慢性腰腿痛患者微创术前焦虑,抑郁状态及相关影响因素分析

doi:10.19723/j.issn.1671-167X.2020.02.015

摘要/Abstract

摘要：

目的调查慢性腰腿痛患者微创手术术前焦虑,抑郁状况,并进一步分析影响焦虑,抑郁发生的相关危险因素.方法: 回顾性分析2018年3~4月因腰椎间盘突出症和/或腰椎管狭窄症在北京大学第三医院住院行微创手术治疗的慢性腰腿痛患者的临床资料,主要收集一般资料(包括年龄,性别,文化程度,既往史,睡眠障碍以及医疗保险状况等),数字评价量表(numeric rating scale,NRS),日本骨科学会(Japanese Orthopedic Association,JOA)下腰痛评价量表和医院焦虑,抑郁自评量表(hospital anxiety and depression scale,HADS)等.统计人口学及临床数据,单因素分析各项可能影响慢性腰腿痛患者发生焦虑,抑郁的相关因素,对差异有统计学意义(P<0.05)的指标进一步行多因素Logistic回归方法.结果: 共有91例患者符合入选标准纳入研究,HADS焦虑平均得分8.1±4.2, 其中焦虑状态阳性患者48例(52.7%), 焦虑状态阴性患者43例 (47.3%);HADS抑郁平均得分6.9±4.9,其中抑郁状态阳性患者38例(41.8%), 抑郁状态阴性患者53 例 (58.2%),至少有焦虑或抑郁其中一种状态的患者共56例(61.5%); 睡眠障碍,JOA评分以及腿部NRS评分等3项指标在发生焦虑和未发生焦虑患者中比较差异具有显著统计学意义(P<0.05),年龄,睡眠障碍以及JOA评分等3项指标在发生抑郁和未发生抑郁患者中比较差异具有统计学意义(P<0.05),进一步Logistic回归分析结果提示,JOA评分和睡眠障碍是患者发生焦虑的独立危险因素,而JOA评分是患者发生抑郁的独立危险因素.结论: 慢性腰腿痛患者微创术前常伴发焦虑,抑郁状态,其中低JOA评分和睡眠障碍增加发生焦虑风险,而低JOA评分增加发生抑郁风险,术前应重视心理状态及其相关易感因素的评估.

关键词: 腰腿痛, 微创, 焦虑, 抑郁, 危险因素

Abstract:

Objective: To investigate anxiety and/or depression status of patients with chronic lumbocrural pain, and to further analyze related risk factors of anxiety and/or depression .Methods: Retrospective analysis of the medical data of patients who suffered from chronic lumbocrural pain caused by lumbar disc herniation and/or lumbar spinal stenosis and received minimally invasive surgery from March 2018 to April 2018. General data (including age, gender, education levels, past history, sleep order and medical insurance), numeric rating scale(NRS), Japanese Orthopedic Association(JOA) back pain scale and hospital anxiety and depression scale(HADS) were collected for analysis. The basic demographic data and clinic data were analyzed, possible related risk factors associated were analyzed by univariate analysis, and multivariate Logistic regression analysis was further used to find the relative independent risk factors and included all the predictive variables with P values less than 0.05 as covariates.Results: A total of 91 patients met the inclusion criteria and finished this study, the mean HADS score for anxiety was 8.1±4.2, 48(52.7%) respondents were screened positive for anxiety, while the rest 43(47.3%) patients had negative anxiety state, the mean HDDS score for depression was 6.9±4.9, 38(41.8%) respondents were screened positive for depression, and the rest 53(58.2%) patients were not depressed, and 56(61.5%) patients experienced anxiety or depression. There were significant difference in sleep disorder, JOA score and leg NRS score between the patients with and without anxiety(P<0.05), and the significant differences were also found in age, sleep disorder and JOA score between the patients with and without depression(P<0.05), Logistic regression analysis further showed that the JOA score and sleep disorder were risk factors for anxiety, and the JOA score was risk factor for depression.Conclusion: Patients with chronic lumbocrural pain are often accompanied by anxiety and/or depression before minimally surgery, the low JOA score and sleep disturbance increased the risk of presenting anxiety, and the low JOA score increased the risk of developing depression. It is necessary to evaluate mental status and related risk factors before surgery.

Key words: Lumbocrural pain, Minimally invasive, Anxiety, Depression, Risk factors

中图分类号:

R749.4

易端,朱薇,孟秀丽,刘晓光,李水清,祝斌,贾东林. 慢性腰腿痛患者微创术前焦虑,抑郁状态及相关影响因素分析[J]. 北京大学学报（医学版）, 2020, 52(2): 285-289.

Duan YI,Wei ZHU,Xiu-li MENG,Xiao-guang LIU,Shui-qing LI,Bin ZHU,Dong-lin JIA. Analysis of anxiety, depression and related factors in patients with chronic lumbocrural pain before minimally invasive surgery[J]. Journal of Peking University (Health Sciences), 2020, 52(2): 285-289.

图/表 2

表1

慢性腰腿痛患者发生焦虑,抑郁相关因素的单因素分析"

Items	Anxiety			Depression
Items	Yes (n=48)	No (n=43)	P	Yes (n=38)	No (n=53)	P
Gender, n(%)
Male	23(47.9)	27(62.8)	0.206^a	19(50.0)	31(58.5)	0.522^a
Female	25(52.1)	16(37.2)		19(50.0)	22(41.5)
Age/years, $x ?$ ±s	54.8±17.2	52.9±19.8	0.636^b	60.0±15.7	49.5±19.1	0.006^b
Sleep disorder, n(%)
Yes	40(83.3)	21(48.8)	0.001^a	31(81.6)	30(56.6)	0.014^a
No	8(16.7)	22(51.2)		7(18.4)	23(43.4)
Diabetes, n(%)
Yes	7(14.6)	8(18.6)	0.778^a	8(21.1)	7(13.2)	0.394^a
No	41(85.4)	35(81.4)		30(78.9)	46(86.8)
CHD, n(%)
Yes	8(16.7)	3(7.0)	0.205^a	7(18.4)	4(7.5)	1.191^a
No	40(83.3)	40(93.0)		31(81.6)	49(92.5)
Hypertension, n(%)
Yes	13(37.1)	12(27.9)	1.000^a	13(34.2)	12(22.6)	0.243^a
No	35(62.9)	31(72.1)		25(75.8)	41(77.4)
Medical insurance, n(%)
Yes	9(18.8)	5(11.6)	0.408^a	5(13.2)	9(17.0)	0.108^a
No	39(81.2)	38(88.4)		33(86.8)	44(83.0)
Education levels, n(%)
Primary school	5(10.4)	2(4.6)	0.542^a	3(7.9)	4(7.5)	0.974^a
Junior middle school	8(16.7)	7(16.3)		6(15.8)	9(17.0)
Senior middle school	10(20.8)	10(23.3)		9(23.7)	11(20.8)
College	21(43.8)	16(37.2)		16(42.1)	21(39.6)
Above College	4(8.3)	8(18.6)		4(10.5)	8(15.1)
JOA score,$\bar{x}±s$	10.6±5.6	15.4±5.9	0.000^b	9.8±5.4	15.0±5.8	0.000^b
NRS score,$\bar{x}±s$
Lumbar	5.4±3.2	4.8±2.4	0.304^b	5.5±3.0	4.8±2.7	0.281^b
Leg	6.3±3.1	5.0±2.7	0.041^b	6.3±3.2	5.3±2.8	0.130^b

表1

表2

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Dependent variable	Independent variable	β	Wald	P	OR	R²
Anxiety
	JOA score	-0.114	7.105	0.008	0.892	0.200
	Sleep disorder	1.226	5.450	0.020	3.407
Depression
	JOA score	-0.156	13.623	<0.001	0.855	0.167