目的: 探讨紧张和焦虑对手术患者术后认知功能的影响。方法: 100例腹部择期手术病人术前1天用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、简易智能测试量表(MMSE)、数字广度对病人进行测试。术后7天分别用MMSE、数字广度进行神经心理学测试, 术后MMSE结果低于术前一个标准差则视为术后认知障碍(POCD)。结果: 术前焦虑、抑郁以及同时发生焦虑和抑郁的阳性率分别为30%、50%和10%。女性患者术后7天POCD的发生率为30%, 男性患者术后7天POCD的发生率为20%; 女性患者焦虑得分为7.2±4.0,高于男性患者4.5±3.3, P=0.05女性患者的抑郁得分为6.5±3.6, 明显高于男性患者4.2±3.4(P=0.1),术前焦虑与POCD的相关性不显著, 术前焦虑与MMSE、数字广度的 Pearson’s相关系数分别为-0.50(P=0.2)和-0.20( P=0.1)。术前抑郁与POCD存在显著的相关性, 其中术前抑郁与MMSE的 Pearson’s相关系数为-0.61(P=0.01), 术前抑郁与数字广度的Pearson’s相关系数为-0.72(P=0.03)。结论: 术前抑郁的患者术后容易发生POCD; 相对于男性患者, 女性更容易出现POCD; 而术前焦虑对POCD没有重要的影响。

Objective: To study the effects of preoperative anxiety and depression on postoperative cognitive function of patients undergoing abdominal selective surgery. Method: 100 patients who were scheduled for abdominal surgery were investigated by using Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD), mini-mental state exam(MMSE)and digital span the day before surgery. The patients were tested in the 7th postoperative day by MMSE and digital span. It could be defined postoperative cognitive dysfunction(POCD)if the MMSE score decreased 1 SD (standard deviation). Results: The positive rates of anxiety, depression, and both anxiety and depression were 30%, 50%, and 10% respectively. The 7th day POCD rate was 30% in female patients and 20% in male patients. The anxiety score of the female patients was 7.2±4.0, higher than that of the male patients (4.5±3.3), P=0.05. The depression score of the female patients was (6.5±3.6), significantly higher than that of the male patients (4.2±3.4), P=0.01.it has no significant relation between preoperative anxiety and POCD.The Pearson’s correlation between preoperative anxiety and postoperative MMSE and digital score is -0.50(P=0.2)and -0.20(P=0.1), respectively. Preoperative depression was significantly related with POCD.The Pearson’s correlation between preoperative depression and postoperative MMSE and digital score is -0.61(P=0.01) and -0.72(P=0.03), respectively. Conclusions: Female patients tend to have postoperative dysfunction compare with male patients. Preoperative depression patients were more likely to have postoperative dysfunction. The anxiety score had no significant influence on postoperative cognitive dysfunction.