腹腔镜结直肠癌根治术患者创伤后应激障碍轨迹的纵向研究OACSTPCD

Objective:To explore the longitudinal trajectory of post-traumatic stress disorder(PTSD)in patients undergo-ing laparoscopic radical resection of colorectal cancer within 1 year after operation,and analyze the predictive effects of psy-chological dimension,social support dimension and inflammatory factors on trajectory categories.Methods:In this prospec-tive observational longitudinal study,patients who underwent laparoscopic radical resection of colorectal cancer in our hospital from February 2021 to August 2022 were selected as the research objects.The PTSD levels of patients at 5 time points were investigated by using the Post-traumatic Stress Disorder Checklist-Civilian Version 6 weeks(T1),3 months(T2),6 months(T3),9 months(T4)and 12 months(T5)after operation.The latent class growth model(LCGM)was used to identify the trajectory category,and the logistic regression analysis was used to identify the predictors of the trajectory category.Results:The change trajectories of PTSD in 193 patients undergoing laparoscopic radical resection of colorectal cancer within 1 year were divided into three potential categories:low-PTSD group(41％),PTSD decline group(33％)and PTSD progression group(26％)by using LCGM.The low-PTSD group was selected as the reference category,and the variables were screened by the stepwise entry method.Logistic regression analysis showed that patients with higher education level(high school and above),lower urinary tract discomfort and high inflammatory factors[interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]levels were more likely to have a decreasing level of PTSD;patients with high inflammatory factors(IL-6 and TNF),high fear of disease progression and high invasive cognition were more likely to have a progressive level of PTSD.Conclusion:There is heterogeneity in PTSD within 1 year after laparoscopic radical resection of colorectal cancer,and there are three different trajectories.Clinical medical staff should pay attention to the early physical discomfort symptoms of pa-tients after surgery,and pay attention to psychological factors such as fear of disease progression,invasive cognition and in-flammatory factors in predicting the trajectory of PTSD.Targeted measures should be developed to prevent chronic progression of PTSD after surgery.