叶晖+刘燕+程英祝

【摘要】目的： 探讨米氮平对子宫全切术后患者焦虑抑郁及性生活质量的影响。方法： 选择2011年1月至2014年8月笔者医院收治的子宫肌瘤行子宫全切术后患者80例，按照随机数字法分为两组，各40例。对照组进行心理学方法干预，观察组则在对照组基础上联合使用米氮平，两组均连续干预治疗12个月，比较两组干预后性状况BISF-W表评分增加比例、恢复性生活时间、性唤起时间、每月性生活频率，干预前后HAMD及HAMA评分变化情况及干预过程中发生的不良反应。结果：干预后两组HAMD及HAMA评分均显著低于干预前（P<0.05），观察组HAMD及HAMA评分低于干预后对照组（P<0.05），观察组性生活恢复时间早于对照组（P<0.05），性唤起时间快于对照组（P<0.05），每月性生活频率多于对照组（P<0.05），观察组性自信、性欲、性高潮、性交流及性交频率加比例均高于对照组（P<0.05），性困惑比例低于对照组（P<0.05），观察组存在睡眠障碍、食欲降低、烦躁、震颤和口干的比例均显著低于对照组（P<0.05）。结论：米氮平能显著改善子宫切除术后患者焦虑抑郁状态，改善患者性功能，提高性生活质量，且治疗后不良反应少，临床安全性高。

【关键词】米氮平；子宫全切术后；性生活；焦虑；抑郁

【Abstract】Objectives： To investigate the effect of mirtazapine on depression， anxiety and sexual life quality of hysterectomy patients. Methods： 80 cases of uterine fibroids hysterectomy from January 2011 to August 2014 were chosen and divided into two groups randomly， with 40 cases in each group. The control group used psychological intervention methods and the observation group used mirtazapine on the basis of psychological intervention methods， all were treated for 12 months. BISF-W Table score increased proportion， time to restore sexual life， arousal time， and monthly sex frequency of the two groups before and after the intervention were compared as well as the HAMD and HAMA score and adverse changes. Results： After intervention， the HAMD and HAMA scores in the two group were significantly lower than these before intervention （P<0.05）. HAMD and HAMA scores in observation group were lower than these in control group after the intervention （P<0.05）. Time to restore sexual life in observation group was shorter than that in control group （P<0.05）； sexual arousal time in observation group was faster than that in control group （P<0.05）. Monthly frequency of sexual activity in observation group was more than that in control group （P<0.05）. The self-confidence， libido， orgasm， sexual intercourse frequency communication and increase rate in the observation group were higher than these in control group （P<0.05）. The proportion of confusion was less than that in control group （P<0.05）. The sleep disorders， loss of appetite， irritability， dry mouth and tremor proportion in observation group were lower than these in control group （P<0.05）. Conclusion： Mirtazapine can significantly improve anxiety and depression of hysterectomy patients and improve sexual function and sexual life quality， with fewer adverse reactions and higher safety.

【Key words】Mirtazapine； Hysterectomy surgery； Sexual life quality； Anxiety； Depressionendprint

【中图分类号】R167【文献标志码】A

妇科手术尤其是生殖系统相关手术将对患者心理状态及术后性生活质量造成一定影响，其主要原因可能是因心理因素和社会因素双重作用的结果，其导致患者身心改变已经引起医护人员的重视。其中女性性生活的质量尤其是性高潮的获得，不但是肉体受到性刺激的产物，而且与心理和精神因素密切相关[1]。其中会阴、阴道以及阴蒂等外生殖器对刺激的敏感性是先决条件，而子宫、卵巢等的良好感觉则可促使性刺激在患者大脑中形成较为稳定条件反射。故女性性高潮是一种心理、精神多种因素综合作用的产物[2]。

研究称，实施子宫切除术后，患者均存在一定程度的性功能障碍。究其原因主要是因为心因性障碍所致。另外实施子宫全切术术后，因身体的不适以及对手术存留的恐惧加上术后出现的盆底结构和功能的变化，尤其是阴道顶部子宫切除后断端伤口，导致患者心理障碍，极易产生顾虑、焦虑甚至抑郁心理，进而出现性生活质量的下降[3]。……