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目的评估颅内听神经瘤患者手术前后的神经心理状态改变,初步分析影响听神经瘤患者情绪变化的相关因素。方法选取2009年3月至2012年3月94例诊断为单侧颅内听神经瘤患者,所有患者均由同一神经外科医生经枕下乙状窦入路进行手术治疗。随访时应用9项病例健康问卷(PHQ-9)和7项广泛性焦虑(GAD-7)自评量表评定患者术后情绪状态及回顾评估术前心理状态,对手术前后患者的抑郁焦虑情况与年龄、性别、肿瘤部位、术后House-Brackmann分级和肿瘤最大直径行Logistic回归分析。结果最终完成有效问卷82例(因不能完成问卷和既往精神疾病史等原因排除12例)。其中,男28例、女54例,平均年龄(47.88±11.05)岁,随访时间(33.83±11.98)个月。情绪量表评定结果显示,术前存在抑郁9/82例(11.0%),焦虑4/82例(4.9%);术后存在抑郁6/82例(7.3%),焦虑3/82例(3.6%)。经Fisher’s精确检验,术前有抑郁症状的患者多于术后(x~2=10.09,df=1,P=0.016);Logistic回归分析显示听力障碍改善不佳(P=0.012)和年龄(P=0.044)是术后患者出现抑郁症状的危险因素。结论听神经瘤患者的术前抑郁、焦虑症状在肿瘤切除后可明显改善,随着术后康复时间的延长抑郁状况可进一步好转。对存在听力恶化或高龄患者,及时发现抑郁焦虑症状并予干预,有助于术后恢复。
Objective To evaluate the changes of neuropsychological status in patients with acoustic neuroma of the brain before and after operation, and to analyze the related factors that affect the emotion of patients with acoustic neuroma. Methods Ninety-four patients diagnosed as unilateral intracranial acoustic neuroma from March 2009 to March 2012 were enrolled. All patients underwent transoccipitated sigmoid sinus surgery by the same neurosurgeon. At follow-up, 9 cases of health questionnaire (PHQ-9) and 7 items of generalized anxiety (GAD-7) self-rating scale were used to evaluate postoperative emotional status and retrospectively evaluate the preoperative psychological status. The prevalence of depression and anxiety Logistic regression analysis was performed with age, sex, tumor location, postoperative House-Brackmann classification, and maximum tumor diameter. As a result, 82 valid questionnaires were finally completed (12 cases were excluded because of failure to complete the questionnaire and previous mental illness history). Among them, 28 males and 54 females with an average age of (47.88 ± 11.05) years and a follow-up time of (33.83 ± 11.98) months. There were 9/82 cases (11.0%) of depression, 4/82 cases of anxiety (4.9%), 6/82 cases of postoperative depression (7.3%), 3/82 anxiety (3.6 cases %). Logistic regression analysis showed poor improvement of hearing impairment (P = 0.012) and age (P = 0.012) in patients who had depressive symptoms before surgery after surgery (x ~ 2 = 10.09, df = = 0.044) were postoperative risk factors for depressive symptoms. Conclusions The preoperative depression and anxiety symptoms of patients with acoustic neuroma can be significantly improved after resection of the tumor, and the depression can be further improved with the extension of postoperative rehabilitation. On the existence of hearing deterioration or elderly patients, timely detection of depression and anxiety symptoms and interventions, help to restore after surgery.