伏隔核毁损术戒毒术前及术后精神心理学量表测评结果分析

Analysis of results of psychological scales before and after ablating nucleus accumbens with stereotactic surgery for treating drug abstinence

目的研究探讨伏隔核定向毁损术戒毒对智力、记忆、人格特征及焦虑情绪的影响,评价手术的安全性。方法采用中国修订韦氏成人智力量表(Wechsleradultintelligencescale-revisedinChina,WAIS-RC)和韦氏记忆量表(Wechslermemoryscale,WMS)、明尼苏达多项人格调查表(Minnesotamultiphasicpersonalityinventory,MMPI),卡特尔16种个性因素测验(theCattell16personalityfactor,16PF)及汉密顿焦虑量表(Hamiltonanxielyscale,HAMA)对2000年7月至2004年11月272名接受手术的药物依赖、成瘾患者进行术前、术后的测评比较。结果术后1个月及3个月WAIS-RC及WMS测评结果与术前比较,未发现手术对智力、记忆有不良影响,且智商和记忆商均较术前有明显改善,VIQ,PIQ,MQ改善显著(P<0.01),而FIQ改善不显著(P>0.01);MMPI测评术后评分较术前显著减少(P<0.01)的有疑病、抑郁、癔病、心理病态,评分显著增加并有显著差异(P<0.01)的有偏执、精神分裂、轻躁狂;术后16PF测评显示,志愿者手术后的人格的多种因素无显著改变,只有H、L、O、Q2和适应焦虑分增高;HAMA测评结果显示,术后躯体性焦虑分数、精神性焦虑分数及焦虑总分均比术前显著降低(P<0.001)。结论定向伏隔核毁损术对志愿者的智力和记忆水平无明显不良影响,部分功能较术前有所改善;对志愿者的人格特征总体影响不显著,但可能对其中的部分个性特征如独立性、敢为性、忧虑性、怀疑性等构成一定影响。手术可使志愿者的焦虑水平明显降低,伏隔核定向毁损术戒毒是安全可行的。

Objective To probe into affecting on intellectuality, memory, characteristic of personality and anxiety emotion of ablating nucleus accumbens with stereotactic surgery for treating drug abstinence and evaluate safety of surgery. Methods The contrast analysis before and after operation were adopted by using the access tools such as WAIS-RC,WMS,MMPI, 16PF and HAMA on volunteers. Results The comparative results of WAIS-RC and WMS before and after the operation indicated that there were no bad effects on intellectuality and memory. Compared with preoperation,intelligence quotient and memory quotient were improved obviously. The VIQ, PIQ and MQ were higher than that of preoperation and the difference were obvious. The MMPI testing showed that the scores of Hs,D, Hy,Pd were markedly lower than that of preoperation（P d0. 01）, while the scores of Pa, Sc, Ma were markedly higher than that of preoperation （P〈0. 01）. 16PF measuring indicated that there were no obvious impact on personality characteristic in general,only scores of H, L, O, Q2, adopt and anxiety were increased. The results of HAMA showed that all scores of physical anxiety, psychological anxiety and general anxiety were lower markedly than that of preoperation（P〈0. 001）. Conclusion Ablating nucleus accumbens bilaterally with stereotactic surgery for alleviating drug abstinence had no impact on level of intellectuality and memory of volunteers, some of the functions were improved than that of preoperation. There were no obvious impact on personality characteristic in general, but may affect on some of them such as independence, boldness, disturbance and suspicion. The surgery can decrease the level of anxiety of volunteers. So it is a safe and feasible procedure.