社区双心模式干预老年冠心病合并焦虑抑郁症状的效果研究-现代医学

社区双心模式干预老年冠心病合并焦虑抑郁症状的效果研究

单位：1. 北京市通州区梨园镇梨园社区卫生服务中心全科医疗科, 北京 101101;
2. 首都医科大学附属北京安贞医院心外科, 北京 100029

分类号：R541.4;R749.2

出版年·卷·期（页码）：2026·54·第六期（937-944）

摘要：

目的：探讨“双心”管理模式下认知行为疗法(CBT)对社区老年冠心病合并焦虑抑郁症状患者的干预疗效，为基层医院双心模式的推广提供理论依据。方法：本研究为前瞻性非随机对照研究。选取2024年1月至2024年12月在北京市通州区梨园镇梨园社区卫生服务中心就诊的老年冠心病患者作为干预组，将附属社区卫生服务站的患者作为对照组。对照组接受常规药物治疗，干预组在药物治疗基础上接受为期16周的CBT。在干预前后分别采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评分，以评估治疗效果。采用线性混合效应模型分析两组在不同随访节点焦虑抑郁症状评分的差异变化。结果：本研究最终纳入干预组41例、对照组54例。主要结局指标：两组HAMA基线评分组间差异无统计学意义(β=0.537，95%CI-0.561~1.635，P=0.338)。干预组HAMA评分的下降幅度在6个月时(β=1.806，95%CI 0.708~2.904，P<0.001)和12个月时(β=1.963，95%CI 0.865~3.061，P<0.001)均大于对照组。两组HAMD基线评分组间差异无统计学意义(β=0.155，95%CI-1.045~1.355，P=0.800)。干预组HAMD评分的下降幅度在6个月时(β=2.458，95%CI 1.258~3.658，P<0.001)和12个月时(β=2.262，95%CI 1.062~3.462，P<0.001)均大于对照组。次要结局指标：12个月内干预组的计划外门急诊就诊率低于对照组(P=0.038)；随访12个月时，两组NT-proBNP、TC及LDL-C水平比较，差异均无统计学意义(均P>0.05)。结论：对于社区合并焦虑抑郁症状的老年冠心病患者，在药物治疗基础上联合CBT，能显著改善其焦虑抑郁症状，并可有效降低计划外门急诊就诊率。这一结果为在基层社区医疗中构建本土化的“双心”干预路径提供了直接证据。

Objective: To explore the efficacy of cognitive behavioral therapy(CBT) under the “psycho-cardiology” management model in aged patients with coronary heart disease(CHD) and comorbid anxiety and depressive symptoms, and to provide theoretical evidence for the promotion of the “psycho-cardiology” model in primary health care. Methods： This study employed a prospective non-randomized controlled design. Aged patients with CHD from Liyuan Community Health Service Center in Tongzhou District, Beijing, from January 2024 to December 2024 were assigned to the intervention group, while patients from affiliated community stations served as the control group. The control group received pharmacotherapy alone, whereas the intervention group received pharmacotherapy plus a 16-week CBT program. The Hamilton Anxiety Rating Scale(HAMA) and Hamilton Depression Rating Scale(HAMD) were administered before and after the treatment to evaluate outcomes. A linear mixed model was used to analyze between-group the differential changesin anxiety and depression symptoms at different follow-up time points. Results: A total of 41 patients in the intervention group and 54 in the control group were included in the final analysis. For the primary outcomes, there was no significant difference between the two groups in baseline HAMA scores(β=0.537, 95%CI -0.561-1.635, P=0.338). The intervention group exhibited a significantly greater reduction in HAMA scores at 6 months(β=1.806, 95%CI 0.708-2.904, P<0.001) and at 12 months(β=1.963, 95%CI 0.865-3.061, P<0.001) compared with the control group. Similarly, baseline HAMD scores did not differ significantly between the two groups(β=0.155, 95%CI -1.045-1.355, P=0.800). The intervention group showed a significantly greater decrease in HAMD scores at 6 months(β=2.458, 95%CI 1.258-3.658, P<0.001) and at 12 months(β=2.262, 95%CI 1.062-3.462, P<0.001) relative to the control group. Regarding secondary outcomes, the rate of unplanned outpatient and emergency visits within 12 months was significantly lower in the intervention group(P=0.038). At 12 months after treatment, there were no statistically significant differences between the two groups in NT-proBNP, total cholesterol, or LDL-C levels(all P>0.05).Conclusion: Among aged patients with CHD and comorbid anxiety and depressive symptoms, the addition of CBT to pharmacological treatment can significantly alleviate anxiety and depressive symptoms and reduce the rate of unplanned outpatient and emergency visits. The findings provide direct evidence for constructing a localized primary health care psycho-cardiology intervention pathway.

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