脑胶质瘤患者的围术期焦虑症状及其对生存期的影响研究
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Anxiety of glioma patients during perioperative period and its influence on survival
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    目的 探讨胶质瘤患者围术期的焦虑症状及其对患者生存预后的影响。方法 回顾性 分析 2016 年 7 月至 2019 年 6 月在首都医科大学附属北京天坛医院接受手术治疗的 186 例脑胶质瘤患 者的资料。采用汉密尔顿焦虑量表(HAMA)评定患者手术前后的焦虑症状并分析其与临床特征的相 关性。采用二元 Logistic 回归分析患者围术期焦虑的影响因素。于随访时记录患者的无进展生存期, 采用 Kaplan-Meier 生存曲线和多因素 Cox 回归分析临床特征及焦虑症状对患者无进展生存期的影响。 结果 术后随访共 64 例患者失访。根据 HAMA 评分将患者分为术前无焦虑组(≤ 7 分,116 例)、术前焦 虑组(>7分,70例)、术后无焦虑组(≤7分,74例)、术后焦虑组(>7分,48例)。术前焦虑组中,2例(1.08%) 患者为明显焦虑,1 例(0.54%)患者为严重焦虑。术后焦虑组中,2 例(1.64%)患者为明显焦虑。女性患 者术前 HAMA 评分高于男性患者,肿瘤位于左侧患者的术后 HAMA 评分高于位于右侧的患者,差异有 统计学意义(P< 0.05)。二元 Logistic 回归分析显示,男性是胶质瘤患者术前焦虑的保护因素(OR=0.461, 95%CI=0.247~0.860,P=0.015)。Kaplan-Meier 曲线显示,术前焦虑组患者的无进展生存期短于无焦虑 组患者,差异有统计学意义(P=0.035)。多因素 Cox 回归结果显示,性别(HR=2.980,95%CI:1.121~7.927, P=0.029)、术前 HAMA 评分(HR=2.573,95%CI:1.079~6.134,P=0.033)是胶质瘤患者术后无进展生存期 的影响因素。结论 女性胶质瘤患者易在术前出现焦虑症状,肿瘤病变在左侧的胶质瘤患者易出现术 后焦虑,而患者术前焦虑对无进展生存期有负面影响作用。在关注胶质瘤患者围术期心理状态的基础 上,应根据患者临床特征,对高风险患者群体的术前心理状态做早期干预。

    Abstract:

    Objective To investigate the occurrence of anxiety symptoms in patients with glioma during the perioperative period and its influence on the survival and prognosis of patients. Methods A total of 186 patients suffered from glioma who underwent surgery in Beijing Tiantan Hospital affiliated to Capital Medical University from July 2016 to June 2019 were retrospectively analyzed. Preoperative and postoperative anxiety symptoms were evaluated using the Hamilton Anxiety Scale (HAMA). The influencing factors of perioperative anxiety were analyzed by binary Logistic regression. The progression free survival period was recorded during follow-up, and Kaplan-Meier survival curve and multivariate Cox regression were used to analyze the impact of clinical characteristics and anxiety symptoms on the progression free survival period. Results A total of 64 patients lost follow-up after operation. According to the score of HAMA, the groups included preoperative anxiety-free group (≤ 7 points, 116 cases), preoperative anxiety group (> 7 points, 70 cases), postoperative anxiety-free group (≤ 7 points, 74 cases), and postoperative anxiety group (> 7 points, 48 cases). There were 2 patients (1.08%) with obvious anxiety symptoms and 1 patient (0.54%) with severe anxiety symptoms in preoperative anxiety group. There were 2 patients (1.64%) with obvious anxiety symptoms in postoperative anxiety group. The preoperative HAMA score of female patients was higher than that of male patients, and the postoperative HAMA score of patients with tumors on the left side was higher than that of patients on the right side, with a statistically significant difference (P < 0.05). Binary Logistic regression analysis showed that the gender of male were protective factors for preoperative anxiety of patients with glioma (OR=0.461, 95%CI=0.247-0.860, P=0.015). Kaplan Meier curve showed that the progression free survival period of patients in the preoperative anxiety group was shorter than that of patients in the anxiety free group, with a statistically significant difference (P=0.035). Multivariate Cox regression showed that gender (HR=2.980, 95%CI=1.121- 7.927, P=0.029) and preoperative HAMA score (HR=2.573, 95%CI=1.079-6.134, P=0.033) were the influencing factors for progression free survival of patients with glioma after surgery. Conclusions Female glioma patients are prone to get anxiety symptoms before surgery, and glioma patients with tumor lesions on the left side are prone to get anxiety symptoms. Preoperative anxiety has a negative effect on progressionfree survival. On the basis of paying attention to the perioperative psychological state of glioma patients, early intervention should be taken on the preoperative psychological state of high-risk patient groups according to their clinical characteristics.

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张广平,张红,李天石,王嘉祥.脑胶质瘤患者的围术期焦虑症状及其对生存期的影响研究[J].神经疾病与精神卫生,2022,22(12):
DOI :10.3969/j. issn.1009-6574.2022.12.004.

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  • 在线发布日期: 2023-02-17