难治性高血压患者心理障碍现状及心理治疗联合抗焦虑抑郁药治疗的疗效

Psychological disorders in patients with resistant hypertension and the effect of psychotherapy combined with antidepressant and anxiolytics

    摘要
  • 摘要: 目的 探究难治性高血压(RH)患者心理障碍的临床特点及相关影响因素,并对RH合并心理障碍患者进行心理治疗联合抗焦虑抑郁药治疗,分析疗效。方法 2021年5月至2023年8月收集中南大学湘雅医院心内科门诊就诊的RH患者247例,对其进行一般人口学资料调查、广泛性焦虑量表(GAD-7)、患者健康问卷(PHQ-9)、患者健康问卷躯体症状群量表(PHQ-15)评定。对RH合并心理障碍患者,在原降压方案治疗基础上,辅以心理治疗和以氟哌噻吨美利曲辛为基础的药物治疗3月,分析降压疗效、降压药数量及GAD-7、PHQ-9和PHQ-15变化。结果 RH合并焦虑、抑郁、躯体化症状检出率分别为41.7%、38.5%、68.8%,心理障碍总检出率为71.3%。多因素logistic回归分析显示,生活压力(OR=3.842,95% CI 1.752~8.427)、PHQ-9评分高(OR=1.183,95% CI 1.085~1.290)、PHQ-15评分高(OR=1.284,95% CI 1.146~1.440)为RH合并焦虑的独立危险因素;病程长(OR=1.693,95% CI 1.086~2.639)、GAD-7评分高(OR=1.181,95% CI 1.084~1.286)、PHQ-15评分高(OR=1.390,95% CI 1.231~1.569)为RH合并抑郁的独立危险因素;GAD-7评分高(OR=1.206,95% CI1.036~1.404)、PHQ-9评分高(OR=1.419,95% CI 1.152~1.748)为RH合并躯体化症状的独立危险因素。躯体化症状评分与GAD-7(rs=0.705,P<0.001)、PHQ-9(rs=0.742,P<0.001)呈正相关。经治疗后患者降压总有效率为94.9%,血压达标率为83.5%,服用降压药数量减少≥1个的患者占51.3%,治疗后GAD-7、PHQ-9、PHQ-15评分及血压较治疗前下降(均P<0.001)。结论 RH患者合并心理障碍发生率高,以躯体化症状为突出表现,焦虑、抑郁、躯体化症状互为影响因素。RH伴心理障碍患者予以心身治疗可提高患者降压疗效,改善患者焦虑抑郁情绪及躯体化症状。

     

    Abstract: Objective To explore the clinical characteristics and related influencing factors of psychological disorders in patients with resistant hypertension (RH), and to analyze the therapeutic effect of psychotherapy combined with antidepressant and anxiolytics. Methods A total of 247 patients with RH were consecutively selected from Cardiovascular Department of Xiangya Hospital, Central South University from May 2021 to August 2023. The general demographic data were collected and the psychological disorders were evaluated by the generalized anxiety disorder-7 items scale (GAD-7), patient health questionnaire-9 items scale (PHQ-9) and patient health questionnaire-15 items scale (PHQ-15). The patients with RH complicated with psychological disorders were treated with psychotherapy combined with flupentixol melitracen-based drugs for 3 months on the basis of the original antihypertensive scheme. The antihypertensive efficacy, the number of antihypertensive drugs and the changes of GAD-7, PHQ-9 and PHQ-15 were analyzed. Results The detection rates of RH combined with anxiety, depression and somatization were 41.7%, 38.5% and 68.8% respectively, and the total detection rate of mental disorders was 71.3%. Multivariate logistic regression analysis showed that life stress (OR=3.842, 95% CI 1.752-8.427), high PHQ-9 score (OR=1.183, 95% CI 1.085-1.290) and high PHQ-15 score (OR=1.284, 95% CI 1.146-1.440) were independent risk factors for anxiety state, and long course of disease (OR=1.693, 95% CI 1.086-2.639), high GAD-7 score (OR=1.181, 95% CI 1.084-1.286) and high PHQ-15 score (OR=1.390, 95% CI 1.231-1.569) were independent risk factors for depression.High GAD-7 score (OR=1.206, 95% CI 1.036-1.404) and high PHQ-9 score (OR=1.419, 95% CI 1.152-1.748) were independent risk factors for somatic symptoms. Somatic symptom scorewas significantly positively correlated with GAD-7 (rs=0.705, P<0.001) and PHQ-9 (rs=0.742, P<0.001) respectively. After treatment, the total effective rate was 94.9%, blood pressure control rate was 83.5%, and in 51.3% patients, the number of antihypertensive drugs taken decreased by ≥1. After treatment, the scores of GAD-7, PHQ-9, PHQ-15 and blood pressure were all decreased (all P<0.001). Conclusions RH patients have a high incidence of psychological disorders, with somatization symptoms as a prominent manifestation. Anxiety, depression and somatization symptoms interact and influence each other. Psychotherapy combined with antidepressant and anxiolytic-stherapy can improve the antihypertensive effect, and improve their anxiety, depression and somatization symptoms in RH patients with mental disorders.

     

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