CAJ | 학술논문

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(χ2=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。
목적：평고로내은신경류환자수술전후적신경심리상태개변，초보분석영향은신경류환자정서변화적상관인소。방법선취2009년3월지2012년3월94례진단위단측로내은신경류환자，소유환자균유동일신경외과의생경침하을상두입로진행수술치료。수방시응용9항병례건강문권(PHQ-9)화7항엄범성초필(GAD-7)자평량표평정환자술후정서상태급회고평고술전심리상태，대수술전후환자적억욱초필정황여년령、성별、종류부위、술후House-Brackmann분급화종류최대직경행Logistic회귀분석。결과최종완성유효문권82례(인불능완성문권화기왕정신질병사등원인배제12례)。기중，남28례、녀54례，평균년령(47.88±11.05)세，수방시간(33.83±11.98)개월。정서량표평정결과현시，술전존재억욱9/82례(11.0%)，초필4/82례(4.9%)；술후존재억욱6/82례(7.3%)，초필3/82례(3.6%)。경Fisher’s정학검험，술전유억욱증상적환자다우술후(χ2=10.09，df=1，P=0.016)；Logistic회귀분석현시은력장애개선불가(P=0.012)화년령(P=0.044)시술후환자출현억욱증상적위험인소。결론은신경류환자적술전억욱、초필증상재종류절제후가명현개선，수착술후강복시간적연장억욱상황가진일보호전。대존재은력악화혹고령환자，급시발현억욱초필증상병여간예，유조우술후회복。
Aim To assess depressive and anxious symptoms before and after the surgical treatment in patients with intracranial vestibular schwannoma and primarily identify correlated risk factors. Methods 94 patients from March 2009 to March 2012 were recruited. The identical surgical procedure was performed for those patients by the same neurosurgical team. Two self-reported questionnaires of Patient Health Questionnaire, 9 items (PHQ-9) and Generalized Anxiety Disorder, 7 items (GAD-7) were sent to 82 eligible patients (out of 94) and 100%of them responded, when patients came to the outpatient department for routine neurosurgical follow-up. The current emotional condition was assessed. SPSS 16.0 was used to perform statistical analysis. The difference of the proportion of patients with depressive or anxious symptoms before and after the surgical operation was tested by Chi square. The emotional symptoms and other factors such as age, gender, duration after the surgical operation, maximum diameters of the tumor, House-Brackmann ranking and hearing dysfunction were performed Logistic regression analysis. Results 82 eligible patients ifnished all the questionnaires (87%), with 54 female and 28 male. Their average age was (47.88±11.05) years old and the time after surgical operation was (33.83±11.98) months. There were 9 patients with depressive symptoms (11%) and 4 patients with anxious symptoms (4.9%) before the surgical operation, whereas 6 patients with depressive symptoms (7.3%) and 3 patients with anxious symptoms (3.7%) after the operation. There were significantly statistical difference (χ2=10.09, df =1, P=0.016) before and after the operation. Logistic regression analysis showed that hearing deterioration and age were associated with depression after the surgical operation (P=0.012 and P=0.044, respectively). Conclusion Depressive and anxious symptoms were very common among the patients with intracranial vestibular schwannoma in both before and after the surgical operation. Though those symptoms could be improved when tumor was removed by surgical operation, depressive symptoms could still occur or exist. Worse hearing function and age might be risk factors for depressive symptoms after the surgical operation.