于波

[摘要] 目的 探讨根据贝克认知疗法实施的心理干预对中青年急性冠脉综合征（ACS）患者焦虑抑郁程度的影响。 方法 选取2015年7月1日～2016年2月1日中国医科大学附属盛京医院第一心血管内科收治的中青年ACS患者82例，根据随机数字表法分为对照组（41例）和观察组（41例）。对照组给予常规心理护理，观察组在此基础上给予根据贝克认知疗法实施的心理干预。所有患者在入院当天和出院当天分别应用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）进行评分比较。 结果 两组患者干预后HAMD和HAMA评分均低于干预前（P < 0.05），其中观察组患者干预后HAMD和HAMA评分低于对照组（P < 0.05）。 结论 根据贝克认知疗法而实施的心理干预能够降低中青年ACS患者的焦虑和抑郁的程度。

[关键词] 贝克认知疗法； 急性冠脉综合征；焦虑；抑郁

[中图分类号] R473.5 [文献标识码] A [文章编号] 1673-7210（2017）01（a）-0170-04

[Abstract] Objective To explore the effect of psychological intervention according to Beck's cognitive therapy on anxiety and depression in young and middle-aged patients with acute coronary syndrome. Methods From July 1， 2015 to February 1， 2016， 82 young and middle-aged patients with acute coronary syndrome admitted to the First Department of Cardiology， Shengjing Hospital of China Medical University were selected. The selected patients were divided into control group （41 cases） and observation group （41 cases）， according to the random number table. Patients in the control group were given the routine treatment and nursing care， and patients in the observation group were given psychological intervention according to Beck′s cognitive therapy in addition to the routine treatment and nursing care. All the patients were measured by Hamilton Depression Scale （HAMD） and Hamilton Anxiety Scale （HAMA ） when they were in and out hospital. Results The HAMD and HAMA scores in both two groups after treatment were lower than those before treatment（P < 0.05）， and after treatment the sores in observation group were lower than those in the control group （P < 0.05）. Conclusion The psychological intervention according to Beck′s cognitive therapy can reduce the level of anxiety and depression in young and middle-aged patients with acute coronary syndrome.

[Key words] Beck′s cognitive therapy； Acute coronary syndrome ； Anxiety； Depression

急性冠脉综合征（ACS）是冠心病死亡的重要原因之一，包括不稳定型心绞痛、非ST段抬高型心肌梗死和ST段抬高型心肌梗死3种类型；不稳定的粥样斑块是ACS的病理基础[1-2]。近几年，受工作压力、不良生活习惯和饮食方式等因素影响，我国ACS的发病率明显增加，并且有年轻化的趋势；ACS年轻化与职业、性别、吸烟、饮酒、精神因素、劳累、遗传因素、肥胖密切相关[3]。由于ACS具有病情危重、变化快、死亡率高等特点，再加之经济及工作等方面的压力，患者往往产生焦虑、抑郁的情绪，尤其是中青年患者通常无重大疾病史，在生活和工作中都扮演着重要的角色，他们的心理应激比老年人更加强烈。而焦虑抑郁等负性情緒均为冠心病的独立预测因素，合并焦虑抑郁的冠心病患者，尤其是ACS患者心血管并发症的发生率明显增加[4]。……