Appels A, Bär F, Lasker J, Flamm U, Kop W
Department of Medical Psychology, Maastricht University, The Netherlands.
J Psychosom Res. 1997 Aug;43(2):209-17. doi: 10.1016/s0022-3999(97)00022-6.
Restenosis after successful percutaneous coronary angioplasty (PTCA) is a major problem because it occurs in 25% to 35% of all patients. Because psychological factors, especially anger and vital exhaustion, have been found to increase the risk of new cardiac events after PTCA, a behavioral intervention might contribute to the reduction of the risk of restenosis. To investigate the operational and methodological aspects of a behavioral intervention, and to estimate the effect size of the risk reduction, we did a feasibility study of angioplasty patients who remained exhausted after PTCA. Breathing therapy was used as the main method for intervention. Thirty patients who participated in the intervention program and 65 controls were followed during an average period of 16 and 18 months, respectively. It was observed that the intervention resulted in a significant decrease of the mean exhaustion scores and reduced the risk of a new coronary event (cardiac death, coronary artery bypass grafting, myocardial infarction, rePTCA, restenosis) by 50% (chi = 2.19; p = 0.13). These results indicate that a clinical trial to test the hypothesis that a reduction of vital exhaustion and hostility reduces the risk of a new cardiac event after PTCA, is feasible and merits the efforts required.
成功进行经皮冠状动脉腔内血管成形术（PTCA）后发生再狭窄是一个主要问题，因为在所有患者中有25%至35%会出现这种情况。由于已发现心理因素，尤其是愤怒和精力耗竭，会增加PTCA后发生新的心脏事件的风险，所以行为干预可能有助于降低再狭窄风险。为了研究行为干预的操作和方法方面，并估计风险降低的效应大小，我们对PTCA后仍感到精力耗竭的血管成形术患者进行了一项可行性研究。呼吸疗法被用作主要干预方法。分别对30名参与干预项目的患者和65名对照组患者进行了平均16个月和18个月的随访。观察到干预使平均精力耗竭得分显著降低，并使新的冠状动脉事件（心源性死亡、冠状动脉搭桥术、心肌梗死、再次PTCA、再狭窄）的风险降低了50%（卡方 = 2.19；p = 0.13）。这些结果表明，进行一项临床试验来检验降低精力耗竭和敌意可降低PTCA后发生新的心脏事件风险这一假设是可行的，且值得付出所需努力。
