Qiu Yuan-gang, Zheng Liang-rong, Chen Jun-zhu, Zhu Jian-hua, Zhang Fu-rong, Xu Yi, Zhao Li-li, Tao Qian-min
Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Mar;24(3):224-8.
To study the psychologic status and their influencing factors in patients suspected of having coronary disease before and after coronary catheterization.
A hundred fifty-eight inpatients (125 men, 33 women, mean age 66.1 +/- 9.6 years) who underwent a scheduled coronary catheterization for the first time and fulfilled entry criteria were enrolled. All the patients were examined by Symptom Check List-90 (SCL-90), a standard self-report symptom inventory on present psychologic status, within 24 hours before the coronary catheterization (after the information consent) and the third day after the procedure.
(1) Before coronary catheterization, factorial scores of somatization, anxiety and phobic anxiety were higher than norm (P < 0.05 or P < 0.01). After the procedure, only somatization score was higher (P < 0.01). (2) Men had higher scores on obsessive-compulsive and psychotism than women (P < 0.05 and P < 0.01, respectively), however, women had higher scores on phobic anxiety (P < 0.05). (3) Compared with patients having coronary disease, those with angiographically normal coronary arteries seemed to have higher scores of somatization, obsessive-compulsive, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotism, global severity index and positive symptoms (P < 0.05 or P < 0.01). (4) After the procedure, significantly decreases in obsessive-compulsive, depression, hostility, global severity index and positive symptom severity index (P < 0.05 or P < 0.01) were seen. (5) Patients merely underwent coronary angiography had higher score in phobic anxiety construct than those having had coronary angiography and percutaneous transluminal coronary angioplasty (1.34 +/- 0.38 vs 1.15 +/- 0.23, P < 0.05). (6) When compared with the degree of explanation under informed consent, specific risk was not informed mentioned, a higher score in positive symptom severity index was seen (2.56 +/- 0.48 vs 2.46 +/- 0.37, P = 0.02). (7) Higher score was seen on positive symptom severity index when patients aged 70 years or more (2.62 +/- 0.45) than those under 60 years old (2.47 +/- 0.43, P < 0.05) or between 60 and 69 years old (2.45 +/- 0.40, P < 0.01).
Patients' psychologic symptoms before and after the coronary catheterization seemed to be related to many factors. The most important appeared one was coronary catheterization itself. Women, patients with angiographically normal arteries, those of 70 years old or more were more likely to have elevated psychologic distress. Detail information including specific risk regarding the procedure was not associated with the increase of psychological symptoms. The findings emphasized the importance of psychologic assessment and counseling for patient who had undergone a scheduled coronary catheterization.
研究疑似冠心病患者在冠状动脉导管插入术前、后的心理状态及其影响因素。
选取158例首次接受择期冠状动脉导管插入术且符合入选标准的住院患者（男性125例，女性33例，平均年龄66.1±9.6岁）。所有患者在冠状动脉导管插入术前24小时内（签署知情同意书后）及术后第3天，均采用症状自评量表90（SCL - 90）进行检查，该量表是一种关于当前心理状态的标准自评症状清单。
（1）冠状动脉导管插入术前，躯体化、焦虑和恐惧焦虑因子得分高于常模（P<0.05或P<0.01）。术后，仅躯体化得分仍较高（P<0.01）。（2）男性在强迫观念和精神病态方面得分高于女性（分别为P<0.05和P<0.01），然而，女性在恐惧焦虑方面得分更高（P<0.05）。（3）与患有冠心病的患者相比，冠状动脉造影正常的患者在躯体化、强迫观念、人际敏感、恐惧焦虑、偏执观念、精神病态、总体严重程度指数和阳性症状方面得分似乎更高（P<0.05或P<0.01）。（4）术后，强迫观念、抑郁、敌对、总体严重程度指数和阳性症状严重程度指数显著降低（P<0.05或P<0.01）。（5）仅接受冠状动脉造影的患者在恐惧焦虑因子方面的得分高于接受冠状动脉造影及经皮冠状动脉腔内血管成形术的患者（1.34±0.38 vs 1.15±0.23，P<0.05）。（6）与知情同意下的解释程度相比，未提及具体风险时，阳性症状严重程度指数得分更高（2.56±0.48 vs 2.46±0.37，P = 0.（7）70岁及以上患者的阳性症状严重程度指数得分（2.62±0.45）高于60岁以下患者（2.47±0.43，P<0.05）或60至69岁患者（2.45±0.40，P<0.01）。
冠状动脉导管插入术前、后患者的心理症状似乎与多种因素有关。最重要的似乎是冠状动脉导管插入术本身。女性、冠状动脉造影正常的患者、70岁及以上的患者更易出现心理困扰加剧。包括手术具体风险在内的详细信息与心理症状的增加无关。这些发现强调了对接受择期冠状动脉导管插入术患者进行心理评估和咨询的重要性。
