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目的研究心理干预对冠心病合并抑郁患者的血管内皮功能的影响。方法 252例冠心病合并抑郁组患者,随机分为心理干预组和对照组各126例,两组患者均给予常规调节血脂、抑制血小板聚集等治疗,心理干预组在常规治疗的同时实施支持性心理干预,所有患者治疗前后均行汉密尔顿抑郁量表(HAMD)评分和接受肱动脉超声检查和血清一氧化氮(NO)、内皮素(ET)浓度测定。结果心理干预组治疗后与治疗前HAMD评分比较明显下降,差异有统计学意义(t=14.7±3.9,18.7±5.3;P<0.001);对照组治疗后与治疗前HAMD评分比较差异无统计学意义(t=18.2±5.2,19.1±4.3;P>0.05)。组间比较,治疗前两组HAMD评分比较差异无统计学意义(t=18.7±5.3,19.1±4.3;P>0.05)。治疗后心理干预组与对照组HAMD评分比较明显下降,差异有统计学意义(t=14.7±3.9,18.2±5.2;P<0.001)。心理干预组治疗后与治疗前FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.65±0.49,12.11±1.93,70.37±19.24,70.65±16.48,4.16±0.38,8.52±1.48,54.13±9.88,90.16±14.31;P<0.001),对照组治疗后与治疗前FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.47±0.36,9.70±1.56,65.70±17.23,82.35±16.57,4.17±0.42,8.63±1.45,53.78±10.12,89.43±15.36;P<0.001)。组间比较,治疗前两组FMD%、NMD%、血浆NO、ET水平比较差异无统计学意义(t=4.16±0.38,8.52±1.48,54.13±9.88,90.16±14.31,4.17±0.42,8.63±1.45,53.78±10.12,89.43±15.36;P>0.05),治疗后两组FMD%、NMD%、血浆NO、ET水平比较差异有统计学意义(t=4.65±0.49,12.11±1.93,70.37±19.24,70.65±16.48,4.47±0.36,9.70±1.56,65.70±17.23,82.35±16.57;P<0.001)。结论心理干预治疗能明显改善冠心病合并抑郁患者的抑郁程度和血管内皮功能。
Objective To study the effect of psychological intervention on the vascular endothelial function in patients with coronary heart disease complicated with depression. Methods 252 cases of coronary heart disease with depression group were randomly divided into psychological intervention group and control group of 126 cases, both groups were given routine regulation of blood lipids, inhibition of platelet aggregation and other treatment, psychological intervention group in the conventional treatment while supporting psychology All patients underwent Hamilton Depression Rating Scale (HAMD) and brachial artery ultrasound examination and serum nitric oxide (NO) and endothelin (ET) concentrations before and after treatment. Results The HAMD score of the psychological intervention group was significantly decreased after treatment compared with that before treatment (t = 14.7 ± 3.9, 18.7 ± 5.3, P <0.001). There was no significant difference in HAMD score between the control group and before treatment Significance (t = 18.2 ± 5.2, 19.1 ± 4.3; P> 0.05). There was no significant difference in HAMD score between the two groups before treatment (t = 18.7 ± 5.3, 19.1 ± 4.3; P> 0.05). The HAMD scores of psychological intervention group and control group decreased significantly after treatment (t = 14.7 ± 3.9,18.2 ± 5.2; P <0.001). The levels of FMD%, NMD%, plasma NO and ET before and after treatment in the psychological intervention group were significantly different (t = 4.65 ± 0.49, 12.11 ± 1.93, 70.37 ± 19.24, 70.65 ± 16.48, 4.16 ± 0.38 and 8.52 ± 1.48,54.13 ± 9.88,90.16 ± 14.31; P <0.001). There was significant difference in the levels of FMD%, NMD%, plasma NO and ET before treatment in the control group (t = 4.47 ± 0.36,9.70 ± 1.56, 65.70 ± 17.23, 82.35 ± 16.57, 4.17 ± 0.42, 8.63 ± 1.45, 53.78 ± 10.12, 89.43 ± 15.36; P <0.001). There was no significant difference in FMD%, NMD%, plasma NO and ET before treatment between two groups (t = 4.16 ± 0.38, 8.52 ± 1.48, 54.13 ± 9.88, 90.16 ± 14.31, 4.17 ± 0.42, 8.63 ± 1.45,53.78 ± 10.12,89.43 ± 15.36; P> 0.05). After treatment, there were significant differences in FMD%, NMD%, plasma NO and ET levels between the two groups (t = 4.65 ± 0.49, 12.11 ± 1.93, 70.37 ± 19.24 , 70.65 ± 16.48, 4.47 ± 0.36, 9.70 ± 1.56, 65.7 ± 17.23, 82.35 ± 16.57; P <0.001). Conclusion Psychological intervention can significantly improve depression and vascular endothelial function in patients with coronary heart disease and depression.