بررسي شايع‌ترين فاكتورهاي پيشگويي‌كننده افسردگي بعد از هيستركتومي در زنان 30 تا 55 سال در سال 1396 در بيمارستان شهيد مطهري اروميه

INVESTIGATION OF THE MOST COMMON PREDICTORS OF DEPRESSION AFTER ABDOMINAL HYSTERECTOMY IN WOMEN AGED 30 TO 55 YEARS OLD IN 2017 IN SHAHID MOTHARI HOSPITAL

پيش زمينه و هدف هيستركتومي به معناي خارج نمودن رحم با يا بدون سرويكس و برداشتن تخمدان ها) اووفوركتومي) مي باشد. امروزه براي درمان بسياري از بيماري هاي خوشخيم و بدخيم هيستركتومي الكتيو صورت مي گيرد. هيستركتومي يك روش جراحي سنگين و تهاجمي است كه تاثيري جدي بر روي خصوصيات جنسي زن دارد و سبب احساس بدشكلي بدني و ساير عوامل مي شود كه ممكن است يك محرك قوي براي استرس و مشكلات رواني در زنان باشد. در اين مطالعه بر آن شديم تا تاثير هيستركتومي را بر روي وضعيت رواني و جنسي بيماران بعد از جراحي، بررسي كنيم. مواد و روش ها بيماران 30 تا 55 سال كه در سال 1396 بدلايل غير بدخيم تحت هيستركتومي الكتيو قرار گرفتند و با همسر خود زندگي مي كردند و قبل از عمل يائسه نبوده و در 6 ماه قبل و بعد جراحي، استرس ماژور و يا سابقه مشكلات روان پزشكي نداشتند انتخاب و پرسشنامه Beck و FSFI براي بيماران 6 ماه بعد از جراحي پر شد. ويژگي هاي دموگرافيك و تعداد فرزند و سن بيمار و همسر بيمار، دليل هيستركتومي، وضعيت اووفروكتومي و داشتن درد شكمي مزمن براي بيماران ثبت شد و داده ها با نرم افزار spss 23 تحت آناليز آماري قرار گرفت. يافته ها يافته ها نشان داد ميانگين امتياز بك بين دو گروه بيماران كه تحت اووفروكتومي دو طرفه قرار گرفته بودند و گروه ديگر كه يك يا دو تخمدان حفظ شده داشتند؛ اختلاف معني داري داشت (002/0 =P). بنابر اين حفظ تخمدان در كاهش ميزان افسردگي موثر بود. درخصوص درد شكم مزمن 6 ماه بعد از هيستركتومي؛ ميانگين نمره بك در بيماران با درد شكم مزمن و بيماران بدون درد شكم اختلاف معني داري داشت (007/0=P). بين طول مدت بستري و افسردگي تفاوت معني داري وجود نداشت (13/0=P). نتايج مطالعه نشان داد بين افسردگي در بيماران خانه دار و بيماران شاغل رابطه معني دار وجود دارد (027/0=P). درخصوص سن همسر؛ با هر سال افزايش سن ميزان افزايش امتياز بك مشهود بود (001/0=P) و افزايش افسردگي را نشان مي داد. اما دلايل هيستركتومي الكتيو بر افسردگي تاثيري نداشت (147/0=P). در مورد وضعيت جنسي بيماران ميانگين FSFI قبل از جراحي براي بيماران حدود 21.14 با انحراف معيار 10.14 و ميانگين FSFI بعد از جراحي 16.42 با انحراف معيار 7.8 بود كه اين موضوع نشان دهنده كاهش ميزان افسردگي بود. همچنين بر اساس آزمون t جفت شده عملكرد جنسي بيماران بعد از هيستركتومي به ميزان معني داري كاهش پيدا كرده بود (p < 0.05). بر اساس نتايج آزمون يومن ويتني، وضعيت جنسي (FSFI) بيماران بعد از عمل و وضعيت اووفروكتومي آن ها نشان دهنده حفظ تخمدان و تاثير مثبت بعد از عمل جراحي بود (01/0>P).

Background & Aims: Hysterectomy means the removal of the uterus with or without cervix or ovaries (ovophorectomy). Today, for the treatment of many benign and malignant diseases, elective hysterectomy is performed. Hysterectomy is a heavy and invasive surgical technique that has serious side effects on female sexual characteristics and causes physical disorientation and other factors. It may also be a strong stimulant to stress and psychological problems in women. In this study, we investigated the effect of hysterectomy on the mental and sexual status of patients after surgery. Materials & Methods: Patients aged 30 to 55 years who underwent a non-malignant elective hysterectomy in 2017 and lived with their spouse, were not menopause and had no major stress or history of psychiatric problems in the 6 months before and after surgery were selected. The Beck and FSFI questionnaires were completed for patients 6 months after surgery. The demographic characteristics, the number of children, the age of the patients and their spouses, the cause of hysterectomy, the status of oophorectomy, and chronic abdominal pain were recorded and the statistical data were analyzed using SPSS (version 23). Results: Results showed a significant difference in Beck score between two groups of patients who underwent bilateral oophorectomy and the other group who had one or two ovaries preserved (p = 0.002). Therefore, ovarian preservation was effective in reducing depression. For chronic abdominal pain 6 months after hysterectomy, significant differences existed between the patients with chronic abdominal pain and patients without abdominal pain (P = 0.007). There was no significant difference between duration of hospitalization and depression (P = 0.13). The results showed that there is a significant relationship between depression in housewives and working patients (P=0.027). Concerning the age of the spouse, a positive relationship existed between the age of spouse and depression based on Beck score (P = 0.001). Also, elective hysterectomy had no effect on depression (P = 0.147). The mean FSFI preoperatively for patients was 21.14 with a standard deviation of 10.14 and a mean FSFI after surgery of 16.42 with a standard deviation of 7.8, indicating a decrease in depression. Paired t-test also showed a significant decrease in sexual function after hysterectomy (p <0.05). Based on the results of FSFI, postoperative patients and their oophorectomy showed ovarian preservation and positive effect after surgery (P <0.01). Conclusion: In the present study, the majority of patients were reported to be slightly depressed after hysterectomy without a history of psychiatric illness. Various studies described hysterectomy with premature ovarian failure that was associated with reduced estrogen doses. In our study, patients also had a higher risk of depression after hysterectomy with increasing age, lower number of children, and higher educational attainment. Overall, the results of this study showed that ovarian preservation after elective hysterectomy was associated with a relative decrease in depression and improvement in sexual function. Being a housewife and raising a partner's age were effective in increasing depression in patients. Patients with more depression had more abdominal pain.