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目的：系统评价心理干预对共病抑郁的慢性心力衰竭患者抑郁与焦虑情绪的干预效果。方法：计算机检索中英文数据库，搜集建库至2024年12月1日发表的关于心理干预对共病抑郁的慢性心力衰竭患者效果的随机对照试验。由两名研究者独立筛选文献、提取资料并评价偏倚风险后，采用RevMan 5.4软件进行Meta分析。结果：共纳入10项随机对照试验，涉及959例患者。Meta分析结果显示，心理干预可显著降低患者的抑郁评分，差异具有统计学意义[标准化均数差（SMD）=-0.38,95%CI:-0.52～-0.24,P<0.001]；亚组分析显示，不同干预时长与类型的干预效果无差异。对于焦虑，心理干预的总体效果有限（SMD=-0.19,95%CI:-0.34～-0.04,P=0.01），但亚组分析发现，其效果在干预后即时评估中不显著，而在短期与长期随访中均显示出显著改善（SMD=-0.44,95%CI:-0.64～-0.23,P<0.001;SMD=-0.40,95%CI:-0.57～-0.23,P<0.001），表明改善效果具有滞后性。结论：心理干预可有效改善共病抑郁的慢性心力衰竭患者的抑郁情绪，且效果稳健；其对焦虑的改善则存在滞后效应，在随访阶段效果更为显著。建议在临床实践中推广规范化的心理干预，并加强长期随访以全面评估其效益。
Abstract：Objective: To systematically evaluate the effects of psychological interventions on depression and anxietyin patients with chronic heart failure(CHF) and comorbid depression. Methods: Randomized controlled trials(RCTs)investigating the effects of psychological interventions in CHF patients with comorbid depression were searched inChinese and English databases from inception to December 1, 2024. Two researchers independently screened theliterature, extracted data, and assessed the risk of bias. Meta-analysis was performed using Rev Man 5.4 software.Results: A total of 10 RCTs involving 959 patients were included. The Meta-analysis showed that psychologicalinterventions significantly reduced depression scores in patients [standardized mean difference(SMD)=-0.38, 95%CI=(-0.52,-0.24), P<0.001]. Subgroup analyses indicated no significant differences in effects based on interventionduration or type. For anxiety, the overall effect of psychological interventions was limited [SMD=-0.19, 95%CI=(-0.34,-0.04), P=0.01]. However, subgroup analyses revealed that the improvement in anxiety was not significantimmediately after the intervention but became significant during both short-term and long-term follow-ups[SMD=-0.44,95%CI=(-0.64,-0.23),P<0.001;SMD=-0.40,95%CI=(-0.57,-0.23),P<0.001], indicating a delayedeffect. Conclusion: Psychological interventions are effective in alleviating depressive symptoms in CHF patients withcomorbid depression, with robust effects. However, the improvement in anxiety exhibits a delayed effect, becomingmore significant during follow-up. It is recommended to promote standardized psychological interventions in clinicalpractice and strengthen long-term follow-up to comprehensively evaluate their benefits.
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基本信息:
DOI：10.13401/j.cnki.jsumc.2025.04.005
中图分类号:R749.4;R541.6
引用信息:
[1]陈国正,施楚君.心理干预对共病抑郁的慢性心力衰竭患者干预效果的Meta分析[J].汕头大学医学院学报,2025,38(04):215-221.DOI:10.13401/j.cnki.jsumc.2025.04.005.
2025-12-30
2025-12-30