贲门失弛缓症患者的精神心理因素和生活质量调查

Investigation of Quality of Life and Psycho-mental Factors in Patients with Achalasia

背景:贲门失弛缓症患者的症状常受情绪影响,但情绪因素在贲门失弛缓症发病中的作用尚不清楚。目的:了解贲门失弛缓症患者的生活质量以及精神心理因素在其发病中的作用。方法:对近10年在北京协和医院确诊并完成扩张治疗的347例贲门失弛缓症患者,通过发信以问卷形式进行调查,内容包括患者一般资料、发病诱因和症状加重原因、症状以及汉化版简明健康调查量表SF-36。结果:共收回问卷166份,应答率为47.8%。发病有明显诱因者占63.9%,其中受情绪影响51.2%,过度劳累21.1%,工作压力15.7%,应激事件15.7%;症状加重有明显原因者占62.0%,其中受情绪影响48.8%,过度劳累27.7%,应激事件15.7%,工作压力12.7%。扩张治疗后,患者8项症状均显著改善(P<0.05),但各维度生活质量仍显著低于健康对照组(P<0.05)。结论:精神心理因素可诱发、加重贲门失弛缓症患者的症状。扩张治疗可使患者的食管、气道等症状明显改善,并有维持疗效的作用。但患者在生理和心理两方面的生活质量仍明显低于健康人。

Background： Although symptoms of patients with achalasia are often related to psycho-mental factors, it remains unclear whether psycho-mental factors are involved in the pathogenesis of achalasia. Aims： To investigate the quality of life in patients with achalasia, and the role of psycho-mental factors in the pathogenesis of achalasia. Methods： The demographic data, psycho-mental factors, symptoms and quality of life （36-item short-form health survey, SF-36） were obtained by mailing questionnaires to 347 patients with achalasia who were diagnosed and treated by endoscopic balloon dilation during the past decade in Peking Union Medical College Hospital. Results： One hundred and sixty-six patients with achalasia mailed back the questionnaires, the response rate was 47.8%. Obvious inducing factors were found in 63.9% of patients, including psycho-mental factors （51.2%）, excess fatigue （21.1%）, working pressure （15.7%） and stress （15.7%）. Worsening factors were found in 62.0% of patients, including psycho-mental factors （48.8%）, excess fatigue （27.7%）, stress （15.7%） and working pressure （12.7%）. All eight symptoms improved markedly after endoscopic balloon dilation （P〈0.05）. All eight dimensions of quality of life in patients with achalasia were lower than those in the healthy subjects （P〈0.05）. Conclusions： Psycho-mental factors can induce and worsen achalasia symptoms. Esophageal and extraesophageal symptoms improved markedly and maintained after endoscopic balloon dilation. However, patients with achalasia have a reduced quality of life than healthy subjects, in both physical and mental aspects.