急性冠脉综合征患者心理状态与应对方式特点及其关系研究
Study of the Psychological Symptoms and Coping Style in Acute Coronary Syndrome Patients
【中文摘要】 目的:分析不同情况下急性冠脉综合征(acute conoary syndrome,ACS)患者的心理状态与应对方式特点及其相互关系,为制定提高患者心理状态、应对能力的对策,促进其疾病的康复提供理论依据。方法:对95例ACS患者用症状自评量表(symptom check list 90,SCL-90)和医学应对方式量表(medical coping modes questionnaire ,MCMQ)评价患者的心理状态、应对方式。按ACS类型分为不稳定型心绞痛( unstable angina , UA)组和急性心肌梗死( acute myocardial infarction ,AMI)组,合并高血压组与不合并高血压组,应用成组设计的t检验对其进行对照研究;应用Pearson’S相关分析判别ACS患者的心理状态和应对方式的相关性。结果:95例ACS患者的SCL-90总分及躯体化、抑郁、焦虑、敌对、恐怖、各因子得分高于常模组,而人际关系、偏执分低于常模组,强迫、精神病性两因子得分较常模组无统计学差异;面对、回避应对方式得分低于常模组,屈服分高于常模组。女性较男性人际关系敏感、焦虑得分更高;男性更多采用面对应对方式,女性更多采用屈服应对方式。60岁以下患者较60岁以上患者抑郁、偏执、精神病性得分更高,更多采用面对应对方式。高中以上学历者较高中以下者SCL-90总分及强迫、人际关系、偏执、精神病性得分更高,多采用面对与回避应对方式。离婚或丧偶比已婚者躯体化、焦虑、抑郁因子分及SCL-90总分高,更多采用屈服应对方式。不吸烟者比吸烟者人际关系敏感、精神病性得分较高,更多采用屈服应对方式。UA比AMI组SCL-90各因子得分及总分无统计学差异,但AMI组更多采用屈服应对方式。合并高血压组较不合并高血压组SCL-90总分、躯体化、焦虑、恐怖因子得分更高,其应对方式无统计学差异。95例ACS患者的心理状态总分与3种应对方式的相关性分析显示,心理状态总分与面对、回避、屈服3种应对方式均呈正相关。结论:ACS患者心理状态较常模差,与疾病常模相比较少采用面对与回避应对方式,较多采用屈服应对方式。其心理状态及应对方式受多种因素影响,高中以上学历、离婚或丧偶、合并高血压患者心理状态较差;男性、60岁以下、高中以上患者更多采用面对应对方式,女性、离婚或丧偶、不吸烟者、AMI患者更多采用屈服的应对方式。心理状态与应对方式之间存在正相关。

【英文摘要】 Objective: To provide theory evidence for making treatment strategy for improving mental states and coping ability of acute coronary syndrome (ACS ) patients, we investigate the related factors and correlation of the psychological symptoms and coping style in ACS patients.Methods : 95 ACS patients were assessed by symptom check list 90(SCL-90)and medical coping modes questionnaire(MCMQ). The patients were divided into unstable angina pectoris (UAP) group and acute myocardial infarction (AMI) group. Data were analyzed by independent sample t test and Pearson’s correlations.Results : Compare with the ordinary mode,ACS 95 patients had significantly higher score of SCL-90 and more psychological symptoms such as somatic symptoms,depression,anxiety,hostility and fears .ACS patients had less symptoms of sensitive interpersonal relationship and paranoid than ordinary mode.There was no statistic difference of the score of obsession and psychosis between ordinary mode and ACS patients. Compare with ordinary mode,ACS patients had lower prevalence of "confrontation" and "avoidance" coping style and higher prevalence of "compromising "coping style.Female patients had more sensitive inter- personal relationship and anxiety symptoms than male. Male had higher prevalence of "confrontation" coping style, however female had higher prevalence of "avoidance "coping style.Patients under sixty had more symptoms of depression, paranoid, psychosis and higher prevalence of "confrontation" coping style than those over sixty. Patients with complete sec. education had significantly higher score of SCL-90 and more symptoms such as obsession,sensitive interpersonal relationship,paranoid and psycho- sis than those with incomplete sec. education.They also had higher pre- valence of "confrontation" and " avoidance " coping style. Compare with married patients,the widowed or divorced had significantly higher score of SCL-90 and more symptoms such as somatic symptoms, depression and anxiety, they had higher prevalence of " com- promising " coping style . As for non-smoker,they had more symptoms of sensitive interpersonal rela- tionship and paranoid and higher prevalence of "compromising" coping style than smoker. There were no statistic difference of the psychological symptoms between UAP and AMI patients, but AMI patients had higher prevalence of " compromising " coping style .Patients with hypertension had higher score of SCL-90 and more symptoms of somatic symptoms, anxiety and fear than those without. Hypertension had no effect on coping style.There was a positive correlation between psychological symptoms and the three kind of coping style in ACS patients.Conclusion: The psychological states of ACS patients were worse than ordinary mode. They had higher prevalence of "compromising" coping style and lower prevalence of "confrontation","avoidance" coping style. There are many related factors affect psychological symptoms and coping style of ACS patients. Patients with complete sec. education, widowed or divorced, or combine hypertension may have bad psychological states. Male, age under sixty or with complete sec. education had high prevalence of "conf- rontation" coping style. Female, patients with AMI or widowed or divorced, or non-smoker had high prevalence of " compromising " coping style . Psychological symptoms had a positive correlation to coping style in ACS patents. 

【中文关键词】 急性冠脉综合征; 心理状态; 应对方式
【英文关键词】 Acute coronary syndrome(ACS) ; Psychological symptoms; Coping style
  急性冠脉综合征患者心理状态与应对方式特点及其关系研究

中文摘要 6-8
英文摘要 8-9
综述 10-19
    参考文献 16-19
正文 19-34
    前言 19-20
    材料和方法 20-22
    结果 22-27
    讨论 27-31
    结论 31-32
    参考文献 32-34
致谢 34