目的探讨焦虑抑郁程度与慢性鼻窦炎（CRS）内镜术后主客观症状改善是否具有相关性，为临床提高CRS内镜手术疗效提供参考。
方法前瞻性收集2018年4月至2019年8月重庆医科大学附属第一医院因CRS行内镜手术的160例患者的临床资料，进行术前及术后6个月常见症状的视觉模拟量表（visual analogue scale，VAS）评分、焦虑自评量表评分（self-rating anxiety scale，SAS）、抑郁自评量表评分（self-rating depression scale，SDS）、Lund-Kennedy内镜评分及Lund -Mackay CT评分，并进行分组分层统计，分析SAS、SDS与患者术前术后主客观症状评分的相关性。160例患者中男101例（63.1%），女59例（36.9%），年龄18~75岁，平均47.3岁。采用SPSS 17.0统计软件对资料进行统计学分析。组间计量资料比较采用单样本、独立或配对 t检验；组间相关性采用 Pearson相关性分析。
结果160例有效病例中，术前焦虑和抑郁状态在年龄、性别、病程分组比较中差异无统计学意义（ t值分别为-0.151、-0.487、-0.846， P值均>0.05； t值分别为-0.473、-1.302、-1.069， P值均>0.05）；患者的术前焦虑抑郁程度与患者的整体不适、鼻塞、流涕和嗅觉减退等主观评分呈正相关（ r值分别为0.515、0.606、0.424、0.306， P值均<0.01； r值分别为0.518、0.584、0.448、0.308， P值均<0.01），与患者的Lund-Mackay CT评分和Lund-Kennedy内镜评分没有明显的相关性（ P值均>0.05）。单因素方差分析显示，以患者整体不适、鼻塞、头痛和流涕等主观评分来判断，严重焦虑抑郁的患者鼻内镜手术后主观症状改善程度较正常、轻度和中度焦虑抑郁的患者更差（ P值均<0.05）；但是各组间术后Lund-Kennedy内镜评分差异无统计学意义（ P值均>0.05）。
结论焦虑抑郁状态影响CRS患者鼻内镜术后主观症状的改善程度，与正常和轻中度焦虑抑郁的患者相比，严重焦虑抑郁的CRS患者鼻内镜术后主观症状的改善更差。临床上有必要对拟行鼻内镜手术的CRS患者进行焦虑抑郁评估。
ObjectiveTo explore whether the improvement of subjective symptoms and objective grades after endoscopic sinus surgery in patients with chronic sinusitis (CRS) are related to the degree of preoperative anxiety or depression and to provide reference for improving the effects of clinical treatment.
MethodsThe clinical data of one hundred and sixty patients with CRS treated by endoscopic sinus surgery in the First Affiliated Hospital of Chongqing Medical University from April 2018 to August 2019 were collected prospectively. The visual analogue scale (VAS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, Lund-Kennedy scores of nasal endoscopy and the Lund-Mackay scores of CT before and 6 months after surgery were used to analyse the correlation between the scores of anxiety or depression and the subjective and objective scores of patients before and after operation by grouping and layering. One hundred and one males (63.1%) and 59 females (36.9%) with an average age of 47.3 years (18-75 years) were included. Single-sample, independent or paired t-test, one-way ANOVA and rank-sum test were used for comparison and Pearson correlation analysis was used for the correlation between groups.
ResultsThere was no statistical difference of anxiety or depression between different groups in terms of age, gender and course in the 160 effective patients ( t values were -0.151, -0.487, -0.846, all P values>0.05; t values were -0.473, -1.302, -1.069, all P values>0.05). And the degree of preoperative anxiety or depression was positively correlated with the subjective scores, including overall discomfort, nasal obstruction, runny nose and olfactory decline ( r values were 0.515, 0.606, 0.424, 0.306, all P values<0.01; r values were: 0.518, 0.584, 0.448, 0.308, all P values<0.01), but not significantly correlated with objective scores of Lund-Mackay and Lund-Kennedy (all P value >0.05). Moreover, as far as the symptoms of overall discomfort, nasal obstruction, headache and runny nose, the results of one-way ANOVA showed that the improvement of symptoms in patients with serious anxiety or depression was worse than that of the normal, mild and moderate patients (all P values<0.05). However, there was no significant difference in the scores of Lund-Kennedy 6 months after surgery between them (both P values>0.05).
ConclusionThe state of anxiety or depression affects the improvement of symptoms after endoscopic sinus surgery for CRS patients. Compared with the patients with normal and mild to moderate anxiety or depression, the improvement of symptoms in patients with severe anxiety and depression is worse. It is necessary to evaluate the anxiety or depression of the patients with CRS who are going to undergo endoscopic sinus surgery.
冯丹丹,黄江菊,柯霞,等. 焦虑抑郁程度与慢性鼻窦炎内镜术后主观症状改善的相关性研究[J]. 中华耳鼻咽喉头颈外科杂志,2020,55(09)：830-836.
DOI:10.3760/cma.j.cn115330-20200327-00249版权归中华医学会所有。
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