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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (5): 857-864. doi: 10.19723/j.issn.1671-167X.2023.05.013

• 论著 • 上一篇    下一篇

新型冠状病毒肺炎疫情期间延迟拔除输尿管支架对泌尿系结石术后患者生活质量和心理状态的影响

赖金惠,王起,姬家祥,王明瑞,唐鑫伟,许克新,徐涛,胡浩*()   

  1. 北京大学人民医院泌尿外科, 北京 100044
  • 收稿日期:2023-03-20 出版日期:2023-10-18 发布日期:2023-10-09
  • 通讯作者: 胡浩 E-mail:huhao@bjmu.edu.cn

Effects of delayed ureteral stents removal during the COVID-19 pandemic on the quality of life and psychological status of postoperative patients with urinary calculi

Jin-hui LAI,Qi WANG,Jia-xiang JI,Ming-rui WANG,Xin-wei TANG,Ke-xin XU,Tao XU,Hao HU*()   

  1. Department of Urology, Peking University People's Hospital, Beijing 100044, China
  • Received:2023-03-20 Online:2023-10-18 Published:2023-10-09
  • Contact: Hao HU E-mail:huhao@bjmu.edu.cn

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摘要：

目的: 探讨因新型冠状病毒肺炎(corona virus disease 2019, COVID-19)疫情而延迟拔除输尿管支架对泌尿系结石术后患者生活质量(quality of life, QoL) 和心理状态的影响。方法: 选择2019年12月至2020年6月在北京大学人民医院接受上尿路内镜碎石术后留置输尿管支架并返回医院取出支架患者的病例资料进行回顾性分析，收集患者人口学资料、输尿管支架症状问卷(ureteral stent symptoms questionnaire, USSQ)评分、焦虑自评量表(self-rating anxiety scale, SAS)评分和抑郁自评量表(self-rating depression scale, SDS)评分等。USSQ由6个维度(包括排尿症状、躯体疼痛、一般健康状态、工作表现、性功能和支架相关感染)共44个问题组成，量表大部分问题采用李克特(Likert)五级量表，小部分问题采用四级或七级量表量化。SAS和SDS均由20个问题组成, 用于评估患者的焦虑抑郁状态，两个量表采用李克特四级量表，主要统计指标总分(20~80分)。使用标准分(总分乘以1.25取其整数)量化临床焦虑和抑郁程度，并运用矩阵结构分析构建多群组结构方程模型。结果: 共纳入患者71例，输尿管支架中位留置时间对照组32(30, 33) d与延迟组94.5(88, 103) d相比，差异有统计学意义。延迟组患者在USSQ多维度中(包括排尿症状、一般健康状态、工作表现和支架相关感染)得分较高，焦虑和抑郁程度也明显比对照组严重。延长输尿管支架留置时间会加重患者排尿症状、躯体疼痛共同对工作表现的负面影响(P=0.029 < 0.05)，其中，患者较严重的排尿症状导致工作表现欠佳受延长置管时间的影响最显著(CR=2.619>1.96)。新型冠状病毒肺炎疫情期间患者焦虑抑郁程度与支架相关症状严重度呈正相关。结论: 因新型冠状病毒肺炎疫情延迟拔管患者的QoL较差，焦虑和抑郁程度较重；新型冠状病毒肺炎疫情期间患者焦虑抑郁程度越重，支架相关症状会加重。为了提高泌尿系结石术后患者在新型冠状病毒肺炎疫情期间的QoL和心理健康水平，应避免延长支架留置时间或采取相应的干预措施。

关键词: 延长输尿管支架留置时间, 生活质量(QoL), 焦虑, 抑郁, 新型冠状病毒肺炎

Abstract:

Objective: To explore the impacts of delayed ureteral stent removal on the quality of life (QoL) and mental health of urinary calculi postoperative patients due to the corona virus disease 2019(COVID-19) pandemic. Methods: The demographic and clinical data of patients with ureteral stent placement after urinary endoscopic lithotripsy and returned to Peking University People's Hospital for stent removal from December 2019 to June 2020 were collected. Ureteral stent symptoms questionnaire (USSQ) score and the outcome 20-item self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were collected to estimate the QoL and mental status. The USSQ consisted of 44 questions in 6 domains (including urinary symptom, physical pain, general health, work performance, sexual function, and ureteral stent related infection). For most questions in each domain, its score was a five-point Likert-type scale from 1 to 5, and a small proportion of questions was quantified by 1 to 4 or 1 to 7 scale. SAS and SDS both contained 20 questions used to assess a patient's level of anxiety and depression. Its scoring for each item was on a four-point Likert-type scale from 1 to 4. A total score (ranging from 20 to 80) was the main statistical indicator. The level of clinical anxiety and depression was quantified by using standard scores (total score multiplied by 1.25 to produce integers). And the multi-group structural equation model was constructed by analysis of moment structure (AMOS) analysis. Results: Overall, 71 patients were enrolled for analysis. It was found that the median duration of ureteral stent time differed significantly between the control and delayed groups for 32 (30, 33) d and 94.5 (88, 103) d, respectively. The delayed group resulted in higher scores in the USSQ multidimensional, which included urinary symptoms, general health, work performance and ureteral stent related infections. Anxiety and depression were also significantly serious in the delayed group than in the control group. A longer indwelling time of a ureteral stent could exacerbate the effects of urinary symptoms and physical pain on work performance (P=0.029 < 0.05). Among them, the patients with severe urinary symptoms leading to poor work performance were most significantly affected by prolonged ureteral stent duration time (CR=2.619>1.96). Conclusion: Patients with delayed ureteral stent removal due to the COVID-19 had resulted in worse QoL and mental status. Stents related symptoms are more severe in patients with higher anxiety and depression degree during COVID-19. To improve the QoL and mental health of patients after urinary calculi surgery during COVID-19, it is still not recommended to prolong the stent duration time or corresponding intervention measures should be taken.

Key words: Prolonged ureteral stent duration time, Quality of life (QoL), Anxiety, Depression, Corona virus disease 2019 (COVID-19)

中图分类号: 

  • R699

表1

入组患者的基线特征资料"

Items Control group Delayed ureteral sent removal group P
Number of patients, n(%) 35 (49.3) 36 (50.7)
Duration ureteric stent time/d, M (P25, P75) 32 (30, 33) 94.5 (88, 103) < 0.001
Gender, n(%) 0.144
    Male 27 (77.1) 22 (61.1)
    Female 8 (22.9) 14 (38.9)
Age，n(%) 0.552
    <40 12 (34.3) 8 (22.2)
    40-60 12 (34.3) 17 (47.2)
    >60 11 (31.4) 11 (30.6)
Surgery type, n(%) 0.017
    PCNL 2 (5.7) 11 (30.6)
    RIRS 23 (65.7) 20 (55.6)
    URL 10 (28.6) 5 (13.9)
Stone location, n(%) 0.275
    Left 13 (37.1) 18 (50.0)
    Right 22 (62.9) 18 (50.0)
Working status, n(%) 0.002
    Full time 16 (45.7) 9 (25.0)
    Not working or unemployed 0 (0) 10 (27.8)
    Retirement 19 (54.3) 17 (47.2)
Bed rest, n(%) 0.005
    No 35 (100.0) 28 (77.8)
    Yes 0 (0) 8 (22.2)
Rest time, n(%) 0.317
    None 20 (57.1) 25 (69.4)
    Half a day 10 (28.6) 5 (13.9)
    Two half a day 5 (14.3) 6 (16.7)

表2

入组患者输尿管支架相关症状评分"

Items Control group (n=35) Delayed ureteral sent removal group (n=36) P
USSQ urinary symptom score (U1－U11), M (P25, P75) 19 (18, 22) 26 (25, 27) < 0.001
USSQ physical pain score (P4－P9), M (P25, P75) 9 (7, 9) 7 (6, 11) 0.024
Overall pain score (SPDS), $\bar x \pm s$ 0.34±1.03 1.22±2.26 0.039
Number of pain sites, $\bar x \pm s$ 0.11±0.32 0.39±0.69 0.035
USSQ general health score (G1－G6), M (P25, P75) 10 (8, 11) 15 (14, 16) < 0.001
USSQ work performance score (W5－W7), M (P25, P75) 4 (3, 5) 7 (7, 8) < 0.001
USSQ sexual function score (S4+S5), $\bar x \pm s$ 1.34±1.95 1.08±1.96 0.578
Sent related sexual abstinence/%, n (%) 23 (65.7) 28 (77.8) 0.259
USSQ ureteral stent related infection (I1－I5), M (P25, P75) 7 (7, 8) 10 (9, 11) < 0.001
Total USSQ score, M (P25, P75) 52 (48, 53) 68 (65, 72) < 0.001

表3

入组患者输尿管支架相关症状分项评分"

Items Control Group Delayed ureteral sent removal group P
USSQ urinary symptom score
    U1-daytime frequency, M(P25, P75) 2 (1, 2) 3 (2, 3) < 0.001
    U2-nocturia, $\bar x \pm s$ 2.23±0.88 2.33±0.59 0.555
    U3-urgency, M(P25, P75) 1 (1, 2) 2 (1, 2) 0.001
    U4-straining to start, M(P25, P75) 1 (1, 2) 2 (1, 2) 0.002
    U5-urge incontinence, $\bar x \pm s$ 1.20±0.41 1.33±0.48 0.209
    U6-residual urine sense, M(P25, P75) 2 (1, 2) 3 (3, 4) < 0.001
    U7-dysuria, $\bar x \pm s$ 2.03±0.71 2.31±0.62 0.084
    U8-hematuria rate, M(P25, P75) 2 (1, 2) 2 (2, 3) 0.016
    U9-hematuria amount, M(P25, P75) 2 (1, 2) 2 (2, 2) 0.034
    U10-total symptom, M(P25, P75) 1 (1, 2) 2 (2, 3) < 0.001
    U11-intention of long-term indwelling stent, M(P25, P75) 3 (3, 3) 4 (3, 4) < 0.001
USSQ physical pain score
    P1-presence of pain, n(%) 4 (11.4) 10 (27.8) 0.083
    P2-presence of upper abdominal pain, n(%) 0 (0) 0 (0) -
    P3-SPDS of upper abdominal pain 0 0 -
    P2-presence of lower abdominal pain, n(%) 0 (0) 5 (13.9) 0.054
    P3-SPDS of lower abdominal pain 0 0.39±1.05 0.033
    P2-presence of suprapubic pain, n(%) 0 (0) 0 (0) -
    P3-SPDS of suprapubic pain 0 0 -
    P2-presence of back pain, n(%) 3 (8.6) 9 (25) 0.065
    P3-SPDS of back pain, $\bar x \pm s$ 0.23±0.81 0.83±1.54 0.042
    P2-presence of penis pain, n(%) 1 (2.9) 0 (0) 0.493
    P3-SPDS of penis pain, $\bar x \pm s$ 0.11±0.68 0 0.324
    P4-physical activity, $\bar x \pm s$ 1.20±0.41 1.47±0.81 0.078
    P5-sleep difficulty, M(P25, P75) 1 (1, 1) 1 (1, 2) 0.024
    P6-pain during voiding, M(P25, P75) 2 (2, 3) 1 (1, 2) 0.002
    P7-flank pain during voiding, $\bar x \pm s$ 1.51±0.51 1.44±0.50 0.562
    P8-analgesics, $\bar x \pm s$ 1.20±0.41 1.31±0.58 0.377
    P9-effects of stent-related pain, $\bar x \pm s$ 1.40±0.55 1.61±1.13 0.319
USSQ general health score
    G1-light physical activities 1 1 -
    G2-heavy physical activities, M(P25, P75) 3 (2, 3) 4 (3, 4) < 0.001
    G3-tiredness and fatigue, M(P25, P75) 1 (1, 2) 2 (2, 2) < 0.001
    G4-calm and tranquility, M(P25, P75) 1 (1, 2) 3 (3, 4) < 0.001
    G5-social activities, M(P25, P75) 1 (1, 2) 4 (3, 4) < 0.001
    G6-extra help from relatives and friends, $\bar x \pm s$ 1.60±0.50 1.72±0.45 0.284
USSQ work performance score, M(P25, P75)
    W5-shorten working hours 1 (1, 1) 2 (2, 2) < 0.001
    W6-change the usual job 1 (1, 2) 2 (1, 2) 0.002
    W7-working hours 2 (1, 3) 4 (3.75, 4) < 0.001
USSQ sexual function score, $\bar x \pm s$
    S4-dyspareunia 1.23±0.43 1.17±0.38 0.519
    S5-sexual life 2.74±0.51 2.94±0.23 0.037
USSQ ureteral stent related infection score
    I1-urinary tract infection frequency, M(P25, P75) 1 (1, 2) 2 (2, 3) < 0.001
    I2-antibiotic use, M(P25, P75) 1 (1, 1) 1 (1, 2) < 0.001
    I3-extra help from medical staff, $\bar x \pm s$ 1.14±0.36 1.25±0.44 0.262
    I4-seek medical attention, M(P25, P75) 1 (1, 1) 1 (1, 1) 0.006
    I5-intention to indwell the second stent on the opposite side, M(P25, P75) 3 (3, 4) 4 (4, 4) < 0.001

表4

USSQ各维度间相关性分析"

Items Urinary symptom Physical pain General health Work performance Sexual function Ureteral stent related infection
Urinary symptom 1
Physical pain -0.120 1
General health 0.626# 0.035 1
Work performance 0.578# 0.007 0.779# 1
Sexual function 0.243* -0.114 0.065 0.064 1
Ureteral stent related infection 0.617# -0.063 0.558# 0.547# 0.099 1

图1

延长输尿管支架留置时间作用于USSQ多维度的理论模型"

表5

延长置管时间作用于USSQ多维度理论模型的路径分析"

Hypothesis model Estimate CR P Label Chidist
General health Urinary symptom 0.637 6.995 < 0.05 Relationship exist 0.574
Physical pain 0.113 1.241 0.215 No relationship
Work performance Urinary symptom 0.588 6.114 < 0.05 Relationship exist 0.029
Physical pain 0.079 0.821 0.412 No relationship
Urinary symptom Ureteral stent related infection 0.623 6.664 < 0.05 Relationship exist 0.351
Physical pain Ureteral stent related infection -0.057 -0.474 0.636 No relationship
General health Ureteral stent related infection 0.572 5.835 < 0.05 Relationship exist
Work performance Ureteral stent related infection 0.565 5.725 < 0.05 Relationship exist

表6

入组患者SAS和SDS评分"

Group SAS SDS
Normal Mild Moderate Severe P Normal Low Moderate Severe P
Control, n(%) 19 (100) 14 (33.3) 2 (20) - < 0.001 19 (86.4) 14 (40) 2 (14.3) - < 0.001
Delayed group, n(%) 0 (0) 28 (66.7) 8 (80) - 3 (13.6) 21 (60) 12 (85.7) - -

图2

新冠疫情期间患者心理状态和USSQ多维度的理论模型"

表7

新型冠状病毒肺炎疫情期间患者心理状态和USSQ多维度理论模型的路径分析"

Path diagram Estimate CR P Label
SAS
    Urinary symptom 0.186 1.671 0.095 No relationship
    Physical pain -0.145 -1.226 0.220 No relationship
    General health 0.336 3.389 < 0.05 Relationship exist
    Work performance 0.433 4.500 < 0.05 Relationship exist
    Ureteral stent related infection 0.284 2.694 0.007 Relationship exist
SDS
    Urinary symptom 0.313 2.814 0.005 Relationship exist
    Physical pain 0.056 0.470 0.638 No relationship
    General health 0.446 4.496 < 0.05 Relationship exist
    Work performance 0.405 4.210 < 0.05 Relationship exist
    Ureteral stent related infection 0.376 3.571 < 0.05 Relationship exist
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ISSN 1671-167X
CN 11-4691/R
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