摘要
目的通过双心医学模式对合并抑郁和焦虑障碍的慢性心力衰竭(CHF)病人进行管理探讨双心医学模式对CHF病人心功能状况、躯体症状障碍和抑郁、焦虑改善情况以及预后的影响。方法选择2017年11月—2018年10月在上海市浦东医院心内科住院的112例CHF病人经利尿剂、洋地黄制剂、β-受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)等规范治疗后病情缓解,心功能改善的纽约心脏病协会(NYHA)心功能分级Ⅱ~Ⅲ级,按出院顺序随机分为管理组和对照组,各56例。管理组在上述心力衰竭正规治疗基础上,采用双心医学模式进行随访管理,包括心理、行为干预、运动放松和抗抑郁药物干预。所有病人连续随访6个月。比较两组随访6个月后N末端脑钠肽前体(NT-proBNP)、左心室射血分数(LVEF)、6 min步行试验(6-MWT)、NYHA心功能分级、躯体化症状自评量表(SSS)评分、病人健康问卷抑郁症状群量表(PHQ-9)评分、广泛性焦虑量表(GAD-7)评分、再入院率、再住院次数、平均住院天数。结果随访6个月后管理组病人NT-proBNP、SSS、PHQ-9和GAD-7低于对照组(P均<0.01),LVEF、6-MWT高于对照组(P<0.01),两组NYHA分级比较差异有统计学意义(P均<0.05)。随访6个月后管理组病人NT-proBNP、SSS、PHQ-9和GAD-7低于随访前(P<0.01),LVEF、6-MWT高于随访前(P均<0.01);对照组NT-proBNP高于随访前(P<0.01),LVEF、6-MWT、SSS、PHQ-9和GAD-7与随访前比较差异无统计学意义(P>0.05)。随访6个月后管理组因心力衰竭加重住院、全因再住院、再住院次数、住院天数低于对照组(P<0.05)。结论双心医学模式通过心理及药物干预对CHF合并抑郁和焦虑障碍病人进行管理,可以改善病人抑郁和焦虑状态,提高运动耐量、心功能状况和生活质量,减少再住院,改善预后。
Objective To apply the management of chronic heart failure patients with depression and anxiety disorder by psycho-cardiology mode,including psychological and behavioral intervention and antidepressant therapy,evaluating the effect of psycho-cardiology mode on the improvement of cardiac status,somatic symptoms disorder,depressive and anxious disorder and prognosis in patients with psycho-cardiology.Methods one hundred and twelve psycho-cardiology patients were recruited from November 2017 to October 2018 after the patient′s condition alleviated and cardiac function status improved through standard treatment by diuretic,digitalis preparation,β-receptor blocker,angiotensin converting enzyme inhibitor(ACEI)or angiotensinⅡreceptor blocker(ARB).The patient′s cardiac function status was gradeⅡto gradeⅢaccording to the cardiac function stardand of New York Heart Association(NYHA).The patients were divided into follow-up management group(manage ment group)and control group randomly according to the sequence of discharged from hospital.Based on the heart failure standard therapy,the manage ment group was accepted follow-up management by ment psycho-cardiology mode,including psychological and behavioral intervention,relaxation exercise and antidepressant therapy.All patients were accepted follow-up visit for 6 months.The levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),6-minute walk test(6-MWT),NYHA cardiac function grade,somatic self-rating scale(SSS)score,patient health questionnaire(PHQ-9)score,generalized anxiety disorder(GAD-7)score,read mission rate,rehospitalization times and mean hospitalization day were compared between the two groups after 6 months.Results After 6 months,NT-proBNP,SSS,PHQ-9 and GAD-7 score of the manage group were significantly lower than those of the control(P<0.01),LVEF and 6-MWT of manage ment group were higher than those of the control(P<0.01),NYHA cardiac function grade were significantly different between the two groups(P<0.05).After 6 months,NT-proBNP,SSS,PHQ-9 and GAD-7 score of the manage ment group were significantly lower than that before follow-up(P<0.01),LVEF and 6-MWT were higher than before follow-up(P<0.01).NT-proBNP of the control group were significantly higher that than before follow-up(P<0.01),LVEF,6-MWT,SSS,PHQ-9 and GAD-7 score had no statistical difference between two group before and after follow-up(P>0.05).After 6 months,The rehospitalization due to aggravated heart failure,rehospitalization of all causes,rehospitalization times and mean hospitalization day of the manage ment group were significantly lower than those of the control(P<0.05 or P<0.01).Conclusion By psychological and drug intervention to manage the psycho-cardiology patients,psycho-cardiology mode could significantly improve the patient′s depressive and anxious status,exercise tolerance,cardiac function status and life quality,reduce readmission and improve patient′s prognosis.
作者
李志强
王春燕
严晓沁
傅咏华
蒋庆渊
胡春燕
LI Zhiqiang;WANG Chunyan;YAN Xiaoqin;FU Yonghua;JIANG Qingyuan;HU Chunyan(Shanghai Pudong Hospital,Hehai University Pudong Medical Center,Shanghai 201399,china)
出处
《中西医结合心脑血管病杂志》
2020年第23期4006-4010,共5页
Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease
基金
上海市浦东新区科技和经济委员会科研项目(No.PKJ2017-Y46)。
关键词
慢性心力衰竭
抑郁
焦虑
双心医学
随访管理
预后
chronic heart failure
depression
anxiety
psycho-cardiology
follow-up management
prognosis
