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[摘要] 目的 分析外阴上皮内非瘤样病变（NEDV）患者焦虑/抑郁心理状态及对其生活质量和性生活质量的影响。方法 采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对80例NEDV患者和120例健康体检妇女进行对照调查分析；比较NEDV患者有无焦虑/抑郁和焦虑/抑郁程度及瘙痒症状评分；采用诺丁汉健康量表（NHP）和性生活功能评估量表（BI-W）调查分析焦虑/抑郁对NEDV患者生活质量和性生活质量的影响。 结果 NEDV患者焦虑、抑郁发生率及评分均高于对照组（P<0.05）。NEDV患者中，有焦虑/抑郁者及焦虑/抑郁重度者瘙痒症状评分均高于无焦虑/抑郁者及焦虑/抑郁轻度者（P<0.05）；有焦虑/抑郁者睡眠评分高于无焦虑/抑郁者，而性、性心理、性行为三个维度评分低于无焦虑/抑郁者，差异有统计学意义（P<0.05）。 结论 NEDV患者焦虑/抑郁水平高于对照组，并影响其睡眠和性生活质量。外阴瘙痒症状是引起焦虑/抑郁的因素之
[] B [文章编号] 1673-9701（2013）25-0017-03
Study of anxiety/depression states of the patients with nonneoplastic epithelial disorders of vulva and their impacts on quality of life
WANG Lin YI Jinling QI Ling ZHU Jun SHEN Yanli
Department of Gynecology，the Fifth Affiliated Hospital of Xinjiang Medical University，Urumqi 830011，China
[Abstract] Objective To clarify whether patients with nonneoplastic epithelial disorders of vulva （NEDV）experience emotional anxiety/depression，and whether anxiety/depression affect their qualities of life and qualities of sexual life. Methods Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were administered to assess the psychological states of 80 patients with NEDV and 120 healthy women；To study whether anxiety / depression of the patients with NEDV were in relation to itching symptom；the Nottingham health poofity（NHP） and Brief index of sexual function for women （BI-W）were administered to investigate and analyzed the effects of anxiety/depression on qualities of life and qualities of sexual life of the patients with NEDV. Results The incidence and the mean scores of anxiety/depression in the patients with NEDV are higher than those in the control group（P<0.05）. Itching mean scores of the patients with NEDV hing anxiety/depression and severe anxiety/depression were higher than those without anxiety/depression and hing mild anxiety/depression（P<0.05）； Sleep score of the patients with NEDV hing anxiety/depression was higher than that without anxiety/depression（P<0.05），while orga/sexual psychology/sexual behior scores of the patients with NEDV hing anxiety/depression were lower than those without anxiety/depression（P<0.05）. Conclusion Compared with the control group，anxiety/depression of the patients with NEDV he higher levels，and affect their sleeps and qualities of life. Genital itching is one of the factors that may give rise to anxiety/depression. Suggesting that the patients should be administered biological therapy，while be psychologically applied help and support.
总之，医务人员在积极治疗NEDV患者外阴瘙痒等主观不适症状同时，应积极重视患者的心理健康问题，帮助其减轻焦虑、抑郁症状，改善睡眠，提高性生活质量，达到身心健康的目的。
[参考文献]
曹泽毅. 妇产科学[M]. 北京：人民卫生出版社，2008：262.
汪向东. 汉密顿焦虑量表（HAS），汉密顿抑郁量表（HAD）. 卫生定量手册[S]. 中国心理卫生杂志，1993，7（增刊）：189.
[3] Tidermark J，Bergstrom G. Esponsiveness of the EuroQol（EQ-5D）and the Nottingham Health Profile（NHP） in elderly patients with femoral neck fractures[J]. Qual Life Res，2007，16（2）：321-330.
[4] Carlson KJ，Miller BA，Fowler FJ. The Maine Women’s Health Study： outcomes of hysterectomy[J]. Obstet Gynecol，1998，83：556-565.
[5] 翁莉，阚延静，池霞，等. 外阴白色病变病人的心理状况分析[J]. 中国妇幼保健，2010，1：52-53.
[6] Jiao LX， Hu LN， Xiong ZA，et al. Treatment of nonneoplastic epithelial disorders of skin and mucosa of vul
[7] Günthert AR，Duclos K，Jahns BG，et al. Clinical scoring system for vulvar lichen sclerosus[J]. Sex Med，2012，9（9）：2342-2350.
[8] Van de Nieuwenhof HP，Meeuwis KA，Nieboer TE，et al. The effect of vulvar lichen sclerosus on quality of life and sexual functioning[J]. Psychosom Obstet Gynaecol，2010，31（4）：279-284.
[9] 王智彪. 外阴白色病变的超声治疗[J]. 实用妇产科杂志，2003，19（1）：6-8.
（收稿日期：2013-06-18）
一、提示对该人群行生物治疗的同时，需心理帮助和支持。
[关键词] 外阴上皮内非瘤样病变；焦虑/抑郁；生活质量；性生活质量[] B [文章编号] 1673-9701（2013）25-0017-03
Study of anxiety/depression states of the patients with nonneoplastic epithelial disorders of vulva and their impacts on quality of life
WANG Lin YI Jinling QI Ling ZHU Jun SHEN Yanli
Department of Gynecology，the Fifth Affiliated Hospital of Xinjiang Medical University，Urumqi 830011，China
[Abstract] Objective To clarify whether patients with nonneoplastic epithelial disorders of vulva （NEDV）experience emotional anxiety/depression，and whether anxiety/depression affect their qualities of life and qualities of sexual life. Methods Self-rating anxiety scale （SAS） and self-rating depression scale （SDS） were administered to assess the psychological states of 80 patients with NEDV and 120 healthy women；To study whether anxiety / depression of the patients with NEDV were in relation to itching symptom；the Nottingham health poofity（NHP） and Brief index of sexual function for women （BI-W）were administered to investigate and analyzed the effects of anxiety/depression on qualities of life and qualities of sexual life of the patients with NEDV. Results The incidence and the mean scores of anxiety/depression in the patients with NEDV are higher than those in the control group（P<0.05）. Itching mean scores of the patients with NEDV hing anxiety/depression and severe anxiety/depression were higher than those without anxiety/depression and hing mild anxiety/depression（P<0.05）； Sleep score of the patients with NEDV hing anxiety/depression was higher than that without anxiety/depression（P<0.05），while orga/sexual psychology/sexual behior scores of the patients with NEDV hing anxiety/depression were lower than those without anxiety/depression（P<0.05）. Conclusion Compared with the control group，anxiety/depression of the patients with NEDV he higher levels，and affect their sleeps and qualities of life. Genital itching is one of the factors that may give rise to anxiety/depression. Suggesting that the patients should be administered biological therapy，while be psychologically applied help and support.
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3.2 焦虑/抑郁状态与外阴瘙痒症状密切相关
外阴瘙痒是NEDV患者最主要的症状之一。本研究显示，有焦虑/抑郁情绪的患者外阴瘙痒症状评分高于无焦虑/抑郁患者，且焦虑/抑郁程度越重，外阴瘙痒症状评分越高（P<0.05），说明疾病本身造成的瘙痒等主观不适容易引起患者的焦虑/抑郁。资料显示[6]，外阴瘙痒治疗后的复发率高达11.2%，因此寻找彻底有效治疗外阴瘙痒的方法是解决NEDV患者焦虑/抑郁心理障碍的根本。3.3 焦虑/抑郁状态对生活质量和性生活质量的影响
本研究在评定NEDV患者生活质量和性生活质量中发现，焦虑/抑郁者睡眠评分高于无焦虑/抑郁者而性、性心理、性行为三个维度评分低于无焦虑/抑郁者，表明焦虑/抑郁情绪大大降低了患者睡眠和性生活质量，分析其可能的原因：①由外阴瘙痒等症状引起的焦虑不安，尤其在夜间瘙痒症状加重（大多数患者的主诉症状）时，严重影响患者睡眠，甚至出现睡眠障碍和负性情感如恐惧、焦虑加重的心理。②除外阴瘙痒，外阴萎缩、狭窄并由此引起的外观改变及痛甚至可能发生的皮肤癌变均给患者带来身体和心理上痛苦，使患者产生焦虑抑郁情绪，抵触性生活。国外研究[7，8]显示，重度外阴硬化性苔藓严重影响患者生活质量诸如性功能紊乱，也与外阴癌的高发生率有关。③该病病因不清且疾病顽固，病程长，无特效治疗，长期的疾病困扰和治疗的不确定也给患者造成长期的精神压力，产生心理障碍，影响睡眠和性生活。3.4 防治措施
外阴上皮内非瘤样病变是一种慢性外阴皮肤病变，因缺乏有效根治手段，给患者身心健康带来严重影响。因此，寻找有效方法治疗患者主观不适症状是解决问题的根本。近10年国内专家采用聚焦超声技术[9]治疗NEDV已取得良好效果。当然，现代生物-心理-社会医学模式要求临床医师在给予NEDV患者生物治疗同时，也应实施系统的心理治疗和健康教育，包括：①给患者讲解NEDV疾病的相关知识，告知其实际病情和可能的预后，让其配合给予的个体化治疗，并坚定治疗的信心。②治疗过程中帮助患者学会适当的心理调节，保持心情舒畅愉悦，减轻焦虑抑郁情绪。③社会和家人应给予患者更多的支持关爱，鼓励患者宣泄不良情绪，以减少不良情绪的负性影响；给予她们宽松愉悦的生活环境，避免和减少不良心理状态的产生。④及时准确评估患者心理状态，发现患者有严重焦虑、抑郁倾向时，及时给予心理干预，必要时加用抗焦虑/抑郁药物，达到治疗干预的目的，从而提高患者的生活质量。总之，医务人员在积极治疗NEDV患者外阴瘙痒等主观不适症状同时，应积极重视患者的心理健康问题，帮助其减轻焦虑、抑郁症状，改善睡眠，提高性生活质量，达到身心健康的目的。
[参考文献]
曹泽毅. 妇产科学[M]. 北京：人民卫生出版社，2008：262.
汪向东. 汉密顿焦虑量表（HAS），汉密顿抑郁量表（HAD）. 卫生定量手册[S]. 中国心理卫生杂志，1993，7（增刊）：189.
[3] Tidermark J，Bergstrom G. Esponsiveness of the EuroQol（EQ-5D）and the Nottingham Health Profile（NHP） in elderly patients with femoral neck fractures[J]. Qual Life Res，2007，16（2）：321-330.
[4] Carlson KJ，Miller BA，Fowler FJ. The Maine Women’s Health Study： outcomes of hysterectomy[J]. Obstet Gynecol，1998，83：556-565.
[5] 翁莉，阚延静，池霞，等. 外阴白色病变病人的心理状况分析[J]. 中国妇幼保健，2010，1：52-53.
[6] Jiao LX， Hu LN， Xiong ZA，et al. Treatment of nonneoplastic epithelial disorders of skin and mucosa of vul
源于：查抄袭率职称论文www.udooo.com
va with focused ultrasound[J].Zhonghua Fuchanke Zazhi，2007，42（1）：6-8.[7] Günthert AR，Duclos K，Jahns BG，et al. Clinical scoring system for vulvar lichen sclerosus[J]. Sex Med，2012，9（9）：2342-2350.
[8] Van de Nieuwenhof HP，Meeuwis KA，Nieboer TE，et al. The effect of vulvar lichen sclerosus on quality of life and sexual functioning[J]. Psychosom Obstet Gynaecol，2010，31（4）：279-284.
[9] 王智彪. 外阴白色病变的超声治疗[J]. 实用妇产科杂志，2003，19（1）：6-8.
（收稿日期：2013-06-18）