急性心肌梗死PCI术后患者焦虑和抑郁状态对血脂调控的影响

发布时间：2018-05-19 09:37

本文选题：心肌梗死 + 焦虑　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:急性心肌梗死(acute myocardial infarction,AMI)是指因持久而严重的心肌缺血所致的部分心肌急性坏死。作为心血管疾病中一种常见的危急重症,严重威胁患者的身心健康。急性心肌梗死本身是一种死亡率较高的危急重症,大部分患者有剧烈的胸痛、心悸、甚至濒死感等不适,这使患者易产生一些诸如焦虑、抑郁[31]等负性情绪。而一部分患者会出现一种精神应激状态,如焦虑抑郁状态、创伤后应激障碍、惊恐障碍、适应障碍、人格偏离,久坐的生活方式和吸烟等行为问题。焦虑和抑郁状态是公认的心血管疾病危险因素,可存在于发生急性心肌梗死之前的老冠心病患者,或第一次出现症状的急性心肌梗死患者,对患者的病情发展、预后及生活质量存在着巨大的影响。国外研究中发现脑细胞胆固醇减少时将会导致脂质微粘度下降,暴露5-羟色胺受体,进而引发抑郁症状[11]。也有学者在研究中发现血脂对情绪的影响并不大[12]。而Van Deedt Dortland[35]等研究则显示,不良的脂质蛋白与抑郁症状密切相关,能导致LDL-C的增高,同时抑郁症状本身能导致HD-C降低。目前国内关于焦虑、抑郁状态对行介入治疗的急性心肌梗死患者血脂水平的影响还鲜见报道,而双心医学模式对急性心肌梗死患者血脂水平的影响也鲜见报道。故本研究通过对行急诊介入治疗的急性心肌梗死患者进行焦虑和抑郁量表测评,观察合并焦虑和抑郁情绪的患者,并测定其入院后及出院4-6周后血脂水平,观察急性心肌梗死患者焦虑和抑郁状态和血脂水平的相关关系。方法:入选武警后勤学院附属医院心血管内科重症监护病房2015年7月至2016年7月共227名年龄80岁急诊行介入治疗的急性心肌梗死病例为研究对象。患者入院后1周内分别采用抑郁自评量表(SDS,Self rating Depression Scale)[5]焦虑自评量表(SAS,Self rating Anxiety Scale)[6]进行焦虑和抑郁评估,依照焦虑和抑郁情绪评分结果,将患者分为观察组和对照组,观察组伴焦虑或抑郁情绪,对照组不伴焦虑或抑郁情绪。于入院第二天晨7时前空腹抽静脉血测定血脂指标,出院后4-6周进行随访,复查血脂指标,分析焦虑抑郁与血脂之间的相关关系。结果:1纳入研究227例,111例(49.0%)存在焦虑,53例(23.0%)存在抑郁,39例(17.0%)焦虑抑郁共病.。观察组125例,对照组102例,两组患者一般资料具有可比性。2入院第二天血脂检查,观察组患者TC、Lp(a)、LDL-C、TG、HDL-C指标与对照组指标无比较意义(P0.05)。3出院4-6周复查血脂,两组患者血脂指标均得到改善,观察组TC、TG、Lp、LDL-C指标显著高于对照组(P0.05),HDL-C指标显著低于对照组(P0.05)。4在院期间与出院后4-6周复查血脂指标比较,观察组TG、TC、LDL-C明显下降(P0.05),HDL-C无明显变化(P=0.0721)。对照组TG、TC、LDL-C明显下降(P0.05),HDL-C有所上升(P0.05)。5观察组与对照组血脂改善差值比较,对照组改善情况显著优于观察组(P0.05)。6观察组焦虑或抑郁评分与TG(r=0.271)、TC(r=0.291)、LDL-C(r=0.110)存在正相关,与HDL-C(r=0.034)存在负相关。结论:急性心肌梗死患者出现焦虑或者抑郁状态发生率较高,伴有焦虑和抑郁情绪的急性心肌梗死介入患者与不伴有焦虑和抑郁情绪的急性心肌梗死介入患者之间的血脂变化存在差异。急性心肌梗死伴随焦虑(抑郁)评分与TG、TC、LDL-C呈现正相关,评分越高,血脂异常越明显,焦虑(抑郁)与HDL-C呈现负相关。
[Abstract]:Objective: acute myocardial infarction (AMI) is a part of acute myocardial necrosis caused by persistent and severe myocardial ischemia. As a common critical disease in cardiovascular disease, it is a serious threat to the physical and mental health of the patients. Acute myocardial infarction is a kind of critical mortality with high mortality and most of the patients have Severe chest pain, palpitations, and even dying feel discomfort, which makes the patient prone to negative emotions such as anxiety and depression [31]. Some patients have a mental stress state, such as anxiety and depression, post-traumatic stress disorder, panic disorder, adaptive disorder, personality deviation, sedentary lifestyle and smoking and other behavioral problems. The state of anxiety and depression is recognized as a risk factor for cardiovascular disease. It can exist in elderly patients with coronary heart disease before acute myocardial infarction, or in patients with acute myocardial infarction with first symptoms, which have a great influence on the development, prognosis, and quality of life of the patients. The decrease in lipid microviscosity, the exposure of 5- serotonin receptor, and further depressive symptoms [11]. have also been found in the study. Some scholars have found that the effect of blood lipid on emotion is not [12]. and Van Deedt Dortland[35] and other studies show that bad lipid protein is closely related to depressive symptoms, which can lead to higher LDL-C, and the depressive symptoms can lead to the depression itself. The influence of anxiety and depression on the level of blood lipid in patients with acute myocardial infarction with interventional therapy is rarely reported, and the effect of the double heart medical model on the level of blood lipid in patients with acute myocardial infarction is rarely reported. Therefore, the anxiety and anxiety of patients with acute myocardial infarction who have been treated with emergency intervention therapy are not reported. The depression scale was used to observe the patients with anxiety and depression, and the blood lipid level after admission and 4-6 weeks after discharge. The relationship between anxiety and depression and blood lipid levels in patients with acute myocardial infarction was observed. Methods: the intensive care unit of the cardio tube department of the Affiliated Hospital of Armed Police Logistics College was selected from July 2015 to July 2016. A total of 227 cases of acute myocardial infarction who were aged 80 years old were treated with acute myocardial infarction. The patients were assessed by the self rating Depression Scale (SDS, Self rating Depression Scale) [5] Anxiety Scale (SAS, Self rating Anxiety Scale) within 1 weeks after admission to the anxiety and depression assessment. The observation group was divided into the observation group and the control group, the observation group was accompanied with anxiety or depression, and the control group did not have the anxiety or depression. The blood lipid indexes were measured before the second day morning and 7 hours in the hospital. The blood lipid indexes were followed up for 4-6 weeks after discharge. The correlation between the blood lipid index and the anxiety and depression was analyzed. Results: 1 were included in 227 cases and 111 cases (49). .0%) existence of anxiety, 53 (23%) depression, 39 cases (17%) of anxiety and depression, 125 cases, 102 cases in the control group, two groups of patients with comparable.2 for second days of blood lipid examination, the observation group of TC, Lp (a), LDL-C, TG, HDL-C index and the control index no comparison significance (P0.05).3 for 4-6 weeks back examination of blood lipids, two groups of patients reviewed lipids, two groups of patients for the review of two patients The indexes of blood lipid were improved, and the indexes of TC, TG, Lp and LDL-C in the observation group were significantly higher than those in the control group (P0.05), and the HDL-C index was significantly lower than the control group (P0.05).4 during the hospital and 4-6 weeks after discharge. The difference between the P0.05.5 observation group and the control group was better than the control group. The improvement of the control group was significantly better than that of the observation group (P0.05). The anxiety or depression score of the.6 observation group was positively correlated with TG (r=0.271), TC (r=0.291), LDL-C (r=0.110), and HDL-C (r=0.034). Conclusion: the patients with acute myocardial infarction have anxiety or depression. The incidence of acute myocardial infarction with anxiety and depression was different from that of the patients with acute myocardial infarction without anxiety and depression. The scores of acute myocardial infarction associated anxiety (depression) were positively correlated with TG, TC, LDL-C, the higher the score, the more obvious dyslipidemia and anxiety (depression). There was a negative correlation with HDL-C.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R749

【参考文献】