截肢患者围手术期的焦虑抑郁状况及其影响因素

Anxious and depressive status of patients with amputation during peri-operation period and its influencing factors

目的:探讨截肢患者围手术期的焦虑抑郁状况及其相关的社会心理因素。方法:对江门市新会区会城医院外科1996-01/2004-05的112例截肢患者手术前后心理状况,应用自制一般问卷及心理调查问卷调查患者年龄、文化程度、经济状况及术前准备情况,应用汉密顿抑郁量表(24项版,采用0～4级5级评分,总分<8,无抑郁症状;>20,可能是轻或中度抑郁;>35,可能为严重抑郁)评估患者抑郁状态,应用汉密顿焦虑量表(14项版,采用0～4级5级评分,总分<7,无焦虑;>7可能有焦虑;>14,肯定有焦虑;>21,肯定有明显焦虑;>29,可能为严重焦虑)评估患者焦虑状态,应用手术状况调查问卷调查手术时间、手术并发症、术式等项目的患者知晓程度,应用术后生活及睡眠状况调查问卷调查术后患者生活情况及睡眠情况,并将其数据进行比较。结果:调查资料完整纳入分析的问卷106份,应答率为94.6%(106/112)。①手术前后焦虑、抑郁情况分析:手术前有焦虑症状的35例(33.0%,35/106),有抑郁症状的41例(38.7%,41/106)。手术后有焦虑症状的26例(24.5%,26/106),有抑郁症状的31例(29.2%,31/106)。手术前汉密顿焦虑量表总分显著高于手术后犤(6.02±5.14),(4.96±5.14)分,P<0.05犦。②手术后焦虑与术前焦虑和抑郁状态的关系:均呈正相关(r=0.377,r=0.313,P<0.0001),术后抑郁与术前焦虑和抑郁状态均呈正相关(r=0.359,r=0.298,P<0.0001)。③手术前后患者心理状况与相关因素的关系:与父母关系、情绪控制、术前陪同、家人对患者的关心、截肢部位、医生态度、术后亲友支持、社会接触的异性态度等因素存在相关性(P<0.05)。结论:①截肢患者术前有焦虑抑郁情绪者术后发生焦虑抑郁的危险性明显增高,而且手术前焦虑抑郁症状的发生率均较手术后高。②截肢患者的心理状况与其父母、亲朋及其他家庭成员等因素有相关性,如果对截肢患者及其家庭成员进行适当的心理干预,会明显降低患者术后精神症状的发生率。

AIM：To study the anxious and depressive state and its related psychosocial factors in patients with amputation during the peri-operation period.METHODS： 112 patients with amputation were enrolled in the study from the Department of Surgery,Jiangmeng City Huicheng Hospital of Xinhui District between January 1996 and May 2004. Self-designed questionnaires were used to evaluate patients ＇mental condition, and items of questionnaire included age, educational level, economic situation and pre-nperative preparation;Hamilton depression rating scale （HAMD）-14th edition and Hamilton anxiety rating scale （HAMA） were used to evaluate patients＇depressive symptoms and anxious symptoms, respectively （HAMD grades 0-4, 〈 8 no depression or anxiety, 〉 20 mild to moderate depression, 〉 35 severe depression; HAMA grades 0-4, 〈 7 no anxiety, 〉 7 perhaps having anxiety,〉 14 confirmed as having anxiety,〉 21 obvious anxiety,〉 29 severe anxiety）. The results of questionnaire for operation （operation time,complication and operation manner, etc.）, questionnaire for postoperative life. and sleening were comnared.RESULTS： 106 questionnaires were complete and enrolled in the results analysis, and the response rate was 94.6%（106/122）. ①Before operation,there were 35 cases （33.0%,35/106） with anxious symptoms and 41 cases（38.7%,41/106） with depressive symptoms; there were 26（24.5%,26/106）and 31 （29.2%,31/106）, respectively, after operation.②The preoperative scores on HAMD and HAMA were significantly higher that the postoperative ones （6.02±5.14 vs 4.96±5.14, P 〈 0.05）. Postoperative anxiety and depression were positively correlated to preoperative depressive and anxious symptoms （P 〈 0.000 1）. ③There was a correlation between patients＇mental status and relationship with parents,emotion control,preoperative accompany,family＇s care on patients,amputation site,physician＇s attitude, postoperative support from relatives and friends, and attitude of people with different sex in societv （P 〈 0.05）CONCLUSION： ①Patients with anxious or depressive symptoms before operation have a high risk for postoperative anxiety or depression. Most of anxious or depressive symptoms occur before operation.② Patients＇ mental status is related to the factors of their parents,relatives and friends.Adequate mental intervention for patients and their family will obviously decrease the incidence rate of postoperative mental symptoms.