Assessment of nasal specific symptoms and psychological dysfunction in patients with chronic rhinosinusitis before and after surgery
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摘要: 目的 探讨鼻部特异性症状可能影响慢性鼻窦炎(chronic rhinosinusitis，CRS)患者合并焦虑、抑郁等心理功能障碍的情况及鼻内镜手术对其心理功能障碍状况的改善。方法 在术前1周内及术后6个月对44例CRS患者完成汉密顿焦虑情绪量表(Hamilton Anxiety Scale，HAMA)、汉密顿抑郁情绪量表(Hamilton Depression Scale，HAMD)及鼻腔鼻窦结局测量22条(the 22-Item Sino-Nasal Outcome Test，SNOT-22)评测，以评估其心理功能状态和鼻部特异性症状改善程度，同时随机选取同期体检的健康成人51例作为对照组。结果 根据SNOT-22评分，合并焦虑、抑郁心理功能障碍的患者有更严重的头昏、头面部胀痛症状及睡眠障碍(P < 0.01或P < 0.05)。经功能性内镜鼻窦手术后，CRS患者HAMD、HAMA及SNOT-22评分较术前均有改善(P < 0.01)。结论 CRS患者合并焦虑、抑郁情况较为普遍，头昏、头面部胀痛特异性症状与CRS患者心理功能障碍关系显著，鼻内镜手术可显著缓解患者特异性症状和心理功能障碍。Abstract: Objective To investigate the effects of nasal specific symptoms on chronic rhinosinusitis(CRS) with anxiety, depression and other psychological dysfunction and endoscopic surgery for the improvement of psychological dysfunction in patients with CRS.Method The Hamilton Anxiety Scale(HAMA), Hamilton Depression Scale(HAMD) and the 22-Item Sino-Nasal Outcome Test(SNOT-22) were completed in 44 patients with CRS within one week before and 6 months after surgery. They were used to assess mental function and nasal specific symptoms.Result According to the SNOT-22 score, patients with anxiety and depression mental dysfunction had more severe symptoms of dizziness, head and face pain and sleep disorders(P < 0.01 or P < 0.05). After endoscopic sinus surgery, the scores of HAMD, HAMA and SNOT-22 in CRS patients were improved compared with preoperative(P < 0.01).Conclusion Patients with CRS have more common anxiety and depression. The specific symptoms of dizziness and head and face pain are significantly related to the psychological dysfunction of patients with CRS. Endoscopic sinus surgery can significantly alleviate the specific symptoms and mental dysfunction.
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Key words:
- sinusitis /
- anxiety /
- depression /
- specific symptoms
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表 1 合并焦虑抑郁组和不合并焦虑抑郁组一般情况的组间比较
指标 合并焦虑
抑郁组不合并焦虑
抑郁组t/χ2 P 年龄 42.85± 12.092 43.61± 9.134 0.227 0.822 性别 2.173 0.140 男 13 13 女 13 5 婚姻 0.000 1.000 未婚 3 2 已婚 23 16 文化程度 1.534 0.674 小学 10 6 初中 9 8 高中或中专 3 3 大专及以上 4 1 
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表 2 合并焦虑抑郁组和不合并焦虑抑郁组患者术前SNOT-22各项组间分析
术前
SNOT-22不合并焦虑
抑郁组
(n=18)合并焦虑
抑郁组
(n=26)t P 擤鼻涕 0.72±1.07 1.08±1.20 -1.007 0.320 打喷嚏 1.06±1.35 1.08±1.02 -0.600 0.952 流清涕 0.83±1.25 1.04±1.31 -0.520 0.606 咳嗽 0.06±0.24 0.15±0.37 -1.079 0.287 鼻涕倒流 1.44±1.34 1.27±1.28 0.438 0.664 流脓涕 2.83±1.69 1.96±1.69 1.686 0.099 嗅觉下降 2.00±1.82 1.73±1.69 0.505 0.616 鼻塞 3.11±1.45 2.58±1.24 1.311 0.197 耳闷 0.39±0.61 0.69±0.84 -1.392 0.171 头昏 1.00±0.84 3.54±1.17 -7.871 0.000 耳痛 0.06±0.24 0.23±0.59 -1.371 0.179 头面部胀痛 0.78±0.73 3.27±1.15 -8.104 0.000 难以入睡 0.28±0.75 1.81±1.44 -4.582 0.000 半夜易醒 0.72±1.02 1.54±1.17 -2.391 0.021 睡眠质量差 0.67±0.91 1.73±1.37 -2.877 0.006 醒后感觉累 0.39±0.50 0.73±1.12 -1.375 0.177 疲倦 0.33±0.59 0.92±1.13 -2.252 0.030 工作效率下降 1.11±1.08 1.88±1.28 -2.103 0.041 注意力不集中 0.94±1.00 1.81±1.17 -2.555 0.014 沮丧/焦躁 0.94±1.11 2.54±1.30 -4.231 0.000 忧虑 0.94±0.80 2.69±1.23 -5.306 0.000 不安/难堪 0.39±0.78 2.27±1.04 -6.499 0.000
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表 3 CRS患者术前术后的HAMA、HAMD及SNOT-22总分比较
术前 术后 t P HAMA总分 6.89±4.88 3.36±2.80 5.387 0.000 HAMD总分 7.57±5.17 4.52±3.06 4.944 0.000 SNOT-22总分 30.05±11.44 10.43±6.68 13.953 0.000
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表 4 CRS组术后与对照组HAMA、HAMD及SNOT-22及各子域评分比较
CRS组术后 对照组 t P HAMA总分 3.36±2.80 2.30±2.45 1.962 0.053 HAMD总分 4.52±3.06 4.26±2.75 0.438 0.665 SNOT-22总分 10.43±6.68 3.64±3.72 5.981 0.000 鼻科症状子域 2.95±1.88 1.06±1.17 5.777 0.000 耳科症状子域 0.39±0.81 0.28±0.54 0.757 0.451 头面部症状子域 0.73±1.26 0.08±0.27 3.328 0.002 睡眠障碍子域 2.95±2.48 1.36±1.98 3.467 0.001 心理功能障碍子域 3.41±2.96 0.86±1.48 5.169 0.000
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