Harv Rev Psychiatry：冠状动脉旁路移植术前后应监测抑郁

　　美国一项荟萃分析研究表明，部分患者在冠状动脉旁路移植术（CABG）后总体抑郁状态改善或缓解，而大部分患者不能缓解，有必要在术前和术后监测抑郁。该研究论文近日发表于《哈佛精神病学述评》[Harv Rev Psychiatry 2013，21（2）：59]。

　　该研究通过EMBASE、PubMed和PsycINFO数据库检索了评估CABG前后抑郁的研究，对术后早期（1～2周）、恢复期（2周～2个月）、中期（2～6个月）和晚期（＞6个月）的抑郁状态进行了荟萃分析。

与冠状动脉相关的拓展阅读：

• JAMA：冠状动脉疾病患者局部心肌变薄与疤痕负荷有关
• Stroke：冠状动脉钙化为卒中独立预测因子
• BMJ：植物性脂肪增加冠状动脉疾病患者死亡风险
• NEJM：PCI +最佳药物疗法与单纯最佳药物疗法治疗稳定型冠状动脉疾病的比较
• HIV感染者更容易出现严重的冠状动脉疾病
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Depressive Symptoms After CABG Surgery: A Meta-analysis

Abstract

Learning Objectives: After participating in this educational activity, the reader should be better able to measure the risk of depression before and after coronary artery bypass graft (CABG) surgery; examine the course of depression after CABG; and apply the results of the study to the treatment of patients.

Objective: Depression is highly comorbid with coronary artery disease. Clinicians face the question of whether patients’ depressive symptoms will improve after coronary artery bypass graft surgery (CABG). The objective of this meta-analysis is to determine the course of depressive symptoms after CABG.

Methods: EMBASE, PubMed, and PsycINFO were searched for studies assessing depression before and after CABG. Meta-analyses were performed for depression at early (1–2 weeks), recovery (>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months) postoperative time points. Heterogeneity and publication bias were analyzed.

Results: Thirty-nine studies were included in the meta-analysis. Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and 9 reported both. Risk of depression was increased early (relative risk [RR] = 1.27; 95% confidence interval [CI], 1.01–1.61). There was a significantly decreased risk of depression at recovery (RR = 0.78; 95% CI, 0.67–0.90), mid (RR = 0.64; 95% CI, 0.58–0.70), and late (RR = 0.68; 95% CI, 0.58–0.79) time points without heterogeneity. All studies reporting continuous depression scales had significant heterogeneity.

Conclusions: The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression. Preoperative and postoperative depression monitoring is important.