腰椎間盤突出手術後一年內憂鬱症之相關性探討

研究目的：椎間盤突出疾病現代人常見且惱人的健康問題之ㄧ，椎間盤突出手術是改善椎間盤突出的重要治療之一，本研究目標將深入探討有椎間盤手術的病患和無椎間盤手術的病患罹患憂鬱症風險之關係，以提供未來臨床照護之參考。研究方法：本研究資料來源為『全民健康保險研究資料庫』（LHID2005）的承保抽樣歸人檔。本研究之研究對象為2001年1月至20011年12月31日期間，健保資料庫之門診處方及治療明細檔(CD檔)中，ICD9CM code722.1；以及門診處方醫令明細檔(OO檔)中，手術代碼為80.51。研究結果：有腰椎間盤突出手術的比沒有做手術的人有1.68倍的風險罹患憂鬱症(勝算比=1.68，95%信賴區間=1.10-2.57，P=0.016)。結論：綜合上述結果得知，有做腰椎間盤突出手術的人比沒有手術的人容易罹患憂鬱症。建議醫療服務提供者，腰椎間盤突出手術後，平均留院觀察日數約三∼七天不等。倘若出院後，病患對於憂鬱症相關知識不足、加上臨床護理人員未能及時發現，很容易錯過黃金治療時機。因此，建議政府可以設立手術後快速篩檢之相關政策，將術後篩檢制度化，提供術後免費憂鬱症篩檢，以便持續追蹤手術後的病患，後續的情緒狀況，以達早期診斷早期治療之目的。

關鍵字

腰椎間盤突出手術；憂鬱症

並列摘要

INTRODUCTION: Pain is one of the major symptoms of Herniated intervertebral discs (HIVD) patients and results in decreased quality of life. Depending on the extent of pain, patients were treated with conservative care or surgical intervention. However, there was still a portion of patients treated with surgery who experienced persist and recurrent pain. Therefore, this study aimed to examine the relationship between Lumbar disc surgery risk of DD on HIVD patients without surgery by using a population-based dataset in Taiwan. METHODS: We retrieved the data for this retrospective cohort study from the Longitudinal Health Insurance Database (LHID2005). The LHID2005 was derived from Taiwan‘s National Health Insurance (NHI) program, which was initiated in 1995. This study consists of a study group and a comparison group. As for study group, we first retrieved 51,301 patients who had received a first-time principal diagnosis of HIVD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 722.1) between January 1, 2001 and December 31, 2001. RESULTS: Lumbar disc surgery OR rates of DD during the 1-year follow-up period were 1.68 (95% CI: 1.10-2.57，P<0.001). Conclusions: In agreement with the literature, our results confirm the negative role of depression in outcome after lumbar disc surgery. We emphasize the consideration of psychological factors in the management of lumbar disc herniation.