肝移植患者术前心理状况的评估

目的 评估肝移植患者术前抑郁、焦虑的心理状况,为临床干预提供参考.方法 2006年10月至2007年7月四川大学华大医院收治的肝移植手术、消化道恶性肿瘤手术以及胆囊切除术患者各40例,手术前1天麻醉医师访视时使用ZUNG氏抑郁自评量表和焦虑自评量表对其进行评分.结果 肝移植患并术前抑郁、焦虑水平均高于全国常模,术前抑郁水平高于本院同期胆囊切除患者和胃肠道肿瘤手术患者,差异有统计学意义;肝移植患者术前抑郁女性高于男性,发生抑郁焦虑的患者与受教育水平无关;活体肝移植患者与原位肝移植患者术前抑郁、焦虑水平两者无统计学差异.结论 肝移植患者术前抑郁焦虑状态发生率较高,尤其是抑郁情绪明显高于常规手术患者,医生应注意沟通技巧,合理的术前用药,合适的心理评估与干预,尤其是女性患者.

Assessment of preoperative psychological state of patients with liver transplantation

Objective To assess the preoperative depression and anxiety levels of the patients undergoing liver transplantation (LT). Methods Zung self-rating depression scale (SDS) and Zung self-rating anxiety scale (SAS) were used to assess the preoperative depression and anxiety levels of 40 patients undergoing LT, 40 patients with gastrointestinal cancer, and 40 patients undergoing cholecystectomy. Results The preoperative anxiety levels of the patients undergoing LT, with gastrointestinal cancer, and undergoing cholecystectomy were all significantly higher than that of the national norm (all P<0.01), without significant differences among the 5 groups of patients. The depression level of the patients undergning LT was significantly higher than those of the national norm, and the patients with gastrointestinal cancer and undergoing cholecystectomy (all P<0.01). There were not significant differences in the preoperative depression and anxiety levels between the patients with gastrointestinal cancer and those undergoing cholecystectomy. The depressive rate of the patients undergoing LT was 40.0% (16/40), significantly higher than those of cholecystectnmy group (17.5%) and cancer resection group (15.0%) , and the depression score of the 6 female patients undergoing LT was 53, significantly higher than that of the male patients in the same group (P<0.01). There was no significant differences in the depression and anxiety levels between the patients undergoing living donor liver transplantation (LDLT) and the patients undergoing orthotopic liver transplantation(OLT). Educational level was not correlated with the preoperative anxiety and depression levels. Conclusion Patients scheduled for LT have high risks of prenperative depressinn and anxiety, especially the former. Suitable pre-medication, optimal psychosocial assessment, and treatment, especially for the female patients, are needed.