微创外科治疗慢性鼻窦炎患者的负性情绪调查

Survey on negative emotion in patients with chronic rhinosinusitis undergoing minimally invasive surgery

摘要:

目的  探讨慢性鼻-鼻窦炎（CRS）患者行鼻内镜微创手术前的心理特点。方法  选取2010年1月-2014年12月该院收治行鼻内镜微创手术的310例CRS患者为研究对象，归为观察组，同时选取同期的200名健康成人作为对照组，采用Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）、症状自评量表SCL-90来评估研究对象的情绪和心理状态，然后对鼻塞、流涕、头痛、面部疼痛或压迫感、精力下降、嗅觉减退等6个CRS症状进行视觉模拟量表（VAS）评分。比较两组患者的SAS和SDS标准分及SCL-90的因子分和总均分，通过单因素和多因素Logistic回归分析筛选出患者发生焦虑和抑郁等不良情绪的影响因素。结果  观察组的SAS和SDS标准分均明显高于对照组（P <0.05）。观察组中无、轻度、中度和重度焦虑者分别为247例（79.7%）、28例（9.0%）、22例（7.1%）和13例（4.2%），无、轻度、中度和重度抑郁者分别为228例（73.5%）、36例（11.6%）、26例（8.4%）和20例（6.5%）。观察组SCL-90的躯体化、人际关系敏感、抑郁和焦虑等的因子分及总均分均明显高于对照组（P <0.05），且与SAS评分和SDS评分呈正相关（P <0.05）。多因素Logistic分析结果表明，女性和合并哮喘是患者发生单纯焦虑的独立危险因素（P <0.05），女性、合并哮喘及变应性鼻炎（AR）是患者发生单纯抑郁的独立危险因素（P <0.05），女性、鼻塞评分≥5分、头痛评分≥5分是患者发生焦虑合并抑郁的独立危险因素（P <0.05）。结论  CRS患者进行鼻内镜微创手术前常合并焦虑、抑郁等不良情绪，故在进行术前谈话过程中应注重其情绪和心理状态，及时进行心理干预。

Abstract:

【Objective】 To investigate the psychological characteristics in patients with chronic rhinosinusitis before endoscopic sinus minimally invasive surgery. 【Methods】 310 patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus minimally invasive surgery from January 2011 to December 2014 were enrolled for the study and classified as observation group. 200 healthy adults during the same time were classified as control group. Self-rating anxiety scale (SAS), self-rating depression scale (SDS) and symptom checklist-90 (SCL-90) were used to evaluate their emotion and psychological state. The visual analogue scale (VAS) was performed to evaluate their clinical symptoms including stuffy nose, runny nose, headache, facial pain or pressure, energy loss and hyposmia. The standard score of SAS and SDS, the factor score of SCL-90 and total score were compared between two groups. Univariate and multivariate logistic regression analysis were performed to screen out the related factors of anxiety and depression. 【Results】 The standard scores of SAS and SDS in observation group were significantly higher than that in control group (P < 0.05). No, mild, moderate and severe anxiety in the observation group were respectively 247 cases (79.7%), 28 cases (9.0%), 22 cases (7.1%) and 13 cases (4.2%). No, mild, moderate and severe depression in the observation group were respectively 228 cases (73.5%), 36 cases (11.6%), 26 cases (8.4%) and 20 cases (6.5%). The factor score of somatization, sensitivity of interpersonal relationship, anxiety, depression and total average score inobservation group were significantly higher than that in control group (P < 0.05), and they had positive correlation with the standard scores of SAS and SDS (P < 0.05). The result of multivariate logistic regression analysis showed that female and combined with asthma were the independent risk factors of patients complicated with pure anxiety (P < 0.05), female, combined with asthma and allergic rhinitis (AR) were the independent risk factors of patients complicated with pure depression (P < 0.05), female, score of nasal congestion ≥ 5 and score of 5 headache ≥score 5 were the independent risk factors of patients complicated with anxiety and depression (P < 0.05). 【Conclusions】 Patients with CRS often has bad mood including anxiety and depression before endoscopic sinus surgery, so doctors should pay attention to the emotional and mental state in preoperative conversation process and given psychological intervention in time.