Chignon J M, Lépine J P, Adès J
DPIM, Service de l'Evaluation médicale, AP-HP Paris.
Encephale. 1994 May-Jun;20(3):319-26.
The relationship of anxiety with cardiovascular function and symptoms has been of long historic interest, culminating in the recent emphasis given to the modulation of cardiovascular response in panic patients. Cognitive approaches postulate an interaction of physiological and psychological factors in the maintenance of panic disorder. Pharmacological approaches postulate a dysfunction of central alpha-adrenoceptors in panic and also in some cardio-vascular diseases. Ambulatory heart rate recordings confirm the presence of major cardiovascular changes during panic attacks in several studies. We have carried out a study in an unselected population being explored in an outpatient cardiology unit with 24 hours ambulatory heart rate recordings. Hundred and ninety-seven consecutive referrals for an ambulatory heart rate examination were assessed with the seven anxiety items of the Hospital Anxiety and Depression Scale (HAD-A). Fifty patients (26 males and 24 females), with an higher score than 8, were interviewed with the SADS-La. Sixty-two per cent of them fit DSM III-R criteria for panic disorder. Among these 50 interviewed patients, 19 (11 males and 8 females) were referred for organic heart disease and 31 (15 males and 16 females) were investigated only for functional symptomatology. The proportion of panickers was similar in patients referred either for functional or organic heart disease (63.2 vs 61.3; chi 2 = .02; p = .89). Nineteen patients (11 males and 8 females) had pathological ECG ambulatory recording results and 31 patients (15 males and 16 females) were classified as Holter (-). The proportion of panickers was found similar in these two subgroups of patients (63.2 vs 61.3; chi 2 = .02; p = .89).(ABSTRACT TRUNCATED AT 250 WORDS)
焦虑与心血管功能及症状之间的关系长期以来一直备受关注，最近对惊恐症患者心血管反应调节的重视达到了顶峰。认知方法假定生理和心理因素在惊恐障碍的维持中相互作用。药理学方法假定惊恐症以及某些心血管疾病中存在中枢α-肾上腺素能受体功能障碍。多项研究中，动态心率记录证实了惊恐发作期间存在重大心血管变化。我们在一个门诊心脏病科对未经过筛选的人群进行了一项研究，采用24小时动态心率记录。对连续197例进行动态心率检查的转诊患者，使用医院焦虑抑郁量表（HAD - A）的七个焦虑项目进行评估。对50名（26名男性和24名女性）得分高于8分的患者进行了情感障碍和精神分裂症检查日程表（SADS - La）访谈。其中62%符合DSM III - R惊恐障碍标准。在这50名接受访谈的患者中，19名（11名男性和8名女性）因器质性心脏病转诊，31名（15名男性和16名女性）仅因功能性症状接受检查。因功能性或器质性心脏病转诊的患者中惊恐症患者的比例相似（63.2对61.3；卡方 = 0.02；p = 0.89）。19名患者（11名男性和8名女性）动态心电图记录结果异常，31名患者（15名男性和16名女性）被归类为动态心电图正常（Holter阴性）。在这两组患者亚组中发现惊恐症患者的比例相似（63.2对61.3；卡方 = 0.02；p = 0.89）。（摘要截断于250字）
