Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia.
Psychol Health Med. 2011 May;16(3):333-45. doi: 10.1080/13548506.2011.553960.
The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.
本研究旨在探讨抑郁和焦虑障碍及其特征症状（快感缺失/低正性情绪和焦虑唤醒，分别），以及状态负性情绪（NA）和 D 型人格特征与心脏手术相关发病率的关系。接受择期冠状动脉旁路移植手术的患者（n=158；20.9%为女性；11.4%同时进行瓣膜手术；年龄 M=64.7，SD=10.6）接受了结构化 MINI 国际神经精神访谈，以确定当前的情感障碍。患者还完成了心境和焦虑症状问卷以及 D 型人格特质的测量。手术后在索引住院期间确认术后心脏发病率，包括中风、肾衰竭、通气>24 小时、深部胸骨伤口感染、再次手术、心律失常和任何部位的 30 天死亡率（n=59，占总人数的 37.3%）。在校正年龄、近期心肌梗死、心力衰竭、高血压、手术紧迫性和体外循环时间后，广泛性焦虑障碍与心脏发病率相关（比值比 [OR]=3.26，95%置信区间 [CI] 1.10-9.67，p=0.03）。对人格特质的调整分析显示，D 型人格的 NA 成分与心脏发病率相关（OR=1.07，95%CI 1.01-1.14，p=0.03）。心境和焦虑症状问卷的分量表与增加的发病率风险无关。情感障碍、情感表型和人格特质与心脏手术后发病率结果独立于心脏手术发病率危险因素相关。抑郁和焦虑与心脏预后的并发研究值得进一步研究。
