Valentini Mariaconsuelo, Spezzaferri Rosa, Brambilla Gabriella, Tavanelli Monica, Sangiuliano Maria, Majorino Giorgio, Racca Vittorio, Ferratini Maurizio
U.O. di Cardiologia Riabilitativa, Centro IRCCS S. Maria Nascente, Fondazione Don Carlo Gnocchi-ONLUS, Milano.
Ital Heart J Suppl. 2005 Jun;6(6):375-81.
Psychological disturbances like anxiety, depression, post-traumatic stress disorder are often associated with coronary artery disease and, in some studies, play a prognostic role after a coronary event. Despite some psychological disturbances following coronary artery bypass graft (CABG) have an impact on outcomes of both the surgical intervention and the rehabilitation program, their complexity as well as their clinical and instrumental determinants are still not fully understood. The aim of this study was to determine in male subjects with coronary artery disease the prevalence and complexity of psychological disturbances occurring after CABG as well as their predictors.
One hundred eighteen males without history of psychological disturbances consecutively admitted to our rehabilitation inpatient service between September 2002 and September 2003 underwent 11 +/- 2 days after CABG extensive psychometric testing including the Minnesota Multiphasic Personality Inventory-2, the Cognitive Behavioral Assessment.2, and the Hamilton test. Cardiac evaluation included coronary risk factors, NYHA class, coronary heart disease history, medical therapy, CABG number, and echocardiography.
Mean age 63.7 +/- 8.1 years; ejection fraction 54.6 +/- 10.3%; NYHA class I 92.4%, NYHA class II and III 7.6%; CABG number 1 (11%), 2 (23.7%), 3 (39.8%), 4 (21.8%), 5 (4.2%); coronary artery disease length 64 +/- 85 months, hospital stay 31.3 +/- 8 days. The score was above clinical cut-off on scale for depression in 16-39.8% of the patients, state anxiety in 27.1%, trauma in 16.1%, type A personality in 16.1%. Subjects above clinical cut-off for depression, anxiety and trauma did not differ from subjects below in terms of clinical and instrumental characteristics. Age, ejection fraction, coronary risk factors, coronary heart disease duration, and CABG number did not predict the development of depression, anxiety and trauma. Psychological disturbances often clustered in the same subjects.
In males following CABG, psychological disturbances are extremely frequent, often clustered, and independent of subjects' characteristics and coronary heart disease severity.
焦虑、抑郁、创伤后应激障碍等心理障碍常与冠状动脉疾病相关，并且在一些研究中，在冠状动脉事件后起预后作用。尽管冠状动脉旁路移植术（CABG）后出现的一些心理障碍会影响手术干预和康复计划的结果，但其复杂性以及临床和仪器方面的决定因素仍未完全了解。本研究的目的是确定冠心病男性患者CABG后发生心理障碍的患病率、复杂性及其预测因素。
2002年9月至2003年9月期间连续入住我们康复住院部的118名无心理障碍病史的男性患者在CABG术后11±2天接受了广泛的心理测量测试，包括明尼苏达多相人格调查表-2、认知行为评估.2和汉密尔顿测试。心脏评估包括冠状动脉危险因素、纽约心脏协会（NYHA）分级、冠心病病史、药物治疗、CABG次数和超声心动图检查。
平均年龄63.7±8.1岁；射血分数54.6±10.3%；NYHA I级92.4%，NYHA II级和III级7.6%；CABG次数1次（11%）、2次（23.7%）、3次（39.8%）、4次（21.8%）、5次（4.2%）；冠心病病程64±85个月，住院时间31.3±8天。16 - 39.8%的患者抑郁量表得分高于临床临界值，27.1%的患者状态焦虑量表得分高于临界值，16.1%的患者创伤量表得分高于临界值，16.1%的患者A型人格量表得分高于临界值。抑郁、焦虑和创伤量表得分高于临床临界值的患者与得分低于临界值的患者在临床和仪器特征方面无差异。年龄、射血分数、冠状动脉危险因素、冠心病病程和CABG次数均不能预测抑郁、焦虑和创伤的发生。心理障碍常聚集在同一患者身上。
在接受CABG的男性患者中，心理障碍极为常见，常聚集出现，且与患者特征和冠心病严重程度无关。
