结肠癌、直肠癌患者围术期的焦虑抑郁状况及影响因素分析

Perioperative anxiety and depression of patients with colorectal cancer and their influencing factors

目的探讨结肠癌、直肠癌患者围术期焦虑、抑郁的发生率及相关影响因素。方法以行择期手术的98例结肠癌、直肠癌患者为研究对象,分别在术前1周内和术后出院前1天采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)进行评分。同时,采用自行设计的心理调查问卷进行精神健康相关因素调查。结果手术前有焦虑症状者占56.12%;有抑郁症状者占40.82%。手术后有焦虑症状者占42.86%;有抑郁症状者占37.76%。手术前HAMA评分显著高于手术后(P=0.003),手术前后HAMD评分没有显著差异。手术后,50岁以下的患者HAMD得分显著高于50岁以上患者(P=0.000)。手术前学历高的患者HAMA得分、HAMD得分均显著高于学历低的患者(P<0.05)。围术期结肠癌、直肠癌患者的焦虑、抑郁情绪与对病情的了解程度、手术的恐惧感、手术根治的效果、经济负担状况、疼痛程度、睡眠质量、术后生活质量、就业和工作前途的担忧等八项因素均有显著相关性(P<0.01)。结论结肠癌、直肠癌患者围术期存在较高的焦虑抑郁情绪,术前焦虑抑郁情绪的发生率均较术后高,且该负性情绪受多种因素的影响,有必要制定相应的干预措施。

Objective To investigate the incidence rate and the influencing factors of perioperative anxiety and depression of patients with colorectal cancer.Methods A total of 96 patients with colorectal cancer who received selective operations were measured with Hamilton anxiety rating scale（HAMA） and Hamilton depression rating scale（HAMD） within one week before operation and one day prior to discharge.Meanwhile,self-developed questionnaire survey on factors relative to mental health was conducted.Results Before operation,there were 56.12% patients with anxiety symptoms and 40.82% with depression symptoms.After operation,there were 42.86% and 37.76%,respectively.The preoperative scores of HAMA were significantly higher than the postoperative scores（t=3.027,P=0.003）.After operation,HAMD scores of patients under fifty years were significantly higher than patients over fifty years old（t=1.016,P=0.000）.Before operation,HAMA and HAMD scores of patients with high educational background were both higher than patients with low educational background（t=-2.020,P=0.046;t=-2.008,P=0.047 respectively）.Results of our analysis also suggested that anxiety and depression were significantly correlated with eight influencing factors,namely,knowledge of their conditions,fear of surgical treatment,results of surgical treatment,financial status,degree of pain,quality of sleep,quality-of-life after operation and concerns on future employment（P0.01）.Conclusion Perioperative anxiety and depression exist in patients with colorectal cancer.Most of anxiety or depression symptoms appear before operation and these negative emotions are affected by many factors.It is necessary to make corresponding mental intervention strategies.