手术绝经对围绝经期妇女精神神经症状的影响

Effects of surgery-induced menopause on neuropsychological symptoms in women with perimenopause

目的探讨手术绝经对围绝经期妇女精神神经症状的影响。方法对68例因妇科良性疾病行双侧卵巢切除的围绝经期妇女,采用改良Kupperman评分法对术前、术后的围绝经期综合征进行评分,包括对精神神经症状进行评分。并让患者对手术再次选择,分成暂缓手术组(n=38)和立即手术组(n=30),再次对两组精神神经症状进行评分。结果术前围绝经期综合征发生率为67.65%(22/68),其中中、重度症状发生率为30.88%;术后发生率为97.06%(66/68),其中中、重度发生率为70.59%,术后发生率显著高于术前(P<0.01)。术后精神神经症状评分均显著高于术前[失眠:(1.68±1.39)分vs(1.55±1.60)分;情绪波动:(2.51±1.82)分vs(1.68±1.77)分;抑郁:(0.98±1.46)分vs(0.60±0.38)分](P<0.01)。选择立即手术的患者仅术后情绪波动的评分明显高于术前评分(P=0.005);而选择暂缓手术的患者术后情绪波动和抑郁评分均明显高于术前评分(P=0.051,P=0.010)。结论围绝经期妇女行双侧卵巢切除术后,围绝经期综合征发生率升高,症状严重程度加重,精神神经症状评分升高,其中抑郁症状可能影响患者再次选择手术的因素。

Objective To investigate the effects of surgery-induced menopause on neuropsychologieal symptoms in women with perimenopause. Methods Sixty-eight women with perimenopause who underwent bilateral oophorectomy for benign indications were evaluated by the modified Kupperman index on the perimenopause syndrome pre- and post-surgery, including the score in neuropsychological symptoms. Patients were further requested to remake a decision on the acceptance of surgery, and were divided into ＂accept the surgery＂ group （ n = 30） and ＂postpone the surgery＂ group （ n = 38）. The neuropsychological symptoms were reevaluated and comparison was made between these two groups. Results The prevalence of perimenopause syndrome pre-surgery was 67.65% （22/68）, and that of moderate and severe symptoms was 30. 88%. The prevalence of perimenopause syndrome post-surery （97.06%） （66/68） was significantly increased, as well as that of moderate and severe symptoms （70.59%） （P 〈 0.01 ）. The scores in neuropsychological symptoms post-surgery were significantly higher than those pre-surgery （1.68 ± 1.39 vs 1.55 ± 1.60, 2.51 ± 1. 82 vs 1.68 ± 1.77 and 0.98 ± 1.46 vs 0. 60 ± 0. 38 for sleep disturbance, emotional fluctuation and depression, respectively） （P 〈 0.01 ）. Patients in ＂accept the surgery＂ group had significantly higher score in motional fluctuation post-surgery than pre-surgery （ P = 0. 005 ） , while those in ＂postpone the surgery＂ group had significantly higher scores in motional fluctuation and depression post-surgery than pre-surgery （ P = 0. 051, P = 0. 010）. Conclusion The prevalence and severity of perimenopause syndrome and the score in neuropsychological symptoms are increased. The symptom of depression may be an important factor for the acceptance of a second surgery by the patient.