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目的:探讨伴焦虑抑郁障碍冠心病患者接受介入治疗前后情况以及肌胺肽苷注射液联合心理干预的效果。方法:采用Zung抑郁自评量表(SDS)、焦虑自评量表(SAS)对201例拟接受冠脉介入治疗的冠心病患者进行焦虑抑郁障碍调查评分。将201例患者随机分为联合干预组和对照组,干预组在手术前1~2d和手术后7~10d静点肌胺肽苷注射液,同时于上述时段以及术后3月、6月、12月、24月给予心理干预,对照组常规治疗并于同样时间进行焦虑抑郁评定和心理干预。结果:术前两组患者抑郁发生率、SDS评分无显著差异。术后干预组的抑郁障碍较对照组有明显改善(SDS评分分别为36.54±4.25和46.17±6.42,P<0.01),手术前后干预组抑郁发生率无明显差异,而对照组术后抑郁发生率明显高于手术前(SDS评分分别为46.54±6.25和73.46±6.73,P<0.01),干预组出院后24个月内再住院、心血管事件发生率明显低于对照组,生活质量提高明显高于对照组。多因素分析显示:教育水平低下、近期负性生活事件、社会经济地位、病程绵长、导管介入治疗后遗症与冠心病抑郁之间存在明显相关(P<0.01);且抑郁程度与患者出院后恢复、恶性心血管事件发生之间存在明显相关(P<0.01)。结论:肌胺肽苷注射液联合心理干预可以有效减轻抑郁焦虑障碍和降低心血管事件的发生,提高患者的生活质量。
Objective: To investigate the situation of patients with coronary heart disease with anxiety and depression before and after receiving interventional therapy and the effect of combined treatment with amifostine and psychosocial intervention. Methods: Zung depression self-rating scale (SDS) and anxiety self-rating scale (SAS) were used to investigate the anxiety and depression disorder scores of 201 CHD patients enrolled in coronary intervention. 201 patients were randomly divided into intervention group and control group. The intervention group received intravenous injection of MPA at 1-2 days before operation and 7-10 days after operation. At the same time, December and 24 months to give psychological intervention, the control group routine treatment and at the same time for anxiety and depression assessment and psychological intervention. Results: There was no significant difference in the incidence of depression between preoperative two groups of patients with SDS. Depression in postoperative intervention group was significantly improved compared with control group (SDS score was 36.54 ± 4.25 and 46.17 ± 6.42, respectively, P <0.01). There was no significant difference in the incidence of depression before and after operation in the intervention group, while the incidence of postoperative depression in the control group (SDS score was 46.54 ± 6.25 and 73.46 ± 6.73 respectively, P <0.01). The intervention group was rehospitalized within 24 months after discharge and the incidence of cardiovascular events was significantly lower than that of the control group, and the quality of life was significantly improved In the control group. Multivariate analysis showed that there was a significant correlation between sequelae of catheter intervention and depression of coronary heart disease (P <0.01), such as low level of education, recent negative life events, socioeconomic status, long course of disease, depression of patients with recovery after discharge, There was a significant correlation between malignant cardiovascular events (P <0.01). Conclusion: The combination of MPA and psychological intervention can effectively reduce depression and anxiety disorders and reduce the incidence of cardiovascular events and improve the quality of life of patients.