住院心肌梗死病人躯体化症状调查及影响因素分析
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摘要
目的探讨住院心肌梗死病人躯体化症状及影响因素,为制定针对性的干预措施提供依据。方法2016年5月—2017年3月,选取住院心肌梗死病人203例,采用躯体化症状自评量表(SSS)、健康问卷抑郁症状群量表(PHQ-9)和广泛性焦虑量表(GAD-7)对入选病人进行测评,对影响住院心肌梗死病人躯体化症状的因素进行多元逐步回归分析。结果住院心肌梗死病人躯体化症状总分为(35.56±9.68)分,躯体化症状与焦虑抑郁呈显著正相关(r=0.530、0.640,P<0.01)。多元逐步回归分析显示,影响住院心肌梗死病人躯体化症状的主要因素为性别、住院次数、是否支架植入及急诊转入等。结论在住院心肌梗死病人中女性躯体化症状较重,对于急症入院或频繁入院、支架植入且伴有焦虑抑郁的病人应采取相应干预措施,提高其生活质量。
Objective To investigate the somatization symptoms and related influencing factors in hospitalized patients with myocardial infarction,and to provide a basis for developing targeted intervention measures. Methods From May 2016 to March 2017,203 hospitalized patients with myocardial infarction were enrolled and assessed with Somatic Self-rating Scale(SSS),Patient Health Questionnaire-9(PHQ-9),and the 7-item Generalized Anxiety Disorder Scale(GAD-7).A multivariate stepwise regression analysis was performed to identify the influencing factors for somatization symptoms in hospitalized patients with myocardial infarction. Results In hospitalized patients with myocardial infarction,the total score of somatization symptoms was35.56±9.68 and somatization symptom score was positively correlated with anxiety and depression(r=0.530 and 0.640,P<0.01).The multiple stepwise regression analysis showed that sex,times of hospitalization,stent implantation,and emergency transfer were the main influencing factors for somatization symptoms in hospitalized patients with myocardial infarction. Conclusion Female hospitalized patients with myocardial infarction have severe somatization symptoms.Related intervention measures should be adopted for patients with emergency admission or frequent admission,stent implantation,and anxiety and depression.
Objective To investigate the somatization symptoms and related influencing factors in hospitalized patients with myocardial infarction,and to provide a basis for developing targeted intervention measures. Methods From May 2016 to March 2017,203 hospitalized patients with myocardial infarction were enrolled and assessed with Somatic Self-rating Scale(SSS),Patient Health Questionnaire-9(PHQ-9),and the 7-item Generalized Anxiety Disorder Scale(GAD-7).A multivariate stepwise regression analysis was performed to identify the influencing factors for somatization symptoms in hospitalized patients with myocardial infarction. Results In hospitalized patients with myocardial infarction,the total score of somatization symptoms was35.56±9.68 and somatization symptom score was positively correlated with anxiety and depression(r=0.530 and 0.640,P<0.01).The multiple stepwise regression analysis showed that sex,times of hospitalization,stent implantation,and emergency transfer were the main influencing factors for somatization symptoms in hospitalized patients with myocardial infarction. Conclusion Female hospitalized patients with myocardial infarction have severe somatization symptoms.Related intervention measures should be adopted for patients with emergency admission or frequent admission,stent implantation,and anxiety and depression.
引文
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[12]文守琴,孟宪东,陈娟,等.PHQ-9与SDS在急诊待床入院患者抑郁筛查中的应用比较研究[J].四川医学,2017,38(2):151-155.
[13]王瑜,陈然,张岚.广泛性焦虑量表-7在中国综合医院住院患者中的信效度研究[J].临床精神医学杂志,2018,28(3):168-171.
[14]周妍妍,毕亚红,劳力敏,等.广泛性焦虑量表在筛查广泛性焦虑障碍中的应用[J].中华全科医师杂志,2018,17(9):735-737.
[15]DEJEAN D,GIACOMINI M,VANSTONE M,et al.Patient experiences of depression and anxiety with chronic disease:a systematic review and qualitative meta-synthesis[J].Ontario Health Technology Assessment Series,2013,13(16):1-33.
[16]汪凯,朱春燕.应重视综合医院躯体化症状的识别[J].中国现代神经疾病杂志,2016,16(5):247-252.
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[18]蔡宏澜,段宝霖,王雅,等.慢性疼痛病人伴发焦虑、抑郁和躯体化症状的现况分析[J].中国疼痛医学杂志,2017,23(10):788-790.
[19]冯颖,李凤,李淮玉.睡眠障碍伴焦虑躯体化症状的临床研究[J].国际神经精神科学杂志,2016,5(3):48-53.
[20]郭琳,丁峰,赵兴胜,等.心内科表现为躯体化症状的心理障碍患者的识别和处理[J].世界最新医学信息文摘,2017,17(76):77-82.
[21]刘辉.综合医院躯体化障碍患者临床资料分析[J].临床心身疾病杂志,2016,22(5):132-133.
[22]POLONI N,IELMINI M,CASELLI I,et al.Medically unexplained physical symptoms in hospitalized patients:a 9-year retrospective observational study[J].Frontiers in Psychiatry,2018,9(9):626.
[23]楼秋英,冯国和,张邢炜,等.延续性护理干预对急性心肌梗死患者PCI术后心理状态及服药依从性的影响[J].中国护理管理,2014,14(1):45-47,48.
[24]刘瑞卿,董晓晶,董佩霞.PCI术后患者疾病感知水平与远期生存质量的相关性分析[J].中华现代护理杂志,2018,24(27):3285-3289.
[25]李英,张瑶琴.院前急救心理护理对急性心肌梗死患者的效果探究[J].山西医药杂志,2017,46(10):1238-1240.
[26]鲁和英,李淑君,彭启凤,等.心理干预对躯体化障碍患者睡眠质量及焦虑情绪的影响[J].国际精神病学杂志,2018,45(5):918-920.
[2]陈伟伟,王文,隋辉,等.《中国心血管病报告2016》要点解读[J].中华高血压杂志,2017,25(7):605-608,600.
[3]DIMSDALE J,CREED F,ESCOBAR J,et al.Somatic symptom disorder:an important change in DSM[J].Journal of Psychosomatic Research,2013,75(3):223-228.
[4]陈子晨.被医学分割的身体:“躯体化”概念的问题和启示[J].文化研究,2017(4):179-192.
[5]刘旭甡,贺苗.“躯体化”模式的文化研究[J].医学与哲学(A),2017,38(6):28-30.
[6]FIGUEREDO V M.The time has come for physicians to take notice:the impact of psychosocial stressors on the heart[J].American Journal of Medicine,2009,122(8):704-712.
[7]中华医学会神经病学分会神经心理学与行为神经病学组.综合医院焦虑、抑郁与躯体化症状诊断治疗的专家共识[J].中华神经科杂志,2016,49(12):908-917.
[8]王维中.高度重视躯体化心理障碍在内科的诊治[J].浙江医学,2017,56(23):2069-2070.
[9]庄琦,毛家亮,李春波,等.躯体化症状自评量表的初步编制及信度和效度研究[J].中华行为医学与脑科学杂志,2010,19(9):847-849.
[10]陈然,王瑜,余建英,等.PHQ-9在综合医院住院患者中信效度研究[J].四川精神卫生,2017,30(2):149-153.
[11]吕兰竹,周月英,苏泳诗.GAD-7和PHQ-9调查分析综合医院住院患者焦虑抑郁状况[J].中国现代医药杂志,2017,19(3):47-49.
[12]文守琴,孟宪东,陈娟,等.PHQ-9与SDS在急诊待床入院患者抑郁筛查中的应用比较研究[J].四川医学,2017,38(2):151-155.
[13]王瑜,陈然,张岚.广泛性焦虑量表-7在中国综合医院住院患者中的信效度研究[J].临床精神医学杂志,2018,28(3):168-171.
[14]周妍妍,毕亚红,劳力敏,等.广泛性焦虑量表在筛查广泛性焦虑障碍中的应用[J].中华全科医师杂志,2018,17(9):735-737.
[15]DEJEAN D,GIACOMINI M,VANSTONE M,et al.Patient experiences of depression and anxiety with chronic disease:a systematic review and qualitative meta-synthesis[J].Ontario Health Technology Assessment Series,2013,13(16):1-33.
[16]汪凯,朱春燕.应重视综合医院躯体化症状的识别[J].中国现代神经疾病杂志,2016,16(5):247-252.
[17]HOUWEN J,LUCASSEN P,STAPPERS H W,et al.Medically unexplained symptoms:the person,the symptoms and the dialogue[J].Family Practice,2017,34(2):245-251.
[18]蔡宏澜,段宝霖,王雅,等.慢性疼痛病人伴发焦虑、抑郁和躯体化症状的现况分析[J].中国疼痛医学杂志,2017,23(10):788-790.
[19]冯颖,李凤,李淮玉.睡眠障碍伴焦虑躯体化症状的临床研究[J].国际神经精神科学杂志,2016,5(3):48-53.
[20]郭琳,丁峰,赵兴胜,等.心内科表现为躯体化症状的心理障碍患者的识别和处理[J].世界最新医学信息文摘,2017,17(76):77-82.
[21]刘辉.综合医院躯体化障碍患者临床资料分析[J].临床心身疾病杂志,2016,22(5):132-133.
[22]POLONI N,IELMINI M,CASELLI I,et al.Medically unexplained physical symptoms in hospitalized patients:a 9-year retrospective observational study[J].Frontiers in Psychiatry,2018,9(9):626.
[23]楼秋英,冯国和,张邢炜,等.延续性护理干预对急性心肌梗死患者PCI术后心理状态及服药依从性的影响[J].中国护理管理,2014,14(1):45-47,48.
[24]刘瑞卿,董晓晶,董佩霞.PCI术后患者疾病感知水平与远期生存质量的相关性分析[J].中华现代护理杂志,2018,24(27):3285-3289.
[25]李英,张瑶琴.院前急救心理护理对急性心肌梗死患者的效果探究[J].山西医药杂志,2017,46(10):1238-1240.
[26]鲁和英,李淑君,彭启凤,等.心理干预对躯体化障碍患者睡眠质量及焦虑情绪的影响[J].国际精神病学杂志,2018,45(5):918-920.