未破裂颅内动脉瘤栓塞术后中长期生活质量和心理状态研究
Mid-to-long-term quality of life and psychological status after endovascular embolization of unruptured in-tracranial aneurysms
张国锋 1李志媚 1徐琳 1肖炜平 1欧斯奇 1齐铁伟 1梁丰 1石磊2
作者信息
- 1. 中山大学附属第一医院神经外科(广州 510080)
- 2. 中山大学附属第一医院重症医学科神经外科ICU
- 折叠
摘要
目的 探究栓塞手术能否改善未破裂颅内动脉瘤患者的生活质量、焦虑和抑郁的中长期结果.方法 前瞻性纳入诊断30 d内的未破裂颅内动脉瘤患者,按处理方式分为栓塞组和保守组.在入组时、3个月时、5年时等时间点使用健康调查简单表36项(medical outcome study short form-36,SF-36)、抑郁自评量表(self-rating depres-sion scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)分别对生活质量、抑郁和焦虑进行评估.栓塞组患者在术后3个月时和5年时使用事件影响量表修订版(impact of event scale-revised,IES-R)分别评估患者的心理创伤水平.结果 共纳入113例患者,其中栓塞组76例,保守组37例.栓塞组在3个月时SF-36的生理机能(80.3±16.4 vs.86.1±12.8,P=0.046)和生理职能(47.37±43.32 vs.67.57±34.29,P=0.015)评分比保守组低,但精神健康评分较高(68.16±18.80 vs.61.62±14.62,P=0.048).5年时,SF-36的各维度评分均较入组时改善(P<0.05).栓塞组的SDS和SAS评分在3个月时和5年时均较入组时下降(均P<0.05),评分增量比较,栓塞组的SDS(-2.8±10.6 vs.0.5±6.5)和SAS(-2.7±11.8 vs.1.2±5.4)评分3个月时变化值大于保守组(均P<0.05).亚组分析中,栓塞组中在入组时存在抑郁或焦虑的患者,在3个月时和5年时的SDS和SAS评分较入组时下降(均P<0.05).此外,栓塞组3个月时IES-R评分(37.5±13.8)分,高于临界值(P=0.005),但在5年时下降为(33.8±13.3)分.结论 未破裂颅内动脉瘤栓塞手术后患者中长期生活质量较术前改善,栓塞手术有助于缓解患者的抑郁和焦虑.
Abstract
Objective To investigate whether embolization surgery can improve mid-to-long-term outcomes related to quality of life,anxiety and depression in patients with unruptured intracranial aneurysms(UIA).Methods This prospective study included patients diagnosed with UIA within 30 days.Patients were divided into two groups based on treatment:the embolization group and the conservative group.The assessments of quality of life,depression,and anxiety were conducted using the medical outcome study short form-36(SF-36),self-rating depression scale(SDS),and self-rating anxiety scale(SAS)at baseline,3 months,and 5 years after treatment.In the embolization group,psychological trauma was assessed using the impact of event scale-revised(IES-R)at 3 months and 5 years post-surgery.Results A total of 113 patients were involved in the analysis including 76 in the embolization group and 37 in the conservative group.Compared to the conservative group,SF-36 data showed that the embolization group had a lower physical function(80.3±16.4 vs.86.1±12.8,P=0.046)and role-physical(47.37±43.32 vs.67.57±34.29,P=0.015)scores at 3 months,but a higher mental health score(68.16±18.80 vs.61.62±14.62,P=0.048).At 5 years,all dimensions of SF-36 improved significantly compared to baseline(all P<0.05).The SDS and SAS scores in the embolization group were significantly lower at both 3 months and 5 years compared to baseline(both P<0.05).The decrease in SDS(-2.8±10.6 vs.0.5±6.5)and SAS(-2.7±11.8 vs.1.2±5.4)scores in the embolization group at 3 months was greater than in the conservative group(both P<0.05).Subgroup analysis showed that patients with depression or anxiety at baseline in the embolization group experienced a significant decrease in SDS and SAS scores at 3 months and 5 years compared to baseline(both P<0.05).Additionally,in the embolization group,the IES-R score at 3 months was 37.5±13.8,which was significantly higher than the critical threshold(P=0.005),but decreased to 33.8±13.3 at 5 years post-surgery.Conclusions Patients with unruptured intracranial aneurysms experienced long-term improvements in quality of life after embolization surgery.Embolization surgery also helped alleviate depression and anxiety.
关键词
颅内动脉瘤/栓塞治疗/生活质量/抑郁/焦虑/心理创伤/创伤后应激障碍Key words
Intracranial aneurysm/Endovascular surgery/Quality of life/Depression/Anxiety/Psychological trauma/Post-traumatic stress disorder引用本文复制引用
基金项目
广州市科技计划项目(202201010798)
出版年
2024
NETL
NSTL
万方数据