浅谈综合医院急诊胸痛患者的心理状态及临床特征【摘要】目的:评估胸痛患者的心理状态，分析描述非心源性胸痛（non-cardiacchestpain,NCCP）的临床特征。方法:横断面研究。收集胸痛为主诉连续就诊的急诊患者711人，采用汉密顿焦虑量表（HamiltonAnxietyRatingScale,HAMA）和汉密顿抑郁量表（HamiltonDepressionRatingScale-17，HAMD-17）评估患者心理状态，比较NCCP与心源性胸痛的临床特点。结果:共231例同意合作的胸痛患者入选，年龄19~79岁，男性106。其中182例为NCCP，49例为有器质性心脏病者（心源性胸痛组）。胸痛患者焦虑抑郁平均分均高于正常界值（HAMA得分≥14；HAMD-17得分≥8），以焦虑症状更明显，NCCP组有明显焦虑症状的患者比例高于心源性胸痛组(64.3%vs.57.1%,P＜0.01)。与心脏病患者相比，NCCP组年龄较小［(48.1±11.7)岁vs.(55.5±10.0)岁,P＜0.01］，≤45岁者较多(37.9%vs.16.3%,P＜0.01)，胸痛发作时更易出现死亡恐惧(59.3%vs.40.8%)、害怕(69.8%vs.34.7%)、失控感(31.9%vs.10.2%)、过度换气(37.4%vs.16.3%)和手脚麻木(37.4%vs.14.3%)等伴随症状（Ps<0.05）；伴随症状成组出现（≥4个）的比例更高(29.7%vs.10.2%，P<0.01)，发作时心电图正常、病程≥6月者更多（49.5%vs.30.6%,P＜0.05）。结论:急诊胸痛患者焦虑症状明显，其中大多数为非心源性胸痛，主要临床特征为年龄较轻、心电图正常、发作时常有特征性伴随症状，或特征性伴随症状成组出现。【关键词】胸痛；焦虑；抑郁；急诊医学；横断面研究doi:10.3969/j.issn.1000-6729.2010.12.003ThementalstateandcharacteristicsofpatientswithchestpainintheemergencydepartmentofgeneralhospitalsHEJian-Hua1,LICong-Jia1,WANGWen-Hua2,BAIShu-Gong1,ZHUHong-Yan1,NARun-Ping1,LIUXin11BEijingAnzhenHospital,CapitalMedicalUniversity,Beijing100029，China2BeijingOfficeforCardiovascularDiseasesPreventionandControl,Beijing100029,ChinaCorrespondingauthor,HEJian-Hua,E-mail:jianhuahe09199@yahoo.com.cn【Abstract】Objective:Toevaluatethementalstateanddelineatecharacteristicsofpatientswithchestpainintheemergencydepartmentofgeneralhospital.Methods:Thiscross-sectionalstudywasperformedintheemergencydepartment(ED)ofanurbantertiarycarehospital.Totally711consecutivepatientscomplainingofchestpainwereenrolledinthestudy.ThementalstatesofpatientswereassessedwiththeHamiltonAnxietyRatingScale(HAMA)andHamiltonDepressionRatingScale-17(HAMD-17).Results:Atotalof231patientspresentedtotheEDwithchestpainparticipatedinthestudy,including106malesand125females,aged19~79years.Amongthem,182patientswereconfirmedwithoutanyheartdisease,diagnosedwithnon-cardiacchestpain(NCCP),and49wereconfirmedwithheartdisease.ThepatientswithchestpainhadhigherscoresofHAMAandHAMD-17,especiallyHAMA.TheNCCPgrouphadhigherproportionofthepatientswhoseHAMAscoreswere≥14thantheheartdiseasegroup(64.3%vs.57.1%,P<0.01).ThepatientsinNCCPgroupwereyoungerthanpatientswithcardiacdisease［(48.1±11.7)vs.(55.5±10.0),P＜0.01)］,andmoreofthemwere≤45years(37.9%vs.16.3%,P＜0.01).TheattacksofchestpainwithNCCPweremorefrequentlyaccompaniedbythepresenceofsomespecifiedsymptomsthanpatientswithcardiacdisease:fearofdying(59.3%vs.40.8%),fear(69.8%vs.34.7%),feelingoutofcontrol(31.9%vs.10.2%),overventilation(37.4%vs.16.3%),numbnessoflimbs(37.4%vs.14.3%),andweremorelikelyappearedinagroupoftheseitemsatleastfourthancardiacdiseasepatients(29.7%vs.10.2%,P<0.01).Theelectrocardiology(ECG)ofNCCPpatientsduringchestpainattackwerenormal,andtheNCCPgrouphadhigherproportionofthepatientswhosediseasecoursewere≥6monththantheheartdiseasegroup(49.5%vs.30.6%,P＜0.05).Conclusion：Patientspresentingwithchestpainhaveapparentlyan...