Bruce E H, Bruce R A, Hossack K F, Kusumi F
Int J Psychiatry Med. 1983;13(1):69-84. doi: 10.2190/twkb-ff29-t4c1-p3y0.
One hundred patients, eighty-nine men and eleven women, with chronic stable angina who were previously selected for aortocoronary bypass grafting gave informed consent for non-invasive and invasive testing of hemodynamic responses to symptom-limited maximal exercise before surgery. Psychosocial coping strategies were evaluated preoperatively by structured interviews and assessment of patients perceptions of symptoms (Cornell Medical Index) and life changes (Holmes and Rahe Schedule of Recent Experiences). Preoperatively forty-one patients were "compartmentalized," forty-two "generalized" and seventeen "vacillated" according to Josten's classification of coping strategies. The Berle Index of social assets was lower and the prevalence of psychiatric symptoms (Cornell categories M to R) was greater in the vacillators preoperatively. Despite less ischemic ST depression in vacillators, no other significant physiological differences were noted between these categories preoperatively. Postoperatively more of the vacillators refused follow-up evaluation, and of vacillators who returned, only one-half were adequately revascularized at operation. Of sixty-five reevaluated after surgery, eight improved, twelve worsened and forty-five did not change classification of coping strategies, yet physiological variables of cardiac function when invasively measured in sixty patients were significantly improved in all three groups. Amounts of improvement, both absolutely and relative to sex- and age-adjusted normal values, were least in vacillators with virtually normal cardiac capacity, and/or inadequate revascularization. Compartmentalized patients were more frequently working, yet only sixty-four in all psychosocial classifications worked before surgery. After this event only forty-five resumed working; none of the non-workers or retired returned to work. Both physiologic improvement and working status were independent of postoperative psychosocial status.
100例慢性稳定型心绞痛患者（89例男性，11例女性），此前已被选定进行主动脉冠状动脉搭桥术，他们在手术前对症状受限的最大运动的血流动力学反应进行无创和有创测试时给予了知情同意。术前通过结构化访谈以及评估患者对症状的感知（康奈尔医学指数）和生活变化（霍尔姆斯和拉赫近期经历量表）来评估心理社会应对策略。根据约斯滕应对策略分类，术前41例患者为“ compartmentalized”，42例为“ generalized”，17例为“ vacillated”。术前，“ vacillated”患者的社会资产伯利指数较低，精神症状（康奈尔分类M至R）的患病率较高。尽管“ vacillated”患者的缺血性ST段压低较少，但术前这些类别之间未发现其他明显的生理差异。术后，更多的“ vacillated”患者拒绝随访评估，而返回的“ vacillated”患者中，只有一半在手术时实现了充分的血运重建。在术后重新评估的65例患者中，8例改善，12例恶化，45例应对策略分类未改变，然而在60例患者中进行有创测量时，所有三组的心脏功能生理变量均有显著改善。改善的程度，无论是绝对的还是相对于性别和年龄调整后的正常值，在心脏功能基本正常和/或血运重建不足的“ vacillated”患者中最少。“ compartmentalized”患者工作的频率更高，但在所有心理社会分类中，术前只有64例工作。在这一事件之后，只有45例恢复工作；非工作者或退休者均未重返工作岗位。生理改善和工作状态均与术后心理社会状态无关。
