1.中南大学湘雅护理学院，湖南 长沙 410013;2.中南大学湘雅三医院 护理部，湖南 长沙 410013
马兵济，中南大学湘雅护理学院硕士研究生，主要从事减重代谢专科护理方面的研究（
湖南省长沙市自然科学基金资助项目（kq2403068）。
1.Xiangya School of Nursing, Central South University, Changsha 410013, China;2.Department of Nursing, the Third Xiangya Hospital, Central South University, Changsha 410013, China
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背景与目的 肥胖已成为严重的全球公共健康问题，袖状胃切除术（LSG）是常用的代谢减重手术，但部分患者术后减重不理想。既往研究表明，心理因素与饮食行为在术后减重中具有重要作用，但其作用机制尚未明晰。本研究旨在探讨LSG术后患者自我控制与术后12个月减重效果（%EWL）的关系，并进一步分析抑郁与情绪性进食的独立及链式中介作用。方法 采用横断面研究设计，纳入中南大学湘雅三医院LSG术后患者202例。使用简式自我控制量表（BSCS）、患者健康问卷-9（PHQ-9）及荷兰饮食行为问卷（DEBQ）进行测评；计算术后12个月内%EWL。以Pearson相关分析变量关系，采用Process 4.0模型6并以Bootstrap法（5 000次重抽样）检验中介效应（控制性别与术后时间）。结果 总体BSCS、PHQ-9、DEBQ及%EWL分别为21.76±4.15、5.54±3.91、30.72±11.25和（60.94±31.61）%。自我控制与抑郁（r=-0.697）及情绪性进食（r=-0.441）呈负相关，与%EWL呈正相关（r=0.566，均P<0.01）；%EWL与抑郁（r=-0.467）和情绪性进食（r=-0.348）呈负相关（均P<0.01）。在控制协变量后，自我控制对%EWL具有正向预测作用（β=0.291 9，P<0.01），抑郁（β=-0.155 6，P<0.05）与情绪性进食（β=-0.115 8，P<0.05）呈负向预测。中介分析显示，经“自我控制→抑郁→%EWL”的间接效应为0.848 8（95% CI=0.178 7~1.573 0），经“自我控制→情绪性进食→%EWL”的间接效应为0.259 8（95% CI=0.033 4~0.564 3），经“自我控制→抑郁→情绪性进食→%EWL”的链式间接效应为0.131 7（95% CI=0.005 9~0.322 8）；总间接效应为1.240 2，占总效应的35.83%。结论 LSG术后患者更高的自我控制水平既可直接改善减重效果，也可通过降低抑郁与情绪性进食（及其链式作用）间接提升%EWL。建议在围手术期与随访中常规开展心理状态与饮食行为评估与干预，以巩固长期减重获益。
Background and aims Obesity is a major global health challenge, and laparoscopic sleeve gastrectomy (LSG) is a widely used bariatric procedure. However, weight loss outcomes vary considerably among patients. Psychological factors and eating behaviors are increasingly recognized as important determinants of postoperative success, yet the underlying mechanisms remain unclear. This study aimed to examine the relationship between self-control and 12-month postoperative weight loss (%EWL) after LSG, and to test the independent and chain mediating roles of depression and emotional eating.Methods In a cross-sectional study, 202 LSG patients from the Third Xiangya Hospital of Central South University completed the Brief Self-Control Scale (BSCS), Patient Health Questionnaire-9 (PHQ-9), and the emotional eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ). %EWL within 12 months after surgery was calculated. Pearson correlations were conducted, and mediation was tested using Process v4.0 (model 6) with 5 000 bootstrap samples while controlling for sex and postoperative time.Results Overall, BSCS, PHQ-9, DEBQ-EE, and %EWL averaged 21.76±4.15, 5.54±3.91, 30.72±11.25, and (60.94±31.61)%, respectively. Self-control correlated negatively with depression (r=-0.697) and emotional eating (r=-0.441) and positively with %EWL (r=0.566; all P<0.01). %EWL correlated negatively with depression (r=-0.467) and emotional eating (r=-0.348, P<0.01). Adjusted regression showed positive prediction of %EWL by self-control (β=0.291 9, P<0.01) and negative prediction by depression (β=-0.155 6, P<0.05) and emotional eating (β=-0.115 8, P<0.05). Mediation analysis showed that the indirect effect through the path "self-control → depression → %EWL" was 0.848 8 (95% CI=0.178 7-1.573 0). The indirect effect through the path "self-control → emotional eating → %EWL" was 0.259 8 (95% CI=0.033 4-0.564 3). The chain indirect effect through the path "self-control → depression → emotional eating → %EWL" was 0.131 7 (95% CI=0.005 9-0.322 8); the total indirect effect accounted for 35.83% of the total effect.Conclusion Higher self-control after LSG enhances weight loss both directly and indirectly by alleviating depression and emotional eating. Routine psychological screening and eating-behavior interventions are warranted to consolidate long-term benefits.
引用本文
马兵济,周浩男,孙林丽.抑郁和情绪性进食在袖状胃切除术后患者自我控制与减重效果之间的链式中介作用[J].中国普通外科杂志,2025,34(7):1464-1472.
DOI:10.7659/j. issn.1005-6947.250145
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- 收稿日期:2025-03-16
- 最后修改日期:2025-07-14
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- 在线发布日期: 2025-09-02