老年与非老年男性喉癌患者术后情绪和认知功能比较及影响因素分析

The clinical characteristics and influencing factors on postoperative emotion and cognitive functions for elderly versus non-elderly male patients with laryngeal cancer

目的探究老年与非老年男性喉癌患者术后情绪和认知功能特点及影响因素。方法采用问卷调查,纳入2018年1月至2019年12月在山西省某两所三级甲等医院头颈外科手术治疗的喉癌患者105例,其中老年组60例,非老年组45例;分别于术前、术后10d、术后1年应用焦虑自评量表(SAS)、抑郁自评量表(SDS)和蒙特利尔认知功能评估量表(MOCA)评价负性情绪和认知功能,分析比较老年组与非老年组患者的临床特点。结果术后1年,老年组患者抑郁和癌症相关认知功能障碍(CRCI)为52例(86.7%)和27例(45.0%),高于非老年组患者30例(66.7%)和4例(8.9%),差异有统计学意义(χ^(2)值分别为6.013、16.115,P<0.05和P<0.01)。老年组与非老年组比较,术后10 d表现焦虑和CRCI更明显(60.50±4.31)分比(55.84±3.81)分和(27.47±1.08)分比(28.31±1.08)分(均P<0.01);术后1年,老年组较非老年组患者抑郁和CRCI更严重,(62.60±5.37)分比(57.20±5.66)分和(26.08±1.42)分比(27.36±1.37)分(均P<0.01)。多元线性回归结果显示,手术方式、术后1年发音情况影响老年患者的焦虑情绪(P<0.01和P<0.05);有无伴侣、文化水平影响抑郁情绪(P<0.05和P<0.01);有无伴侣、文化水平和手术方式影响认知功能(P<0.01、P<0.05、P<0.05)。非老年组患者临床分期影响焦虑和抑郁情绪(均P<0.05),文化水平影响认知功能(P<0.05)。结论喉癌患者的术后情绪和认知功能自术后持续恶化,受多种因素影响,尤其是老年患者更明显,需尽早进行积极有效的干预。

Objective To analyze the clinical characteristics and influencing factors on postoperative emotional and cognitive function for elderly versus non-elderly male patients with laryngeal carcinoma.Methods The patients with laryngeal cancer hospitalized in the Department of Otorhinolaryngology-Head and Neck Surgery were selected for a questionnaire survey in two Grade Ⅲ-A Hospital in Shanxi Province from January 2018 to December 2019.There were 105 patients with laryngeal cancer,including 60 in the elderly and 45 in the non-elderly group.Negative emotion and cognitive function were investigated by using Self-rating Anxiety Scales(SAS),Self-rating Depression Scale(SDS),and Montreal Cognitive Assessment(MOCA)before surgery,10 days after surgery,and 1 year after surgery,respectively.The clinical characteristics of the elderly versus non-elderly groups were analyzed and compared.Results One year after surgery,there were 52 cases(86.7%)and 27 cases(45.0.%)of depression and cancer-related cognitive impairment(CRCI) in the elderly group,which were higher than 30 cases(66.7%)and 4 cases(8.9%)in the non-elderly group,with statistically significant difference(χ^(2)=6.013,χ^(2)=16.115 andP<0.05,P<0.01).The elderly group showed much more anxiety and CRCI 10 days after surgery(60.50±4.31 vs.55.84±3.81,27.47±1.08 vs.28.31±1.08,P<0.01)and showed much more depression and CRCI(57.20±5.66 vs.62.60±5.37,27.36±1.37 vs.26.08±1.42,P<0.01)than did the non-elderly group 1 year after surgery.The results of multiple linear regression analysis in the elderly group showed that the mode of operat10n and the pronunciation one year after surgery significantly affected their anxiety;the marriage and the educated level significantly affected their depression;the marriage,the educated level and operation mode significantly affected their cognitive function.Clinical stage of tumor significantly affected anxiety and depression,the educated level significantly affected cognitive function m the nonelderly group.Conclusions Postoperative negative emotion and cognitive function in patients with laryngeal cancer continues to deteriorate after surgery,which were affected by many factors,especially in elderly patients.It is necessary to conduct active and effective interventions as soon as possible.