由于外围动脉疾病而经历重大截肢的患者患有严重抑郁症的风险很高,需要长期服用抗抑郁药
Elizabeth Lavanga1, Fadi Samaan1, Jacob W Soucy1
1Department of Medical Education, Penn State College of Medicine, Hershey, PA.
Journal of vascular surgery
|March 23, 2025
概括
与较小的截肢相比,主要的下肢截肢显著增加患抑郁症的风险,并在手术后需要抗抑郁药. 这凸显了对主要截肢患者进行主动精神病学转诊的需要.
科学领域:
- 血管外科 血管外科
- 精神病学是一个精神病学.
- 流行病学 流行病学
背景情况:
- 周围动脉疾病 (PAD) 显著影响患者的流动性和生活方式.
- 对PAD的下肢截肢与术后抑郁症的增加有关.
- 截肢和抑郁症的现有研究受到范围和时间框架的限制.
研究的目的:
- 评估下肢截肢水平与手术后抑郁症的发展之间的关联.
- 为了识别患有截肢后抑郁症高风险的患者.
- 通知血管外科医生,以便及时向精神病医生转诊.
主要方法:
- 从TrinetX数据库对48,568名经历PAD相关下肢截肢的患者进行了回顾性分析.
- 排除患有手术前抑郁症或使用抗抑郁药的患者.
- 倾向分数匹配为主要 (膝盖上方/下方) 和轻微 (脚/脚) 截肢创建了可比的队列.
- 在6个月和1年间隔分析的结果包括主要抑郁症 (MDD) 诊断,抗抑郁药物处方和死亡率.
主要成果:
- 严重的截肢与较小的截肢相比,在6个月后的MDD (6.3%对4.6%) 和抗抑郁药使用率 (26.8%对15.8%) 更高.
- 一年后,重大截肢显示MDD发病率较高 (7.7%对6.4%) 和抗抑郁药需要 (28.6%对18.5%).
- 大型截肢组的一年死亡率明显高 (小型截肢组为21.5%,大型截肢组为20.7%) 与单独的轻型截肢组 (10.8%).
结论:
- 随着时间的推移,手术后抑郁症和抗抑郁药物的需要在重大和小截肢者中都会增加.
- 经历重大截肢或轻微截肢之后的大型截肢的患者面临更大的术后MDD和抗抑郁药物需求的可能性.
- 血管外科医生应该认识到大截肢患者的高抑郁症发病率,并考虑早期精神病学转诊.
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