伴有抑郁的急性冠状动脉综合征患者抗抑郁治疗的临床分析.docVIP

伴有抑郁的急性冠状动脉综合征患者抗抑郁治疗的临床分析 　　作者：杨和平,张团炜,杨利平　　作者单位：陕西省榆林市第一医院 　　【摘要】 目的：对伴有抑郁的急性冠脉综合征患者抗抑郁治疗后，观察抑郁障碍与胸痛症状的改善的相关性，抗抑郁治疗的安全性及相应ST段回落情况。方法：对346例住院后经心电图、心肌酶确诊的急性冠状动脉综合征，同时符合轻中度抑郁焦虑障碍的患者随机双盲分为两组：抗抑郁治疗组= 常规治疗+氟西汀+奥氮平组173例，常规治疗组173例，组疗程均为4周，治疗前、治疗后1、2、4周分别用Hamiton抑郁量表(HAMD) 、Hamiton焦虑量表(HAMA)、胸痛自评表观察2组疗效的差异及抗抑郁焦虑障碍与胸痛症状改善情况、心电图ST段回落的相关性。结果：抗抑郁治疗组胸痛症状改善及ST段回落较常规治疗组明显。其中抗抑郁治疗组1周内见效，HAMD、HAMA减分率均为(58.6±14.0)%，胸痛自评量表减分率为(74.6±18.4)%;治疗4周后抗抑郁治疗组HAMD、HAMA减分率分别为(81.4±14.7)%、(82.3±13.5)%，与常规治疗组(HAMD)(21.9±9.2)%，HAMA(23.8±12.4)%比较差异有统计学意义(P0.05);抗抑郁治疗组四周后胸痛自评减分率与HAMD、HAMA减分率呈正相关(r分别为0.886,0.883,均P0.01),心电图ST-T改善较常规治疗组明显。治疗过程中2组均无严重药物不良反应。结论：对伴有抑郁、焦虑的急性冠状动脉综合征患者,抗抑郁、焦虑治疗后在改善抑郁焦虑症状的同时也明显改善胸痛症状及心电图ST-T,并且安全性好。这些患者抑郁症状的改善和胸痛症状及心电图ST-T改善存在着明显的相关性。 　　【关键词】 抑郁症,焦虑,急性冠状动脉综合征;氟西汀;ST段 　　Abstract：Objectivewe observed the therapeutic effectveness and safety of antidepressants as well as correlated between symptomatic improvement of depression and improvement of chest pain and improvement ST-elevation in patients with acute coronary syndrome comorbid depression.MethodIn this double-blinded randomized study,a total of 346 patients were allocated into two groups：Group F +O+ Routine therapeutic of ACS:Fluoxetin 20 mg+olanzepine 2.5 mg QH+Rneine therapy of ACS(n=173); Routine therapy of ACS(n=173).The total therapy duration was 4 weeks.HAMD,HAMA，self-evaluation table of chest pain and ST-elevation were obtained before therapy,at the end of 1 and 2 weeks after therapy.ResultsBaseline HAMD and HAMA scores and self-evaluation score of chest pain were similar among 2 groups and all scores were significantly improved post various therapies in order of group F+O+Rgroup R.The rate of score decrease were seen after 1 week treatment in group F+O+R.There was a significant positive correlation between the rates of self-evaluation chest pain score decrease and HAMD (r=0.876,P0.01)and HAMA (0.865,P0.01) and ST-elevation score decrease after 4 weeks therapies(P0.05).During the whole course of treatmen