新型冠状病毒肺炎疫情期间延迟拔除输尿管支架对泌尿系结石术后患者生活质量和心理状态的影响

Effects of delayed ureteral stents removal during the COVID-19 pandemic on the quality of life and psychological status of postoperative patients with urinary calculi

目的:探讨因新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情而延迟拔除输尿管支架对泌尿系结石术后患者生活质量(quality of life,QoL)和心理状态的影响。方法:选择2019年12月至2020年6月在北京大学人民医院接受上尿路内镜碎石术后留置输尿管支架并返回医院取出支架患者的病例资料进行回顾性分析,收集患者人口学资料、输尿管支架症状问卷(ureteral stent symptoms questionnaire,USSQ)评分、焦虑自评量表(self-rating anxiety scale,SAS)评分和抑郁自评量表(self-rating depression scale,SDS)评分等。USSQ由6个维度(包括排尿症状、躯体疼痛、一般健康状态、工作表现、性功能和支架相关感染)共44个问题组成,量表大部分问题采用李克特(Likert)五级量表,小部分问题采用四级或七级量表量化。SAS和SDS均由20个问题组成,用于评估患者的焦虑抑郁状态,两个量表采用李克特四级量表,主要统计指标总分(20~80分)。使用标准分(总分乘以1.25取其整数)量化临床焦虑和抑郁程度,并运用矩阵结构分析构建多群组结构方程模型。结果:共纳入患者71例,输尿管支架中位留置时间对照组32(30,33)d与延迟组94.5(88,103)d相比,差异有统计学意义。延迟组患者在USSQ多维度中(包括排尿症状、一般健康状态、工作表现和支架相关感染)得分较高,焦虑和抑郁程度也明显比对照组严重。延长输尿管支架留置时间会加重患者排尿症状、躯体疼痛共同对工作表现的负面影响(P=0.029<0.05),其中,患者较严重的排尿症状导致工作表现欠佳受延长置管时间的影响最显著(CR=2.619>1.96)。新型冠状病毒肺炎疫情期间患者焦虑抑郁程度与支架相关症状严重度呈正相关。结论:因新型冠状病毒肺炎疫情延迟拔管患者的QoL较差,焦虑和抑郁程度较重;新型冠状病毒肺炎疫情期间患者焦虑抑郁程度越重,支架相关症状会加重。为了提高泌尿系结石术后患者在新型冠状病毒肺炎疫情期间的QoL和心理健康水平,应避免延长支架留置时间或采取相应的干预措施。

Objective:To explore the impacts of delayed ureteral stent removal on the quality of life(QoL)and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19)pandemic.Methods:The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People’s Hospital for stent removal from December 2019 to June 2020 were collected.Ureteral stent symptoms questionnaire(USSQ)score and the outcome 20-item self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were collected to estimate the QoL and mental status.The USSQ consisted of 44 questions in 6 domains(including urinary symptom,physical pain,general health,work performance,sexual function,and ureteral stent related infection).For most questions in each domain,its score was a five-point Likert-type scale from 1 to 5,and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale.SAS and SDS both contained 20 questions used to assess a patient’s level of anxiety and depression.Its scoring for each item was on a four-point Likert-type scale from 1 to 4.A total score(ranging from 20 to 80)was the main statistical indicator.The level of clinical anxiety and depression was quantified by using standard scores(total score multiplied by 1.25 to produce integers).And the multi-group structural equation model was constructed by analysis of moment structure(AMOS)analysis.Results:Overall,71 patients were enrolled for analysis.It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32(30,33)d and 94.5(88,103)d,respectively.The delayed group resulted in higher scores in the USSQ multidimensional,which included urinary symptoms,general health,work performance and ureteral stent related infections.Anxiety and depression were also significantly serious in the delayed group than in the control group.A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance(P=0.029<0.05).Among them,the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time(CR=2.619>1.96).Conclusion:Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status.Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19.To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19,it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.