帕罗西汀对伴抑郁状态冠心病患者的疗效观察
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摘要
目的:探讨伴抑郁状态冠心病患者的临床特征和帕罗西汀的临床疗效。
方法:对2008年4月-12月在我院住院的480例冠心病患者应用抑郁自评量表(SDS)进行评分,分析伴抑郁状态冠心病患者的比例和临床特征,对伴抑郁状态的冠心病患者予以分组治疗,观察组单纯使用心血管药物,治疗组在口服心血管药物的基础上分别设立心理辅导、帕罗西汀、心理辅导联合帕罗西汀治疗,比较分析其治疗效果。
结果:1伴抑郁状态冠心病患者占抽样调查冠心病患者的21.6%。2该类患者除了其相应冠心病的症状外,常表现为主诉多,难以缓解的胸闷、胸痛、气促和心悸等症状,血压波动大。3治疗的耐受性和依从性差,单纯使用心血管药物治疗效果欠佳,联合使用心理干预和抗抑郁药物帕罗西汀治疗疗效显著(P<0.001)。
结论:1抑郁状态在冠心病患者中占有很高的比例,对此类患者的主诉应加以分析,注意识别其类似于心血管疾病的躯体化症状。2对此类患者在治疗心血管疾病的同时,应联合给予心理干预及抗抑郁药物治疗。
Objective: To study the proportion, clinical characteristics and treatment of depression in coronary heart disease patients.
Methods: 480 patients in our department from April to December in 2008 were graded by SDS. The proportion and clinical characteristics of patients with coronary heart disease complicating depression were studied. Pations were divied into four groups randomly:control group(single cardio- vascular drugs), treatment groups of mental intervention,single paroxetine and paroxetine combind mental intervention.
Results: 1 21.6% of coronary heart disease patients was complicated with depression.2 Besides the symptoms corresponded to coronary heart disease, this section of coronary heart disease patients have more complaining and particular symptoms, such as chest distress, thoracodynia, breathlessness, palpitation and fluctuation of blood pressure et al, which were all hard to catabatic.3 They responded bad to only routine cardio- vascular drugs treatment. Additional administration of antidepressant drug and mental therapy were effective.
Conclusion: 1 The proportion of depression in coronary heart disease patients is very high. We should identify the symptoms of depression carefully, which is similar to cardiac disease.2 It is important to ad- ministrate antidepressant drug and mental therapy in the treatment of coro- nary heart disease patients with depression.
方法:对2008年4月-12月在我院住院的480例冠心病患者应用抑郁自评量表(SDS)进行评分,分析伴抑郁状态冠心病患者的比例和临床特征,对伴抑郁状态的冠心病患者予以分组治疗,观察组单纯使用心血管药物,治疗组在口服心血管药物的基础上分别设立心理辅导、帕罗西汀、心理辅导联合帕罗西汀治疗,比较分析其治疗效果。
结果:1伴抑郁状态冠心病患者占抽样调查冠心病患者的21.6%。2该类患者除了其相应冠心病的症状外,常表现为主诉多,难以缓解的胸闷、胸痛、气促和心悸等症状,血压波动大。3治疗的耐受性和依从性差,单纯使用心血管药物治疗效果欠佳,联合使用心理干预和抗抑郁药物帕罗西汀治疗疗效显著(P<0.001)。
结论:1抑郁状态在冠心病患者中占有很高的比例,对此类患者的主诉应加以分析,注意识别其类似于心血管疾病的躯体化症状。2对此类患者在治疗心血管疾病的同时,应联合给予心理干预及抗抑郁药物治疗。
Objective: To study the proportion, clinical characteristics and treatment of depression in coronary heart disease patients.
Methods: 480 patients in our department from April to December in 2008 were graded by SDS. The proportion and clinical characteristics of patients with coronary heart disease complicating depression were studied. Pations were divied into four groups randomly:control group(single cardio- vascular drugs), treatment groups of mental intervention,single paroxetine and paroxetine combind mental intervention.
Results: 1 21.6% of coronary heart disease patients was complicated with depression.2 Besides the symptoms corresponded to coronary heart disease, this section of coronary heart disease patients have more complaining and particular symptoms, such as chest distress, thoracodynia, breathlessness, palpitation and fluctuation of blood pressure et al, which were all hard to catabatic.3 They responded bad to only routine cardio- vascular drugs treatment. Additional administration of antidepressant drug and mental therapy were effective.
Conclusion: 1 The proportion of depression in coronary heart disease patients is very high. We should identify the symptoms of depression carefully, which is similar to cardiac disease.2 It is important to ad- ministrate antidepressant drug and mental therapy in the treatment of coro- nary heart disease patients with depression.
引文
1. Penninx BW, Guralnik JM ,Mendes de leon CF, et al. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age[J]. Am J Cardiol 1998;81(8):988-994.
2. Rugulies R. Depression as a predictor for coronary heart disease. a review and meta-analysis[J].Am J PrevMed 2002;23 (1):51-61.
3. Penninx BW ,Beekman A T, Honig A , et al. Depression and cardiac mortality: results from a community-based longitudinal study[J].Arch Gen Psychiatry 2001;58 (3) : 221-227.
4. Rumsfeld JS,Magid DJ , Plomondon M E, et al. History of depresion angina, and quality of life after acute coronary syndromes[J].Am Heart J 2003;145(3): 493-499.
5. Wassertheil Smoller S, Shumaker S, Ockene J , et al. Depression and cardio- vascular sequelae in postmenopausal women. The Women′s Health Initiative (WHI) [J]. Arch Intern Med 2004;164 (3) : 289-298.
6. Barefoot JC, Helm S, Mark DB,et al. Depression and long-term mortality risk in patients with coronary artery disease.Am J Cardiol 1996;78(6):613-617.
7. Wassertheil-Smoller S,Applegate WB,Berge K,et al. Changes in depression as a precursor of cardiovascular events. Arch Intern Med 1996;156(5):553-561.
8. Wulsin LR,Vaillant GE.Wells VE. A systematic review of the mortality of depression. Psychosom Med 1999;61(1):6-17.
9. Glassman AH, Shapiro PA.Depression and the course of coronary artery disease. AM J Psychiatry 1998;155(1):4-11.
10. Abraham AA,Mary H,Catherine MT, et al.Do depression symptoms and Risks of Coronary Heart Disease and Mortality in Elderly Americans.Circulation 2000;102:1773-1779.
11. Carney RM,Sannders RD,Freedland KE, et al.Association of depression with reduced heart rate variability in coronary artery diease.AM J Cardiol 1995;76: 562-564.
12. Musselman DL , Evans DL ,Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment [J]. Arch Gen Psychiatry 1998;55 (7):580-592.
13.段新杰,谢东明,张军,等.冠状动脉造影对非典型心绞痛伴焦虑抑郁情绪者特征的分析[J].中国临床康复2003;7(5):879.
14.李宏玉.心绞痛患者住院后的负性情绪特征[J].中国临床康复2003;7(12):1835.
15.岳桂珍,张荫川.抑郁情绪对稳定型心绞痛患者心肌缺血频度和程度的影响[J].中国临床康复2004;8(18):3451-3452.
16. Todaro JF, Shen BJ ,Niaura R, et al. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study)[J]. Am J Cardiol 2003;92 (8):901-906.
17. Davies SJ , Jackson PR, P tokar J , et al. Treatment of anxiety and depressive disorders in patients with cardiovascular disease [J].BMJ 2004; 328 (7445) : 939-943.
18. Musselman DL, Evans DL, Nemeroff CD. The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 1998;55;580-92
19. Kop WJ,Ader DN.Assessment and treatment of depression in coronary artery disease patients.Ital Heart J 2001;2(12):890-894.
20. Thornton LA.Depression in post-acute myocardial infarction patients.J Am Acad Nurse Pract 2001;13(8):364-367.
21. Ferketich A K, Schwartzbaum JA , Frid DJ , et al. Depression as an antecedent to heart disease among women and men in the NHANESI study. National Health and Nutrition Examination Survey[J].Arch InternMed 2000;160 (9):1261-1268.
22. Hippisley-Cox J, Fielding K,Pringle M. Depression as a risk factor for ischae- mic heaft disease in men:population based case-control study.BMJ 1998:316 (7146):1714-1719.
23. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease.Am J Psychiatry 1998;155 (1):4211.
24. Stein PK, Carney RM , F reedland KE, et al. Severe dep ression is associated w ith markedly reduced heart rate variability in patients w ith stable co ronary heart disease. J Psychosom Res 2000;48 (425) :493-500.
25. Miller GE, Stetler CA , Carney RM , et al. Clinical depression and inflammatory risk markers for coronary heart disease.Am J Cardiol 2002;90 (12):1279-1283.
26. Panagiotakos DB, Pitsavos C, Chrysohoou C, et al. Inflammation, coagulation, and depressive symptomato logy in cardiovascular disease-free peop le; the A TT ICA study. Eur Heart J 2004;25 (6):492-499.
27. Ariyo AA , HaanM , Tangen CM , et al. Depressive symptoms and risk s of coro-nary heart disease and mortality in elderly Americans.Cardiovascular Health Study Collabo rative Research Group.Circulation 2000;102 (15):1773-1779.
28. Smith Barusch A , Rogers A , Abubader SH. Depressive symptom s in the frail elderly: physical and psycho-social co rrelates.Int J A ging Hum Dev 1999;49 (2) :107-125.
29. Meredim LS,Well KB,Camp P.Clinician specialty and without medical comorbidities .Arch Fam Med 1994;3:1065-1072.
30.刘萍.抗焦虑剂治疗对高血压病人降压药物疗效的影响[J].心血管康复医学杂志2001;10(3):225-26.
31.丁会霞,孙树果,孙霞,等.心理干预对冠心病伴抑郁患者躯体症状及心功能改善的观察[J].现代康复2001;5(10):103.
32.陈颍敏,毛家亮,王彬尧,等.心血管疾病患者伴焦虑抑郁状态的临床特征与治疗[J].上海第二医科大学学报2001;21(1):78-81.
33. Shen BJ ,M cCreary CP,M yers HF. Independent and mediated contributions of personality, cop ing, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation [J]. J BehavM ed 2004; 27 (1) : 3962.
1.叶任高,陆再英.内科学.人民卫生出版社,2004, 155.
2. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardio vascular disease:epidemiology,bidogy,and tiratment. Arch Gen Psychiatry 1998;55(7):580-592.
3. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease . Am J Psychiatry 1998;155:4-11.
4.陈银娣,周天锌,施慎逊,等.老年冠心病病人焦虑、抑郁症状的调查.上海精神医学2000;12(1):17.
5.张泽萍,李艳红,张存良. 60例冠心病患者心理状态分析.健康心理学杂志2001;9(4):306.
6. Barefoot JC,Helm S, Mark DB, et al. Depression and long term mortality risk in patients with coronary artery disease . Am J Cardiol 1996;78:613-617.
7. Frasure SN, Lesporance F,Gravel G,et al. Social support、depression and mortality during the first my cardial infaction. Circulation 2000;101(16):1919.
8. Ariyo AA, Haan M, Tangen CM, et al. Depression symptoms and Risk of Coronary Heart Disease and Mortality in Elderly Americans. Cardiovascular health study collaborative research group.Circulation 2000;102 (15):1773-1779.
9. Denninx BW, Guralnik JM, Mendes de leon CF, et al. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. Am J Cardiol 1998;81(8):988-994.
10.季康,黄捷英,沈璐华.冠心病患者的心理评估及心理干预.北京医学2005;27(2):69-71.
11.张明园.精神病科评定量表手册[M].长沙:湖南科学技术出版社,1993:34-38.
12.沈渔邨,主编.精神病学.第四版.北京:人民卫生出版社,1994.627-664.
13. Chris T. Mood Disorders. Medicine , 2000 ,28 :11-14.
14.十二地区精神疾病流行病学调查协作组.各类精神病、药物依赖、酒精依赖及人格障碍的调查资料分析.中华神经精神科杂志, 1986 ,19 :70-72.
15.江开达.心境障碍.见:陈彦方,李舜伟,主编.脑部疾病诊断治疗.北京:中国协和医科大学出版社, 2003. 1173-1174.
16.胡宗宪,翁孝刚,张绍荣,等.综合医院内科住院病人的精神障碍.临床精神医学1995;5:34.
17. Shapiro PA , Lidagoster L , Glassman Ah. Depression and heart disease.Psychiatr Ann 1997;27:347-352.
18.张继志.提高综合医院对抑郁症的识别能力刻不容缓.中华精神科杂志1997;30(4):195.
19. Harefoot JC, Helm S, Mark DH, et al. Depression and long term mortality risk in patients with coronary artery disease . J Am J Cardiol 1996;78(6):613-617.
20.吴兆苏.社会心理因素与心血管病关系的流行病学研究进展.中国医学科学院学报2001;23(1):73-77.
21.中华医学会精神科分会,主编.中国精神障碍分类与诊断标准.第三版.济南:山东科学技术出版社,2001. 87-88.
22.张明园.应重视综合医院就诊者心理障碍的诊断与治疗.中华医学杂志1999 ;79 :325-326.
23.肖泽萍,严和骎 ,肖世富,等.综合医院门诊病人抑郁障碍的研究.中华医学杂志1999;79 :329-331.
24.吴文源,刘美兰,李春波,等.综合医院就诊病人伴发的抑郁焦虑症状及其治疗.中华医学杂志1999;79 :509-511.
25.李舜伟.精神疾病和神经症.见:汤洪川,主编.实用神经病诊断治疗学.合肥:安徽科学技术出版社2000;755-786.
26.杨菊贤.心血管疾病患者伴有焦虑和抑郁的处理.上海预防医学杂志2002;14(3):145-146.
27.袁浩龙.内科疾病中的焦虑和抑郁.四川精神卫生1999;12(1):69-70.
28.石晓燕,杨倩,宋连香,等.117例内科疾病患者并发焦虑和抑郁症状的研究.华西医学1997;12(1):60-62.
29.陈颖敏,王家亮,王彬尧,等.心血管患者伴焦虑抑郁症状的临床特征与治疗.上海第二医科大学学报2001;21(1):79.
30. Zaubler TS, Kapton W, Papton W. Panic disorder in the general medical setting . J Psychosom Res 1998;44(1):25-42.
31.张亚哲,赵耕源,张书刚,等.心理干预在冠心病治疗中的作用.中国行为医学科学1997;6(1):39-41.
32.杨菊贤.生物反馈技术及其在心血管心身疾病的应用.辽宁医学杂志1999;13(2):61.
33.王义润.运动生理学[M].北京人民体育出版社,1978 .48.
2. Rugulies R. Depression as a predictor for coronary heart disease. a review and meta-analysis[J].Am J PrevMed 2002;23 (1):51-61.
3. Penninx BW ,Beekman A T, Honig A , et al. Depression and cardiac mortality: results from a community-based longitudinal study[J].Arch Gen Psychiatry 2001;58 (3) : 221-227.
4. Rumsfeld JS,Magid DJ , Plomondon M E, et al. History of depresion angina, and quality of life after acute coronary syndromes[J].Am Heart J 2003;145(3): 493-499.
5. Wassertheil Smoller S, Shumaker S, Ockene J , et al. Depression and cardio- vascular sequelae in postmenopausal women. The Women′s Health Initiative (WHI) [J]. Arch Intern Med 2004;164 (3) : 289-298.
6. Barefoot JC, Helm S, Mark DB,et al. Depression and long-term mortality risk in patients with coronary artery disease.Am J Cardiol 1996;78(6):613-617.
7. Wassertheil-Smoller S,Applegate WB,Berge K,et al. Changes in depression as a precursor of cardiovascular events. Arch Intern Med 1996;156(5):553-561.
8. Wulsin LR,Vaillant GE.Wells VE. A systematic review of the mortality of depression. Psychosom Med 1999;61(1):6-17.
9. Glassman AH, Shapiro PA.Depression and the course of coronary artery disease. AM J Psychiatry 1998;155(1):4-11.
10. Abraham AA,Mary H,Catherine MT, et al.Do depression symptoms and Risks of Coronary Heart Disease and Mortality in Elderly Americans.Circulation 2000;102:1773-1779.
11. Carney RM,Sannders RD,Freedland KE, et al.Association of depression with reduced heart rate variability in coronary artery diease.AM J Cardiol 1995;76: 562-564.
12. Musselman DL , Evans DL ,Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment [J]. Arch Gen Psychiatry 1998;55 (7):580-592.
13.段新杰,谢东明,张军,等.冠状动脉造影对非典型心绞痛伴焦虑抑郁情绪者特征的分析[J].中国临床康复2003;7(5):879.
14.李宏玉.心绞痛患者住院后的负性情绪特征[J].中国临床康复2003;7(12):1835.
15.岳桂珍,张荫川.抑郁情绪对稳定型心绞痛患者心肌缺血频度和程度的影响[J].中国临床康复2004;8(18):3451-3452.
16. Todaro JF, Shen BJ ,Niaura R, et al. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study)[J]. Am J Cardiol 2003;92 (8):901-906.
17. Davies SJ , Jackson PR, P tokar J , et al. Treatment of anxiety and depressive disorders in patients with cardiovascular disease [J].BMJ 2004; 328 (7445) : 939-943.
18. Musselman DL, Evans DL, Nemeroff CD. The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 1998;55;580-92
19. Kop WJ,Ader DN.Assessment and treatment of depression in coronary artery disease patients.Ital Heart J 2001;2(12):890-894.
20. Thornton LA.Depression in post-acute myocardial infarction patients.J Am Acad Nurse Pract 2001;13(8):364-367.
21. Ferketich A K, Schwartzbaum JA , Frid DJ , et al. Depression as an antecedent to heart disease among women and men in the NHANESI study. National Health and Nutrition Examination Survey[J].Arch InternMed 2000;160 (9):1261-1268.
22. Hippisley-Cox J, Fielding K,Pringle M. Depression as a risk factor for ischae- mic heaft disease in men:population based case-control study.BMJ 1998:316 (7146):1714-1719.
23. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease.Am J Psychiatry 1998;155 (1):4211.
24. Stein PK, Carney RM , F reedland KE, et al. Severe dep ression is associated w ith markedly reduced heart rate variability in patients w ith stable co ronary heart disease. J Psychosom Res 2000;48 (425) :493-500.
25. Miller GE, Stetler CA , Carney RM , et al. Clinical depression and inflammatory risk markers for coronary heart disease.Am J Cardiol 2002;90 (12):1279-1283.
26. Panagiotakos DB, Pitsavos C, Chrysohoou C, et al. Inflammation, coagulation, and depressive symptomato logy in cardiovascular disease-free peop le; the A TT ICA study. Eur Heart J 2004;25 (6):492-499.
27. Ariyo AA , HaanM , Tangen CM , et al. Depressive symptoms and risk s of coro-nary heart disease and mortality in elderly Americans.Cardiovascular Health Study Collabo rative Research Group.Circulation 2000;102 (15):1773-1779.
28. Smith Barusch A , Rogers A , Abubader SH. Depressive symptom s in the frail elderly: physical and psycho-social co rrelates.Int J A ging Hum Dev 1999;49 (2) :107-125.
29. Meredim LS,Well KB,Camp P.Clinician specialty and without medical comorbidities .Arch Fam Med 1994;3:1065-1072.
30.刘萍.抗焦虑剂治疗对高血压病人降压药物疗效的影响[J].心血管康复医学杂志2001;10(3):225-26.
31.丁会霞,孙树果,孙霞,等.心理干预对冠心病伴抑郁患者躯体症状及心功能改善的观察[J].现代康复2001;5(10):103.
32.陈颍敏,毛家亮,王彬尧,等.心血管疾病患者伴焦虑抑郁状态的临床特征与治疗[J].上海第二医科大学学报2001;21(1):78-81.
33. Shen BJ ,M cCreary CP,M yers HF. Independent and mediated contributions of personality, cop ing, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation [J]. J BehavM ed 2004; 27 (1) : 3962.
1.叶任高,陆再英.内科学.人民卫生出版社,2004, 155.
2. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardio vascular disease:epidemiology,bidogy,and tiratment. Arch Gen Psychiatry 1998;55(7):580-592.
3. Glassman AH, Shapiro PA. Depression and the course of coronary artery disease . Am J Psychiatry 1998;155:4-11.
4.陈银娣,周天锌,施慎逊,等.老年冠心病病人焦虑、抑郁症状的调查.上海精神医学2000;12(1):17.
5.张泽萍,李艳红,张存良. 60例冠心病患者心理状态分析.健康心理学杂志2001;9(4):306.
6. Barefoot JC,Helm S, Mark DB, et al. Depression and long term mortality risk in patients with coronary artery disease . Am J Cardiol 1996;78:613-617.
7. Frasure SN, Lesporance F,Gravel G,et al. Social support、depression and mortality during the first my cardial infaction. Circulation 2000;101(16):1919.
8. Ariyo AA, Haan M, Tangen CM, et al. Depression symptoms and Risk of Coronary Heart Disease and Mortality in Elderly Americans. Cardiovascular health study collaborative research group.Circulation 2000;102 (15):1773-1779.
9. Denninx BW, Guralnik JM, Mendes de leon CF, et al. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. Am J Cardiol 1998;81(8):988-994.
10.季康,黄捷英,沈璐华.冠心病患者的心理评估及心理干预.北京医学2005;27(2):69-71.
11.张明园.精神病科评定量表手册[M].长沙:湖南科学技术出版社,1993:34-38.
12.沈渔邨,主编.精神病学.第四版.北京:人民卫生出版社,1994.627-664.
13. Chris T. Mood Disorders. Medicine , 2000 ,28 :11-14.
14.十二地区精神疾病流行病学调查协作组.各类精神病、药物依赖、酒精依赖及人格障碍的调查资料分析.中华神经精神科杂志, 1986 ,19 :70-72.
15.江开达.心境障碍.见:陈彦方,李舜伟,主编.脑部疾病诊断治疗.北京:中国协和医科大学出版社, 2003. 1173-1174.
16.胡宗宪,翁孝刚,张绍荣,等.综合医院内科住院病人的精神障碍.临床精神医学1995;5:34.
17. Shapiro PA , Lidagoster L , Glassman Ah. Depression and heart disease.Psychiatr Ann 1997;27:347-352.
18.张继志.提高综合医院对抑郁症的识别能力刻不容缓.中华精神科杂志1997;30(4):195.
19. Harefoot JC, Helm S, Mark DH, et al. Depression and long term mortality risk in patients with coronary artery disease . J Am J Cardiol 1996;78(6):613-617.
20.吴兆苏.社会心理因素与心血管病关系的流行病学研究进展.中国医学科学院学报2001;23(1):73-77.
21.中华医学会精神科分会,主编.中国精神障碍分类与诊断标准.第三版.济南:山东科学技术出版社,2001. 87-88.
22.张明园.应重视综合医院就诊者心理障碍的诊断与治疗.中华医学杂志1999 ;79 :325-326.
23.肖泽萍,严和骎 ,肖世富,等.综合医院门诊病人抑郁障碍的研究.中华医学杂志1999;79 :329-331.
24.吴文源,刘美兰,李春波,等.综合医院就诊病人伴发的抑郁焦虑症状及其治疗.中华医学杂志1999;79 :509-511.
25.李舜伟.精神疾病和神经症.见:汤洪川,主编.实用神经病诊断治疗学.合肥:安徽科学技术出版社2000;755-786.
26.杨菊贤.心血管疾病患者伴有焦虑和抑郁的处理.上海预防医学杂志2002;14(3):145-146.
27.袁浩龙.内科疾病中的焦虑和抑郁.四川精神卫生1999;12(1):69-70.
28.石晓燕,杨倩,宋连香,等.117例内科疾病患者并发焦虑和抑郁症状的研究.华西医学1997;12(1):60-62.
29.陈颖敏,王家亮,王彬尧,等.心血管患者伴焦虑抑郁症状的临床特征与治疗.上海第二医科大学学报2001;21(1):79.
30. Zaubler TS, Kapton W, Papton W. Panic disorder in the general medical setting . J Psychosom Res 1998;44(1):25-42.
31.张亚哲,赵耕源,张书刚,等.心理干预在冠心病治疗中的作用.中国行为医学科学1997;6(1):39-41.
32.杨菊贤.生物反馈技术及其在心血管心身疾病的应用.辽宁医学杂志1999;13(2):61.
33.王义润.运动生理学[M].北京人民体育出版社,1978 .48.