整形美容患者心理状况分析

目的:研究整形美容患者的心理状况,为术前准备与术后治疗提供依据,并寻找相应的防治措施,减少患者对手术效果不满的发生率。方法:选用焦虑自评量表(SAS)与抑郁自评量表(SDS)对60例整形美容患者进行测验,同时用60例正常人作为对照组。术前3天进行测试,测试前说明目的与意义。结果:手术组SAS与SDS得分分别为47.24±5.67与50.34±4.28,标准分界值为50分,结果显示手术组得分明显高于对照组。结论:部分整形美容患者存在着明显的焦虑与抑郁。在临床工作中,我们应该学会正确识别该类型的患者,并积极探索心理治疗方法,使就医者能客观看待手术带来的外观上的变化,从而减少医疗纠纷的发生。  

Health-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery

Background: Extreme obesity, defined by a body mass index (BMI) ≥40 kg/m², is associated with increased risk of depression and with impairments in healthrelated quality of life (HRQoL). This study examined the relationships among BMI, HRQoL, and symptoms of depression in persons with extreme obesity. Method: Participants were 306 patients who sought bariatric surgery (mean ± SD age 43.8±9.4 years, BMI 52.8±9.3 kg/m²) and who completed questionnaires to assess symptoms of depression and HRQoL prior to surgery. We defined HRQoL impairment as a score ≥1 SD below national means. Results: Impairments in HRQoL were common: >40% of participants scored in the impaired ranges of physical functioning, physical role limitations, and bodily pain. Results of analyses of variance (ANOVAs) indicated that impairments in HRQoL were significantly related to symptoms of depression. Patients with impaired HRQoL scored above the cut-off point for clinically significant depression, while those without such impairment scored below that cut-off, regardless of BMI. The contribution of BMI to depression was not significant in any ANOVA. Conclusion: HRQoL is more strongly and more directly related to symptoms of depression than is BMI. These findings highlight the need to assess HRQoL in patients with extreme obesity and suggest that interdisciplinary strategies to address HRQoL impairments may be beneficial in this population.  

Depression score predicts weight loss following Roux-en-Y gastric bypass

Background: The prevalence of obesity is increasing in the United States. Bariatric surgery is the only intervention that can reliably induce and maintain significant weight loss in obese patients. The association between pre-surgical severity of depression and success at weight loss following Roux-en-Y gastric bypass (RYGBP) has not yet been fully elucidated. Methods: 145 charts of patients who underwent RYGBP for morbid obesity were reviewed. 47 patients who filled out the Beck Depression Inventory (BDI) before surgery and completed 1 year of follow-up were studied. The relationship between pre-surgical severity of depression and success at weight loss was examined through multivariate regression analysis using percent excess weight loss (%EWL) as a dependent variable and BDI score as one of the predictors. Results: Weight loss at 1 year was significantly related to the BDI score before surgery (P =0.014). BDI score was also found to be a significant predictor of the amount of weight lost (kg) 1 year after surgery (P =0.027). Age (P =0.03) and initial body mass index (BMI) (P =0.011) were the only other variables with significant independent relations to %EWL. Conclusions: Our data show a positive correlation between pre-surgical severity of depression as measured by BDI score and the 1-year success at weight loss after RYGBP as measured by %EWL. More depressed individuals tend to lose greater amounts of weight compared with less depressed individuals. Future prospective studies should examine possible mechanisms and effects of depression and other psychiatric disturbances on long-term weight loss after RYGBP.  

Psychiatric diagnoses and psychiatric treatment among bariatric surgery candidates

Background: This study investigated the psychiatric diagnoses and psychiatric treatment histories of 90 bariatric surgery candidates. Methods: Prior to surgery, all participants completed the Weight and Lifestyle Inventory, the Questionnaire on Eating and Weight Patterns, and the Beck Depression Inventory-II. Participants also underwent a behavioral/psychological evaluation with a psychologist, which reviewed responses to the measures and provided further assessment of participants' psychiatric status. The evaluation also was used to produce a recommendation on the patients' psychological appropriateness for surgery. Results: Almost two-thirds of patients received a psychiatric diagnosis, the most common of which was major depressive disorder. Nearly two-fifths of all participants, and more than half of those given a psychiatric diagnosis, were engaged in some form of psychiatric treatment at the time of the evaluation. Nevertheless, 64% of patients were unconditionally approved for surgery; 31% were recommended for additional psychiatric or nutritional counseling prior to surgery. Three patients were not recommended for surgery. Conclusion: Results of this study provide important information on the preoperative psychiatric status and treatment histories of bariatric surgery candidates. Given the increasing population of bariatric surgery patients, evaluation of patients' preoperative psychiatric status may play an important role in maximizing successful postoperative outcomes.  

Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data

Background. This study examines the evidence from publisheddata concerning the adverse respiratory and haemodynamic effectsof three analgesic techniques after major surgery; i.m. analgesia,patient-controlled analgesia (PCA), and epidural analgesia. Methods. A MEDLINE search of the literature was conducted forpublications concerned with the management of postoperativepain. Information relating to variables indicative of respiratorydepression and of hypotension was extracted from these studies.Over 800 original papers and reviews were identified. Of thesepapers, 212 fulfilled the inclusion criteria but only 165 providedusable data on adverse effects. Pooled data obtained from thesestudies, which represent the experience of a total of nearly20 000 patients, form the basis of this study. Results. There was considerable variability between studiesin the criteria used for defining respiratory depression andhypotension. The overall mean (95% CI) incidence of respiratorydepression of the three analgesic techniques was: 0.3 (0.1–1.3)%using requirement for naloxone as an indicator; 1.1 (0.7–1.7)%using hypoventilation as an indicator; 3.3 (1.4–7.6)%using hypercarbia as an indicator; and 17.0 (10.2–26.9)%using oxygen desaturation as an indicator. For i.m. analgesia,the mean (95% CI) reported incidence of respiratory depressionvaried between 0.8 (0.2–2.5) and 37.0 (22.6–45.9)%using hypoventilation and oxygen desaturation, respectively,as indicators. For PCA, the mean (95% CI) reported incidenceof respiratory depression varied between 1.2 (0.7–1.9)and 11.5 (5.6–22.0)%, using hypoventilation and oxygendesaturation, respectively, as indicators. For epidural analgesia,the mean (95% CI) reported incidence of respiratory depressionvaried between 1.1 (0.6–1.9) and 15.1 (5.6–34.8)%,using hypoventilation and oxygen desaturation, respectively,as indicators. The mean (95% CI) reported incidence of hypotensionfor i.m. analgesia was 3.8 (1.9–7.5)%, for PCA 0.4 (0.1–1.9)%,and for epidural analgesia 5.6 (3.0–10.2)%. Whereas theincidence of respiratory depression decreased over the period1980–99, the incidence of hypotension did not. Conclusions. Assuming a mixture of analgesic techniques, AcutePain Services should expect an incidence of respiratory depression,as defined by a low ventilatory frequency, of less than 1%,and an incidence of hypotension related to analgesic techniqueof less than 5%.  

Depression and bone mineral density: is there a relationship in elderly Asian men? Results from Mr. Os (Hong Kong)

Previous epidemiological study has suggested that depression might be associated with low bone mass in Caucasian women. This has not been studied in Asian men. Mr. Os (Hong Kong) is the first, large, cohort study on osteoporosis in Asian men, and the current analysis deals with the association between depression and bone mass in this group. Data from the baseline examination of Mr. Os (Hong Kong) were used. Two thousand Hong Kong men aged 65 to 92 years were recruited from the community. Depression was diagnosed by face-to-face interview, using a validated Chinese version of the Geriatric Depression Scale (GDS), with depression being defined as a cut-off score of 8 or more. Bone mineral density (BMD) of the lumbar spine, total hip and total body was measured by dual X-ray densitometry (DEXA) using the Hologic QDR-4500 W densitometer. Multiple regression was used to compare BMD in depressed and non-depressed subjects, controlling for confounding variables. In the study sample 8.5% of men were found to be depressed, and the BMD at the total hip in these subjects was 2.1% lower than in non-depressed subjects (95% CI –0.13 to –4.1), after adjustment for age, body weight, medical history, alcohol consumption, cigarette smoking, calcium intake, physical activity and antidepressant use. Depression was associated with a 1.4-fold (95% CI 1.00 to 2.08) relative risk (RR) of being diagnosed with a T-score equal to or less than –1.0 (low bone mass). We conclude that depression is associated with lower BMD; however, to determine whether depression causes lower BMD or vice versa, we will need to await findings from future prospective studies.Abstract presented at the 25th Annual Meeting of the American Society for Bone and Mineral Research on 21 September 2003, Minnesota, Minneapolis, USA  

The Objective of Psychological Evaluation in the Process of Qualifying Candidates for Bariatric Surgery

Psychosocial and behavioral variables play an important role in both the development and treatment of obesity. Therefore, in the process of qualifying the patient for bariatric surgery, it is necessary to professionally evaluate his/her psychological state. Such evaluation is very helpful in the identification of factors potentially disturbing the effectiveness of the treatment. Clinical interviews with a group of 80 patients were conducted by a psychologist in the pre- and post-surgical period. The qualitative analysis of the interviews led to the identification of the major elements which should become the object of psychological evaluation in the process of qualifying patients for bariatric surgery. Conducting a clinical interview comprising these elements allows one to evaluate their potential influence on the process of surgical treatment of obesity and to provide optimal psychological support for the patient before and after the surgery.  

急性心肌梗死患者焦虑抑郁状况及预测因素分析

目的了解急性心肌梗死患者急性期的焦虑抑郁状况及其预测因素,以期为护理人员采取预防性的心理护理措施提供依据。方法对136例急性心肌梗死患者在其发病的第5~7天采用综合医院焦虑抑郁量表和SF-12生活质量量表进行问卷调查。结果急性心肌梗死患者中焦虑症状阳性者72例(52.94%),抑郁症状阳性者22例(16.18%)。患者既往的生理职能、锻炼情况和精神健康是患者焦虑水平的影响因素(P<0.05,P<0.01);既往的活力、社会功能和吸烟史是患者抑郁水平的影响因素(P<0.05,P<0.01)。结论急性心肌梗死患者发病前的生活质量和生活方式会影响其急性期焦虑抑郁的发生,护理人员应加强评估并提供针对性的措施,预防和缓解患者的不良心理状况。  

自体颗粒脂肪移植矫治颜面部凹陷

目的：探讨自体颗粒脂肪移植治疗颜面部凹陷的疗效。方法：肿胀麻醉下,利用注射器抽吸脂肪颗粒。过滤纯化后用脂肪抽吸针将脂肪颗粒注射在面部凹陷部位。结果：采用自体脂肪颗粒移植治疗颜面部凹陷20例,17例手术一次成功,另3例补充注射1次,效果均满意。结论：利用自体颗粒脂肪移植治疗颜面部凹陷,手术易行,创伤小,效果较好,值得推广。  

慢性前列腺炎疗效与患者精神状况及相关因素Cox回归分析

目的:筛选验证与慢性前列腺炎/慢性骨盆疼痛综合征(CP/CPPS)相关的精神心理因素,采用Cox回归分析方法研究这些精神心理因素及其他相关因素对CP/CPPS治疗效果的影响,为CP/CPPS治疗过程中有针对性的精神心理干预提供科学依据。方法:连续调查于我院就诊的291名CP/CPPS患者(病例组)的年龄、文化程度、职业、性格类型、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、病程、NIH慢性前列腺炎症状指数(NIH-CP-SI)和前列腺液白细胞计数,同时选择相同年龄阶段的健康男性100名(对照组)进行病例对照研究,筛选验证与CP/CPPS相关的精神心理因素。调查结束后,病例组所有患者均接受为期6周的统一方案治疗并进行随访(6周),以治疗是否有效为终结事件,以治疗见效时间为时间变量,采用单因素和多因素Cox回归分析研究与CP/CPPS相关的精神心理因素及其他可能影响CP/CPPS治疗效果的因素,筛选能够影响CP/CPPS治疗效果的相关因素。结果:病例组回收有效问卷258份,对照组回收有效问卷87份。病例组SAS和SDS评分分别为(42.8±11.43)分和(48.15±11.49)分,均显著高于对照组[SAS(32.12±9.68)分,SDS(35.12±10.81)分,P<0.01]。病例组焦虑、抑郁以及焦虑或/和抑郁障碍的检出率分别为25.97%、21.71%和34.50%,均显著高于对照组(P<0.01);内向性格和外向性格的检出率亦分别高于和低于对照组(P<0.01);提示焦虑、抑郁和内向性格与CP/CPPS具有正联系,而外向性格与CP/CPPS具有负联系。病例组接受为期6周统一治疗后的总有效率达70.54%,Cox回归分析显示,在上述与CP/CPPS相关的4个因素(焦虑、抑郁、内向性格、外向性格)和另外可能影响CP/CPPS治疗效果的4个因素(年龄、病程、前列腺液中白细胞计数、CPSI)中,对CP/CPPS治疗效果有确切负性影响的危险因素有焦虑、抑郁和病程。结论:焦虑和抑郁等精神心理障碍在CP/CPPS发生、发展及治疗转归过程中具有重要作用;在CP/CPPS治疗过程中,应充分重视患者的精神心理状况,必要时应有针对性地给予适当的精神心理干预。