颅脑肿瘤患者围手术期抑郁状态危险因素分析

Risk factors for perioperative depressive symptom in patients undergoing elective supratentorial tumor resection

目的探讨择期行神经外科幕上肿瘤切除术患者发生围手术期抑郁状态(perioperative depressive symptom,PDS)的危险因素。方法本研究为单中心前瞻队列研究,通过筛选2017年7月至2018年8月于首都医科大学附属北京天坛医院择期行幕上肿瘤切除术患者的人口统计学及临床相关资料,并于手术前1 d应用病人健康问卷抑郁量表(Patient Health Questionnaire-9,PHQ-9)对所筛选患者进行抑郁状态评估。根据PHQ-9评分结果将患者分为无/轻度抑郁组(0~9分)、中重度抑郁组(≥10分)两组。分析与围手术期抑郁状态相关危险因素,并应用Logistic回归分析各因素与围手术期抑郁状态发生的关系。结果本研究共筛选并访视了812例择期行幕上肿瘤切除术患者,无/轻度抑郁组633例,中重度抑郁组179例。在年龄、性别、平均月收入、最终受教育程度、既往合并恶性肿瘤病史、肢体活动受限、慢性疼痛病史、Charlson评分等因素,两组间比较差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前合并肢体活动受限、Charlson评分是患者合并围手术期中重度抑郁状态的危险因素。结论本组幕上肿瘤切除术患者群体的PDS发生率为22%。肢体活动受限以及术前Charleson评分较高为PDS的独立危险因素。

Objective To investigate the risk factors of perioperative depression symptom(PDS)in patients undergoing supratentorial tumor resection.Methods This was a single-center prospective cohort study.Demographic and clinical data were collected from patients undergoing supratentorial tumor resection in Beijing Tiantan Hospital,Capital Medical University from July 2017 to August 2018.The patients were assessed by the Patient Health Questionnaire-9(PHQ-9)one day before operation and then divided into two groups based on PHQ-9 results:a moderate or severe PDS group(≥10 scores)and a none/mild PDS group(0-9 scores).The risk factors of PDS were analyzed and the Logistic regression model was established to determine the relationship between these risk factors and PDS.Results There were 812 patients enrolled into the current study,including 179 patients with moderate to severe PDS and 633 patients without or with mild PDS.There were significant differences between the two groups in age,gender,average monthly income,academic qualification,previous malignant tumor history,extremity movement impairment,chronic pain history and the Charlson score(P<0.05).The Logistic regression model revealed that extremity movement impairment and the Charlson score were the risk factors of perioperative moderate or severe depression symptoms.Conclusions The incidence of PDS is 22%in patients undergoing supratentorial tumor resection.Extremity movement impairment and the high Charlson score are the independent risk factors of PDS.