腹腔镜结直肠癌根治术患者创伤后应激障碍轨迹的纵向研究

Longitudinal Study on the Trajectory of Post-traumatic Stress Disorder in Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

目的:探讨腹腔镜结直肠癌根治术患者术后1年内创伤后应激障碍(posttraumatic stress disorder,PTSD)的纵向变化轨迹,分析心理维度、社会支持维度及炎症因子对轨迹类别的预测作用。方法:本研究为前瞻性观察性纵向研究。选取2021年2月至2022年8月我院结直肠癌行腹腔镜根治术的患者为研究对象,于术后6周(T1)、术后3个月(T3)、术后6个月(T4)、术后9个月及术后12个月(T5)采用创伤后应激障碍平民版量表调查患者5个时间点的PTSD水平,采用潜类别增长模型(latent class growth model,LCGM)识别轨迹类别,采用Logistics回归分析识别轨迹类别的预测因素。结果:采用LCGM方法将193例腹腔镜结直肠癌根治术患者术后1年内PTSD的变化轨迹分为3个潜在类别即PTSD低水平组(占41%)、PTSD下降组(占33%)、PTSD进展组(占26%);选择PTSD低水平组作为参考类别,采用逐步进入法筛选变量,Logistic回归分析结果显示,高中及以上文化程度、下尿路不适及炎症因子[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)]水平越高的患者更易进入PTSD下降组,炎症因子(IL-6、TNF)、恐惧疾病进展及侵入性认知水平越高的患者更易进入PTSD进展组。结论:腹腔镜结直肠癌根治术患者术后1年内的PTSD存在异质性,有3种不同的变化轨迹,尤其应重视初始分值较低的PTSD进展组。临床医护人员应关注患者术后早期的身体不适症状,同时重视心理因素如恐惧疾病进展、侵入性认知及炎症因子对PTSD轨迹的预测作用,制定针对性的措施预防术后PTSD慢性进展。

Objective:To explore the longitudinal trajectory of post-traumatic stress disorder(PTSD)in patients undergoing laparoscopic radical resection of colorectal cancer within 1 year after operation,and analyze the predictive effects of psychological dimension,social support dimension and inflammatory factors on trajectory categories.Methods:In this prospective observational longitudinal study,patients who underwent laparoscopic radical resection of colorectal cancer in our hospital from February 2021 to August 2022 were selected as the research objects.The PTSD levels of patients at 5 time points were investigated by using the Post-traumatic Stress Disorder Checklist-Civilian Version 6 weeks(T1),3 months(T2),6 months(T3),9 months(T4)and 12 months(T5)after operation.The latent class growth model(LCGM)was used to identify the trajectory category,and the logistic regression analysis was used to identify the predictors of the trajectory category.Results:The change trajectories of PTSD in 193 patients undergoing laparoscopic radical resection of colorectal cancer within 1 year were divided into three potential categories:low-PTSD group(41%),PTSD decline group(33%)and PTSD progression group(26%)by using LCGM.The low-PTSD group was selected as the reference category,and the variables were screened by the stepwise entry method.Logistic regression analysis showed that patients with higher education level(high school and above),lower urinary tract discomfort and high inflammatory factors[interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]levels were more likely to have a decreasing level of PTSD;patients with high inflammatory factors(IL-6 and TNF),high fear of disease progression and high invasive cognition were more likely to have a progressive level of PTSD.Conclusion:There is heterogeneity in PTSD within 1 year after laparoscopic radical resection of colorectal cancer,and there are three different trajectories.Clinical medical staff should pay attention to the early physical discomfort symptoms of patients after surgery,and pay attention to psychological factors such as fear of disease progression,invasive cognition and inflammatory factors in predicting the trajectory of PTSD.Targeted measures should be developed to prevent chronic progression of PTSD after surgery.