Engel B T, Baile W F, Costa P T, Brimlow D L, Brinker J
Psychosom Med. 1985 May-Jun;47(3):274-84. doi: 10.1097/00006842-198505000-00005.
A group of 83 men and women who had been referred to Johns Hopkins Hospital for cardiac catheterization for evaluation of chest pain and possible coronary artery bypass surgery were assessed behaviorally for their chest pains. During the approximately 2-week period between clinical evaluation and catheterization, the patients completed self-report forms about their chest pains. Patients completed one form for each episode of chest pain. Referring physicians also completed a form about the patients "typical" chest pain. The data were analyzed in terms of the antecedents, concomitants, and consequences of the chest pain, and patients' reports were compared to physicians' judgments. Major findings were as follows: 1) Antecedents--most episodes occurred while the patient was at home at times when his mood was one of contentment. 2) Concomitants--the average patient reported fewer than one episode per day which persisted for about 4 min and was rated as 36 on a scale of 0 to 100. The most common physical symptoms accompanying the episode were breathlessness and weakness, and the most common pain sensations were reported to be pressing or aching. There was no consistency among patients either in primary location or path of radiation of the pain. Duration of pain did not correlate significantly either with sensation or symptoms; however, severity rating did correlate with symptoms and sensations. 3) Consequences--most episodes were self-treated with nitroglycerin or rest. Patients typically returned to their ongoing activities; however, there were a number of interactions between the likelihood of returning to ones ongoing activity and the antecedents of the episodes. 4) The referring physicians significantly overestimated the frequency and severity of their patients' episodes; furthermore, they were selective in their abilities to identify correctly the antecedents or concomitants associated with their patients' pain--e.g., they were reliable in their judgments about subjects who had sleep-related episodes; however, they were inaccurate in characterizing the typical sensations or symptoms reported by their patients. It is suggested that a behavioral analysis may enable a physician to characterize his patient's chest complaints better, and perhaps also may facilitate the differentiation between chest complaints indicative of coronary artery disease and chest complaints of a noncoronary origin.
一组83名男女因胸痛接受评估并可能需要进行冠状动脉搭桥手术，被转诊至约翰霍普金斯医院进行心脏导管插入术。在临床评估和导管插入术之间约2周的时间里，患者填写了关于其胸痛的自我报告表格。患者为每一次胸痛发作填写一份表格。转诊医生也填写了一份关于患者“典型”胸痛的表格。数据根据胸痛的前驱因素、伴随因素和后果进行了分析，并将患者的报告与医生的判断进行了比较。主要发现如下：1）前驱因素——大多数发作发生在患者在家且心情愉悦的时候。2）伴随因素——平均每位患者每天报告的发作次数少于一次，持续约4分钟，在0至100的量表上评分为36分。发作时最常见的身体症状是呼吸急促和虚弱，最常见的疼痛感觉据说是压榨性或酸痛性。患者在疼痛的主要部位或放射路径上没有一致性。疼痛持续时间与感觉或症状均无显著相关性；然而，严重程度评分与症状和感觉相关。3）后果——大多数发作通过服用硝酸甘油或休息进行自我治疗。患者通常会恢复日常活动；然而，恢复日常活动的可能性与发作的前驱因素之间存在一些相互作用。4）转诊医生显著高估了患者发作的频率和严重程度；此外，他们在正确识别与患者疼痛相关的前驱因素或伴随因素方面能力具有选择性——例如，他们对有与睡眠相关发作的受试者的判断是可靠的；然而，他们对患者报告的典型感觉或症状的描述不准确。有人认为，行为分析可能使医生能够更好地描述患者的胸部不适，也许还能有助于区分指示冠状动脉疾病的胸部不适和非冠状动脉起源的胸部不适。
