肺源性心脏病伴焦虑抑郁患者的心率变异分析

目的观察肺源性心脏病伴焦虑抑郁情绪障碍患者与心率变异性的关系,探讨合理的抗焦虑抑郁治疗方案。方法对确定焦虑抑郁症的肺源性心脏病患者计算其在我病房的构成比。应用holter-star24H全信息动态心电图系统对39例确诊为肺源性心脏病不伴焦虑抑郁症的患者和81例肺源性心脏病合并焦虑抑郁症的患者进行心率变异性频域、时域的检测。60例肺源性心脏病合并焦虑抑郁症的患者随机分为药物治疗（百忧解和黛力新）30例和心理治疗组30例,观察治疗8周后患者的平均正常RR间期的标准差（SDNN）、相邻RR间期差的均方根（rMSSD）、相差〉50ms的相邻RR间期的总数（NN50）、相差〉50ms的相邻RR间期占RR间期总数的百分比（PNN50）、每5个正常RR间期平均值的标准差（SDANN）、总的频域值（TP）、极低频成分（VLF）、低频成分（LF）、高频成分（HF）、低频成分/高频成分（LF/HF）、汉密尔顿抑郁他评量表（HAMD）的评分。结果肺源性心脏病患者在我病房的发生率为67.5%,其中轻度焦虑抑郁为20%,中度焦虑抑郁为29.17%,重度焦虑抑郁为18.33%。肺源性心脏病合并焦虑抑郁患者SDNN,SDANN,TP,HF,LF的测量值随焦虑抑郁的严重程度下降,与单纯肺源性心脏病比较差异有统计学意义。rMSSD,PNN的测量值随焦虑抑郁的严重程度上升,且差异有统计学意义（P〈0.05）；药物治疗组和心理治疗组8周治疗后对患者的HAMD评分两组差异没有统计学意义（P≥0．05）,SDNN、rMSSD、NN50、PNN50、SDANN、TP、VLF、LF、HF、VLF、LF／HF的测量值差异没有统计学意义（P≥0．05）。结论肺源性心脏病合并焦虑抑郁患者存在有心交感神经的张力增加；合理的抗焦虑抑郁治疗（药物和心理治疗）利于改善患者的焦虑抑郁情绪,改善交感神经的张力。

Relationship between pulmonary heart disease with anxiety-depression state and hear rate variability

Objective Observing the relationships between the pulmonary heart disease(PHD) with anxiety-depression state and the hear rate variability.Methods The first step was to calculate the prevalence of anxiety-depression state in the patients of the pneumocardial disease.Then by holter-star 24H,the heart rate variability was examined among 39 PHD without and 81 PHD with anxiety-depression state,including SDNN,rMSSD,NN50,PNN50,SDANN,TP,VLF,LF,HF,VLF,LF/HF.The third step, 60 PHD cases with anxiety-depression state were randomly divided into drug group 30 causes and mental group 30 cases in stochastic process.Observing the SDNN,rMSSD,NN50,PNN50,SDANN,TP,VLF,LF,HF,VLF,LF/HF,scores of HAMD,after 8 weeks treatment.Results The prevalence of anxiety-depression state in the patients of diabetes mellitus is 67.5%.SDNN,SDANN,TP,HF,LF is lower in the patients of PHD with anxiety-depression state,the difference is signified.rMSSD,PNN is statistical different between PHD and PHD with anxiety-depression state; 3.8 weeks late,SDNN,rMSSD,NN50,PNN50,SDANN,TP,VLF,LF,HF,VLF,LF/HF,scores of HAMD between drug group and mental group,there are not statistical difference.Conclusions The activity of sympathectomy occurred in the patients of PHD with anxiety-depression state.The activity of sympathectomy can be controlled by anti-anxiety-depression therapy,either drug group or mental group.Rational treatment is beneficial in PHD with anxiety-depression state.