早期上消化道肿瘤患者内镜下黏膜剥离术前后心理焦虑和抑郁变化及影响因素

Changes of psychological anxiety and depression and their influencing factors before and after endoscopic submucosal dissection in patients with early upper gastrointestinal cancer

目的:探索早期上消化道肿瘤患者内镜下粘膜剥离术前后心理焦虑和抑郁变化及影响因素。方法:选取2010年2月至2017年2月于我院就诊并确诊为早期上消化道肿瘤患者326例,所有患者均行内镜下粘膜剥离术。按随机数表法将患者分为观察组(n=163)和对照组(n=163),观察组患者于围手术期给予心理干预,对照组不做干预。对比两组患者手术前后的焦虑评分(SAS)、抑郁评分(HAMD)和症状评分(SCL-90);对比两组患者的手术时间、住院时间、术后禁食时间及术后不良反应出现情况;对比两组患者的整体满意度。结果:对照组患者手术前后均存在心理焦虑和抑郁,两组患者术后SAS、HAMD及SCL-90评分均有所上升;观察组患者手术前后的SAS、HAMD及SCL-90评分均明显低于对照组(t=-14.36,-11.51,-14.30,-17.01,-3.14～-14.84;P<0.05);观察组患者的手术时间、住院时间及禁食时间均明显短于对照组(t=-12.771,-14.883,-7.159;P<0.05);观察组患者术后不良反应发生率为7.37%,对照组为21.47%,观察组术后不良反应发生率明显低于对照组(χ~2=13.651,P<0.05);观察组患者的整体满意度为96.32%,对照组为77.30%,观察组的整体满意度显著高于对照组(χ~2=41.872,P<0.05)。结论:早期上消化道肿瘤患者行内镜下粘膜剥离术前会导致患者心理焦虑和抑郁,术后患者心理焦虑和抑郁会加重,于患者围手术期给予心理干预,能明显降低患者心理焦虑和抑郁程度,减少患者术后不良反应发生率,提高患者整体满意度,值得临床推广。

Objective:To explore the changes of psychological anxiety and depression and their influencing factors before and after endoscopic submucosal dissection in patients with early upper gastrointestinal cancer.Methods:326 cases of patients with early upper gastrointestinal cancer who were treated and diagnosed in our hospital from February 2010 to February 2017 were selected.All patients were given endoscopic submucosal dissection.The patients were divided into observation group(n=163)and control group(n=163)according to the random number table method.Observation group was given psychological intervention during perioperative period,and control group was not interfered.The scores of self-rating anxiety scale(SAS),Hamilton depression scale(HAMD)and symptom check list(SCL-90)were compared between the two groups before and after operation,and the operative time,hospital stay,postoperative fasting time and postoperative adverse reaction were compared between the two groups,and the overall satisfaction of the two groups was compared.Results:There were psychological anxiety and depression before and after operation in control group,and the scores of SAS,HAMD and SCL-90 were increased in the two groups after operation.The scores of SAS,HAMD and SCL-90 scores in observation group before and after operation were significantly lower than those in control group(t=-14.36,-11.51,-14.30,-17.01,-3.14^-14.84;P<0.05).The operative time,hospital stay and fasting time were significantly shorter in observation group than those in control group(t=-12.771,-14.883,-7.159;P<0.05).The incidence rate of postoperative adverse reaction in observation group was significantly lower than that in control group(7.37% vs 21.47%)(χ~2=13.651,P<0.05).The overall satisfaction in observation group was significantly higher than that in control group(96.32% vs 77.30%)(χ~2=41.872,P<0.05).Conclusion:Endoscopic submucosal dissection in patients with early upper gastrointestinal cancer will lead to psychological anxiety and depression which will aggravate after operation.Perioperative psychological intervention can significantly reduce psychological anxiety and depression,reduce the incidence rate of postoperative adverse reaction,and improve overall satisfaction,therefore it is worthy of clinical promotion.