伴有焦虑抑郁症状的女性急性心肌梗死患者心理干预研究

摘要

目的 观察伴心理应激的女性急性心肌梗死(AMI)患者入院时的临床特点,探讨心理干预在女性AMI患者治疗过程中的作用.方法 103例女性AMI患者分别用焦虑自评量表(SAS)、抑郁自评量表(SDS)进行评定,比较有无焦虑、抑郁情绪及患者入院时的临床特征.将伴有心理应激的68例患者采用抽签法分为干预组(34例)和对照组(34例),对照组给予常规药物治疗,干预组在常规药物治疗的基础上进行心理干预;治疗前后进行SAS、SDS评定.对2组出现的并发症进行对比分析.结果 与无心理应激的女性AMI患者相比较,伴心理应激者年龄较大,文化程度较低,就诊延迟时间较长[(7.9±5.8)h比(5.1±3.6)h,P<0.01],合并高血压及糖尿病者较多[分别为58.8%(40/68)比37.1%(13/35),41.2%(28/68)比20.0%(7/35),均P<0.05].4周后,干预组较对照组患者SAS总分、SDS总分均有显著降低[分别为(39.7±6.1)分比(53.8±6.7)分,(37.5±5.6)分比(54.6±7.1)分,均P<0.01];干预组心绞痛发作、心力衰竭和死亡的发生率均明显低于对照组[20.6%(7/34)比44.1%(15/34),23.5%(8/34)比47.1%(16/34),5.9%(2/34)比23.5%(8/34),均P<0.05].结论 与无心理应激的女性AMI患者比较,有心理应激者危险因素较多.心理干预有助于改善女性AMI患者焦虑、抑郁情绪,提高其临床疗效.%Objective To investigate the clinical features of female acute myocardial infarction(AMI)patients with psychological stress and to study application and clinical efficacy of psychological intervention for female patients with AMI.Methods One hundred and three female AMI patients were examined respectively by self-rating anxiety scale(SAS)and serf-rating depression scale(SDS),then baseline characteristics were compared between anxiety depression patients and non-anxiety depression patients.Sixty-eight cases of female AMI patients with anxiety depression were randomly divided into the interference group(34 cases)and the control group(34 cases).The patients in control group were given general medication,the patients in interference group were given psychological intervention as well as general medication.SAS and SDS were conducted before and after intervention.The complications were analysed.Results The patients with psychological stress were significantly older than the patients with non-psychological stress[(68.7±10.8)years vs(63.2±9.5)years,P<0.01]and low education level.Higher incidence of hypertension.diabetes mellitus and treatment-seeking delay were more common in patients with paychological stress than in patients with non-psychological stress[ 58.8%vs 37.1%,P<0.05;41.2%vs 20.0%,P<0.05;(7.9±5.8)h vs(5.1±3.6)h,P<0.01;respectively].After four weeks,the total scores of SAS,SDS in interference group were lower than those in control group[(39.7±6.1)scores vs(53.8±6.7)scores;(37.5±5.6)scores vs.(54.6±7.1)scores:all P<0.01 ].The occurrence rate of angina pectoris,heart failure and death were significantly less in interference group compared with control group(20.6%vs 44.1%:23.5%vs 47.1%;5.9%vs 23.5%;all P<0.05).Conclusions Compared with female AMI patients with no-psychological stress,female AMI patients with psychological stress have higher risk factor rates.Psychological intervention for female AMI patients can improve their anxiety and depression.