂志(电子版),2015,7(8):45-47.
[6]Guler E,Schmid JP,Wiedemar L,et al.Clinical diagnosis of posttraumatic stress disorder after myocardial infarction[J].Clin Cardiol,2009,32(3):125-129.
[7]Singh A,Agrawal S,Gargya S,et al.Posttraumatic stress disorder after myocardial infarction and coronary artery bypass grafting[J].Int J Crit Illn Inj Sci,2017,7(2):84-90.
[8]Sumner JA,Kubzansky LD,Elkind MS,et al.Trauma Exposure and Posttraumatic Stress Disorder Symptoms Predict Onset of Cardiovascular Events in Women[J].Circulation,2015,132(4):251-259.
[9]Perkins-Porras L,Joekes K,Bhalla N,et al.Reporting of Posttraumatic Stress Disorder and Cardiac Misconceptions Following Cardiac Rehabilitation[J].J Cardiopulm Rehabil Prev,2015,35(4):238-245.
[10]Wiedemar L,Schmid JP,Müller J,et al.Prevalence and predictors of posttraumatic stress disorder in patients with acute myocardial infarction[J].Heart Lung,2008,37(2):113-121.
[11]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会,等.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[12]Sheng QH,Hsu CC,Li JP,et al.Combining fragmented QRSand TIMI score for predicting in-hospital short-term prognosis after acute myocardial infarction[J].J Zhejiang Univ Sci B,2018,19(5):349-353.
[13]吴鑫,陈龙,戴文杰,等.创伤后应激障碍症状阳性者的人格特征与创伤后应激障碍预后的关系[J].中国心理卫生杂志,2017,31(4):268-273.
[14]Li H,Wang L,Shi Z,et al.Diagnostic utility of the PTSDChecklist in detecting ptsd in Chinese earthquake victims[J].Psychol Rep,2010,107(3):733-739.
[15]王学义,马文有.艾森克人格问卷简式量表中国版对神经症的测试研究[J].河北精神卫生,2002,15(1):13-15.
[16]周宵,伍新春,安媛媛,等.事件相关反刍量表在地震后青少年群体中的适用性研究[J].中国临床心理学杂志,2017,25(6):1001-1006.
[17]刘瑛,陈宝坤,俞平,等.创伤后应激障碍评估量表综述[J].国际精神病学杂志,2015,42(1):114-118.
[18]梁冰,梁晶冰,邢姿,等.人格特征对急性心肌梗死所致创伤后应激障碍的影响[J].海南医学,2016,27(19):3146-3148,3149.
[19]Edmondson D,Cohen BE.Posttraumatic stress disorder and cardiovascular disease[J].Prog Cardiovasc Dis,2013,55(6):548-556.
[20]徐向东,吕淑云,张莉,等.突发群体事件后社区居民创伤后应激障碍及抑郁症的相关因素[J].中国心理卫生杂志,2014,28(4):241-247.
[21]Chung MC,Berger Z,Rudd H.Comorbidity and personality traits in patients with different levels of posttraumatic stress disorder following myocardial infarction[J].Psychiatry Res,2007,152(2-3):243-252.
[22]Aidman EV,Kollaras-Mitsinikos L.Personality dispositions in the prediction of posttraumatic stress reactions[J].Psychol Rep,2006,99(2):569-580.
[23]Stevanovi?A,Fran?i?kovi?T,Vermetten E.Relationship of early-life trauma,war-related trauma,personality traits,and PTSD symptom severity:a retrospective study on female civilian victims of war[J].Eur J Psychotraumatol,2016,7:30964.
[24]Stockton H,Hunt N,Joseph S.Cognitive processing,rumination,and posttraumatic growth[J].J Trauma Stress,2011,24(1):85-92.
[25]伍新春,周宵,王文超,等.关于创伤后应激障碍与创伤后成长的辩证认识--基于整合-比较的视角[J].北京师范大学学报(社会科学版),2018(2):41-50.