听神经瘤患者手术前后焦虑、抑郁及相关因素评估

Assessment of Depressive and Anxious Symptoms before and after the Operation and Related Factors in Patients with Intracranial Vestibular Schwannoma

目的评估颅内听神经瘤患者手术前后的神经心理状态改变,初步分析影响听神经瘤患者情绪变化的相关因素。方法选取2009年3月至2012年3月94例诊断为单侧颅内听神经瘤患者,所有患者均由同一神经外科医生经枕下乙状窦入路进行手术治疗。随访时应用9项病例健康问卷(PHQ-9)和7项广泛性焦虑(GAD-7)自评量表评定患者术后情绪状态及回顾评估术前心理状态,对手术前后患者的抑郁焦虑情况与年龄、性别、肿瘤部位、术后House-Brackmann分级和肿瘤最大直径行Logistic回归分析。结果最终完成有效问卷82例(因不能完成问卷和既往精神疾病史等原因排除12例)。其中,男28例、女54例,平均年龄(47.88±11.05)岁,随访时间(33.83±11.98)个月。情绪量表评定结果显示,术前存在抑郁9/82例(11.0%),焦虑4/82例(4.9%);术后存在抑郁6/82例(7.3%),焦虑3/82例(3.6%)。经Fisher's精确检验,术前有抑郁症状的患者多于术后(x^2=10.09,df=1,P=0.016);Logistic回归分析显示听力障碍改善不佳(P=0.012)和年龄(P=0.044)是术后患者出现抑郁症状的危险因素。结论听神经瘤患者的术前抑郁、焦虑症状在肿瘤切除后可明显改善,随着术后康复时间的延长抑郁状况可进一步好转。对存在听力恶化或高龄患者,及时发现抑郁焦虑症状并予干预,有助于术后恢复。

Aim To assess depressive and anxious symptoms before and after the surgical treatment in patients with intracranial vestibular schwannoma and primarily identify correlated risk factors.Methods 94 patients from March 2009 to March 2012 were recruited.The identical surgical procedure was performed for those patients by the same neurosurgical team.Two self-reported questionnaires of Patient Health Questionnaire,9 items（PHQ-9） and Generalized Anxiety Disorder,7 items（GAD-7） were sent to 82 eligible patients（out of 94） and 100%of them responded,when patients came to the outpatient department for routine neurosurgical follow-up.The current emotional condition was assessed.SPSS 16.0 was used to perform statistical analysis.The difference of the proportion of patients with depressive or anxious symptoms before and after the surgical operation was tested by Chi square.The emotional symptoms and other factors such as age,gender,duration after the surgical operation,maximum diameters of the tumor,House-Brackmann ranking and hearing dysfunction were performed Logistic regression analysis.Results82 eligible patients finished all the questionnaires（87%）,with 54 female and 28 male.Their average age was（47.88±11.05） years old and the time after surgical operation was（33.83±11.98） months.There were 9patients with depressive symptoms（11%） and 4 patients with anxious symptoms（4.9%） before the surgical operation,whereas 6 patients with depressive symptoms（7.3%） and 3 patients with anxious symptoms（3.7%）after the operation.There were significantly statistical difference（x～2=10.09,df=1,P=0.016） before and after the operation.Logistic regression analysis showed that hearing deterioration and age were associated with depression after the surgical operation（P=0.012 and P=0.044,respectively）.Conclusion Depressive and anxious symptoms were very common among the patients with intracranial vestibular schwannoma in both before and after the surgical operation.Though those symptoms could be improved when tumor was removed by surgical operation,depressive symptoms could still occur or exist.Worse hearing function and age might be risk factors for depressive symptoms after the surgical operation.