抑郁症是冠状动脉旁路手术后死亡的风险因素
James A Blumenthal1, Heather S Lett, Michael A Babyak
1Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA. blume003@mc.duke.edu
Lancet (London, England)
|August 29, 2003
概括
临床抑郁症显著增加了冠状动脉旁路移植 (CABG) 手术后的死亡风险. 持续或严重的CABG后抑郁症需要仔细监测和治疗,以改善患者的生存率.
科学领域:
- 心脏病学 心脏病学
- 精神病学是一种精神病学.
- 医学成果研究研究成果
背景情况:
- 之前关于抑郁症作为心脏事件风险因素的研究冠状动脉旁路移植 (CABG) 手术后的研究受到小样本大小和短的随访时间的限制.
- 在CABG后抑郁症和死亡率之间的关联尚未得到充分评估,原因是之前的研究中统计能力不足.
研究的目的:
- 确定抑郁症是否是CABG手术患者死亡率增加的独立风险因素.
- 评估术前和持续的术后抑郁症对CABG后的生存率的长期影响.
主要方法:
- 评估了杜克大学医学中心在1989年至2001年期间接受CABG的817名患者的队列.
- 患者完成了中心流行病学研究-抑郁症 (CES-D) 尺度手术前和CABG后6个月,随访长达12年.
- 进行了生存分析,调整了关键的临床共变量,包括年龄,性别,糖尿病和心脏功能.
主要成果:
- 在平均5.2年的随访期间,817名患者中发生了122例死亡 (15%).
- 38%的患者接受了抑郁症查结果 (CES-D ≥16),其中12%的患者表现出中度至严重的抑郁症 (CES-D ≥27).
- 中度至严重的基线抑郁症 (调整HR 2.4) 和从基线持续到6个月的持续抑郁症 (调整HR 2.2) 与较高的死亡率显著相关.
结论:
- 抑郁症被确定为CABG手术后死亡率的重要,独立预测因素.
- 这些发现强调了监测和管理CABG患者的抑郁症的重要性,以潜在地改善长期结果.
- 尽管在手术和医疗保健方面取得了进展,但抑郁症等心理因素在CABG后的生存中起着至关重要的作用.
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