前列腺良性增生合并上尿路结石术后患者焦虑抑郁情绪及相关因素分析

Severity of anxiety and depression after surgery for benign prostatic hyperplasia complicating upper urinary tract stones and risk factor analysis

摘要:

目的 探讨先行经尿道前列腺电切（TURP）术再经电切镜镜鞘置入输尿管硬镜/软镜碎石治疗前列腺良性增生合并上尿路结石患者术后焦虑抑郁情绪程度及相关因素。方法 前瞻性选取2016年3月—2022年6月衡水市人民医院先行TURP术再经电切镜镜鞘置入输尿管硬镜/软镜碎石的130例患者。收集患者临床资料，包括年龄、婚姻状态、收入状况、医疗条件、对工作的担忧、家属心理状态、睡眠质量、结石直径、手术时长、术中出血量、并发感染、术后导尿引流。应用医院焦虑抑郁量表（HAD）评估所有患者的围手术期焦虑和抑郁状态。结果 两组患者年龄、收入状况、医疗条件、对工作的担忧、家属心理状态、睡眠质量、结石直径、手术时长、并发感染、术后导尿引流情况比较，差异均有统计学意义（P <0.05）；两组患者婚姻状态、术中出血量比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：年龄≥ 75岁［O^R=4.387（95% CI：1.275，10.339）］、收入< 5 000元/月［O^R=3.026（95% CI：1.078，9.325）］、睡眠质量差［O^R=3.982（95% CI：1.581，6.959）］、并发感染［O^R=4.873（95% CI：1.768，7.521］及术后导尿引流［O^R=6.923（95% CI：1.923，11.587）］均为接受联合术治疗前列腺良性增生合并上尿路结石患者并发焦虑抑郁的危险因素（P <0.05）。结论 对于接受先行TURP术再经电切镜镜鞘置入输尿管硬镜/软镜碎石的前列腺良性增生合并上尿路结石患者，应格外关注年龄≥ 75岁、收入< 5 000元/月、睡眠质量差、并发感染、术后导尿引流的患者，并制订相关预防措施，避免焦虑、抑郁的发生。

Abstract:

Objective To analyze the severity of anxiety and depression after transurethral resection of the prostate (TURP) followed by sheath-guided rigid/flexible ureteroscopic lithotripsy for the treatment of benign prostatic hyperplasia with upper urinary tract stones and the risk factors thereof.Methods A total of 130 patients who underwent TURP surgery followed by sheath-guided rigid/flexible ureteroscopic lithotripsy in our hospital from March 2016 to June 2022 were prospectively selected. The clinical data of all patients including age, marital status, income status, medical conditions, concerns about work, psychological states of family members, sleep quality, stone size, operative duration, intraoperative bleeding, concurrent infections, and postoperative urinary catheterization were collected. The Hospital Anxiety and Depression Scale (HAD) was used to evaluate the perioperative anxiety and depression status of all patients. The statistical analysis was performed via SPSS 22.0, and the risk factors were determined based on the multivariable Logistic regression models.Results There were significant differences in age, income status, medical conditions, concerns about work, psychological states of family members, sleep quality, stone size, operative duration, concurrent infections, and postoperative urinary catheterization between patients with and without anxiety and depression (P < 0.05), while there was no statistically significant difference between the two groups in terms of marital status and intraoperative bleeding (P > 0.05). The multivariable Logistic regression analysis revealed that the age ≥ 75 years old [O^R = 4.387, (95% CI: 1.275, 10.339) ], income status < 5 000 yuan/month [O^R = 3.026, (95% CI: 1.078, 9.325) ], poor sleep quality [O^R = 3.982, (95% CI: 1.581, 6.959) ], concurrent infections [O^R = 4.873, (95% CI: 1.768, 7.521) ], and postoperative urinary catheterization [O^R = 6.923, (95% CI: 1.923, 11.587)] were risk factors for developing anxiety and depression in patients undergoing combined surgery for benign prostatic hyperplasia with upper urinary tract stones (P < 0.05).Conclusions For patients with benign prostatic hyperplasia and upper urinary tract stones undergoing TURP followed by sheath-guided rigid/flexible ureteroscopic lithotripsy, special attentions should be paid to patients with characteristics such as age ≥ 75 years old, income status < 5 000 yuan/month, poor sleep quality, concurrent infections, and postoperative urinary catheterization. In addition, relevant preventive measures should be taken to avoid the occurrence of anxiety and depression.