| With the rapid growth of the aging population,the incidence of acute myocardial infarction(Acute myocardial infarction,AMI)in urban and rural residents is gradually increasing,and has a younger trend.During the attack of AMI,the pain is severe,accompanied by sweating,panic and dyspnea,and even shock occurs in severe cases,which is a direct threat to life and safety.Myocardial revascularization has become the first choice for the treatment of acute myocardial infarction,in which the application of percutaneous coronary intervention(Percutaneous coronary intervention,PCI)can save the injured myocardium in time.However,PCI is an invasive operation.After experiencing the double blow of basic disease and PCI,patients are easy to produce psychological stress disorder,cause cardiac autonomic nervous disorder and affect the prognosis of the disease under the influence of many factors.At present,the effect of psychological disorders on autonomic nerves after PCI in patients with acute myocardial infarction has not been fully elucidated.When the patient's condition is relatively stable,the autonomic nervous function can be quantitatively evaluated by heart rate variability(Heart rate variability,HRV)and heart rate deceleration force(Deceleration capacity of rate,DC)analysis.According to different degrees of anxiety and depression,HRV and DC were used to evaluate the autonomic nervous function,to explore the relationship between psychological disorders and autonomic nervous function changes in patients with acute myocardial infarction after PCI,and to explore the influencing factors of psychological disorders in patients with acute myocardial infarction.Through the psychological disorder score of selected patients,statistics of anxiety and depression,according to different degrees of anxiety and depression,autonomic nervous function was evaluated by HRV and DC.The purpose of this study is to study the relationship between autonomic nerve state and TCM syndrome type through TCM syndrome differentiation of patients with mental disorder after PCI of acute myocardial infarction,so as to provide some reference basis for the treatment of psychological disorder after PCI of acute myocardial infarction with combination of traditional Chinese and western medicine.Part ? : Study on the relationship between psychological disorder and autonomic nervous function and its influencing factors after PCI in patients with acute myocardial infarction.Methods:From January 2019 to December 2019,133 patients with acute myocardial infarction were treated with PCI in the Department of Cardiology,Central War Zone General Hospital of Chinese people's Liberation Army.The anxiety and depression scale was used to score the psychological disorders of the patients within one week after PCI,and the occurrence of anxiety and depression was investigated.The patients were divided into four groups: simple anxiety group(n=35),simple depression group(n=33),anxiety-depression comorbid group(n=39)and non-anxiety-depression group(n=26).The general data of patients were recorded and the indexes of HRV and DC in each group were analyzed.Again,the patients were divided into three groups: mild group,moderate group and severe group according to the score of the scale.The HRV and DC indexes of each group were compared,and the risk factors of patients with anxiety and depression were analyzed.Results: 1.(1)There were no significant differences in sex,age,dyslipidemia,years of education and family history of cardiovascular disease among the four groups,but there were significant differences in hypertension,diabetes and smoking history(P<0.05),and there was no significant difference in biochemical indexes.(2)The results of comparison of different types of psychological disorders: compared with non-anxiety-depression group and simple anxiety group,the levels of DC,SDNN and SDNNI in simple depression group and comorbid group were significantly lower than those in non-anxiety-depression group and simple anxiety group,and SDANN in comorbid group was significantly lower than that in non-anxiety-depression group and simple anxiety group.There was no significant difference in r MSSD,PNN50 and HF among the four groups.Compared with non-anxiety-depression group and simple anxiety group,LF in co-disease group was significantly higher than that in non-anxiety-depression group and simple anxiety group.2.The results of comparison of anxiety and depression with different degrees of anxiety:(1)the DC of moderate and severe anxiety groups was significantly lower than that of mild anxiety group,and the DC of severe anxiety group was significantly lower than that of moderate anxiety group(P<0.05).The levels of SDNN,SDANN and SDNNI in severe anxiety were significantly lower than those in moderate and mild anxiety,but there was no significant difference in r MSSD,PNN50,LF and HF among the three groups.(2)the DC of moderate depression and severe depression was significantly lower than that of mild depression,and the DC of severe depression was significantly lower than that of moderate depression(P<0.05).(2)the DC of moderate depression and severe depression was significantly lower than that of mild depression.The levels of SDNN,SDANN and SDNNI in severe depression were significantly lower than those in moderate and mild depression,but there was no significant difference in r MSSD,PNN50,LF and HF among the three groups.3.Hypertension and smoking are the independent risk factors of anxiety after PCI,and the level of education is the independent risk factors of depression after PCI.Conclusion: 1.After PCI of acute myocardial infarction,the autonomic nerve regulation function was impaired,the sympathetic nerve was overexcited,the vagus nerve tension decreased,and DC and HRV decreased in the state of anxiety and depression.When there was anxiety and depression,the imbalance of autonomic nervous system increased,and the decrease of DC and HRV was the most significant.2.Compared with mild,moderate and severe anxiety and depression,DC,SDNN,SDANN and SDNNI decreased in turn.In severe anxiety and depression,the sympathetic nerve activity was significantly enhanced,the vagus nerve activity was significantly weakened,and the autonomic nerve imbalance was serious;3.Hypertension and smoking are the risk factors of anxiety in patients with acute myocardial infarction after PCI,and the level of education is the risk factors of depression in patients with acute myocardial infarction after PCI.Part ?:Study on the relationship between TCM classification of psychological disorders and autonomic nervous function in patients with acute myocardial infarction after PCI.Methods: From March 2019 to September 2019,79 patients with AMI were treated with PCI in the Department of Cardiology,Central War Zone General Hospital of Chinese people's Liberation Army.According to the relevant standards of syndrome differentiation,statistics of the distribution of TCM syndrome types of patients with anxiety and depression,using DC and HRV to evaluate autonomic nervous function.Results: 1.In patients with acute myocardial infarction,the syndrome of qi stagnation and blood stasis(32.9%)was the most common syndrome after PCI,followed by liver depression and qi stagnation syndrome(25.3%);2.(1)among the TCM syndromes associated with anxiety after PCI,qi stagnation and blood stasis syndrome(45.6%)was the most,followed by liver stagnation and qi stagnation syndrome(19.6%);(2).The levels of DC,SDNN,SDANN and SDNNI in qi stagnation and blood stasis syndrome were significantly lower than those in qi stagnation and blood stasis syndrome(P<0.05).There was no significant difference in r MSSD,PNN50 and LF among different syndrome types(P>0.05).Compared with other syndrome types,HF of qi stagnation and blood stasis syndrome decreased significantly.3.(1)the most TCM syndrome types of depression after PCI were qi stagnation and blood stasis syndrome(70.3%),followed by liver depression and qi stagnation syndrome(13.5%).(2)compared with depression related TCM syndromes,the DC of qi stagnation and blood stasis syndrome decreased significantly(P<0.05).There was no significant difference in SDNN,SDANN,SDNNI,r MSSD,PNN50,LF and HF among different syndrome types.Conclusion: 1.The TCM syndrome types of patients with acute myocardial infarction after PCI are mainly deficiency and excess mixed syndrome,followed by excess syndrome,and deficiency syndrome is less;2.There are more TCM syndrome types of anxiety after acute myocardial infarction(PCI).There is a certain correlation between anxiety TCM syndrome and autonomic nerve activity: sympathetic nerve is overexcited and autonomic nerve imbalance is the most serious in qi stagnation and blood stasis syndrome.3.There are more TCM syndromes of depression after PCI of acute myocardial infarction,and the relationship between TCM syndromes of depression and autonomic nerves is not statistically significant,so further research is needed. |
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