Effect of psychological intervention on preoperative anxiety in patients with percutaneous transforaminal endoscopic discectomy
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摘要:
目的探讨心理干预对局麻下椎间孔镜手术患者术前焦虑的影响。 方法回顾分析2016年1月~2018年12月间使用阿姆斯特丹术前焦虑与信息量表（APAIS）进行术前焦虑评分、接受局麻经皮椎间孔镜髓核摘除术（PTED）治疗患者的临床资料。将符合纳入标准的患者根据是否接受术前心理干预分为对照组、干预组，比较两组间不同时间点APAIS评分、VAS评分、收缩压、出血量、手术时间等，分析心理干预对患者术前焦虑程度及手术的影响。 结果共纳入患者128例，对照组69例，干预组59例。干预组患者准备间APAIS评分（11.83±1.49）比入院时（14.12±1.83）明显下降（P=0.000），对照组患者准备间APAIS评分（13.77±1.59）与入院时（14.22±2.03）相比差异无统计学意义（P=0.150）。干预组患者准备间APAIS评分（11.83±1.49）低于对照组（13.77±1.59），差异有统计学意义（P=0.000）。对照组患者准备间收缩压、术中收缩压、出血量、手术时间均高于干预组（P<0.005）。两组之间术后VAS评分、术中是否加用镇痛药物差异无统计学意义（P>0.05）。 结论心理干预可以明显缓解患者术前焦虑，减少椎间孔镜手术出血量、缩短手术时间。 -
关键词:
- 经皮椎间孔镜髓核摘除术 /
- 心理干预 /
- 术前焦虑
Abstract:ObjectiveTo explore the effect of psychological intervention on preoperative anxiety in patients with percutaneous transforaminal endoscopic discectomy (PTED). MethodsThe clinical data of patients with preoperative anxiety score and PTED under local anesthesia between January 2016 and December 2018 were analyzed retrospectively. Patients who met the inclusion criteria were divided into control group and intervention group according to whether they received preoperative psychological intervention. Different time points of APAIS score, VAS score, systolic blood pressure (SBP), amount of bleeding and operation time were compared between the two groups. The influence of psychological intervention on preoperative anxiety and operation related parameters was analyzed. ResultsOne hundred and twenty-eight patients were included, 69 in the control group and 59 in the intervention group. The APAIS score of the intervention group at waiting room (11.83 ± 1.49) was significantly lower than that at admission (14.12 ± 1.83, P=0.000). There was no significant difference in APAIS score of the control group between at waiting room(13.77 ± 1.59) and the admission (14.22 ± 2.03,P = 0.150). The APAIS score of the intervention group at waiting room (11.83 ± 1.49) was lower than that of the control group (13.77 ± 1.59), the difference was significant (P=0.000). The SBP at waiting room, intraoperative SBP, amount of bleeding and operation time of the control group were higher than those of the intervention group (P<0.005). There was no significant difference in postoperative VAS score, extra analgesic between the two groups (P>0.05). ConclusionPsychological intervention can relieve preoperative anxiety, reduce the amount of bleeding, and shorten the operation time. -
表 1 两组患者临床资料基线情况（Mean±SD）
Table 1. Baseline data of two groups of patients
因素 对照组（n=69） 干预组（n=59） χ2/t P 性别（男/女） 43/26 36/23 0.023 0.880 年龄（岁） 33.5±8.2 34.9±7.8 −0.985 0.327 病程（月） 8.2±4.3 8.3±3.4 −0.214 0.831 术前VAS评分（分） 6.4±1.0 6.5±1.0 −0.318 0.751 入院时收缩压（mmHg） 125.9±7.4 125.6±7.7 0.232 0.817 入院时APAIS评分（分） 14.22±2.03 14.12±1.83 0.287 0.774 受教育程度（n） 高 21 17 0.498 0.852 中 46 39 低 2 3 
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表 2 对照组入院时与准备间APAIS评分（n=69, Mean±SD）
Table 2. APAIS score between admission and preparation of the control group
条目 入院时 准备间 t P 1. 对麻醉感到担忧 1.78±0.76 1.59±0.58 1.634 0.105 2. 一直在想麻醉的事 1.48±0.58 1.46±0.53 0.152 0.879 3. 想尽可能更多了解有关麻醉的事 1.70±0.71 1.59±0.52 0.952 0.343 4. 对手术感到担忧 3.29±0.81 3.23±0.71 0.448 0.655 5. 一直在想手术的事 2.88±0.87 2.87±0.66 0.110 0.912 6. 想尽可能更多了解有关手术的事 3.09±0.836 3.01±0.68 0.560 0.576 APAIS 评分 14.22±2.03 13.77±1.59 1.447 0.150
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表 3 干预组入院时与准备间APAIS评分（n=59，Mean±SD）
Table 3. APAIS score between admission and preparation in intervention group
条目 入院时 准备间 t P 1. 对麻醉感到担忧 1.78±0.72 1.59±0.59 1.537 0.127 2. 一直在想麻醉的事 1.32±0.51 1.36±0.52 −0.360 0.720 3. 想尽可能更多了解有关麻醉的事 1.69±0.73 1.53±0.54 1.443 0.152 4. 对手术感到担忧 3.41±0.75 2.64±0.74 5.587 0.000 5. 一直在想手术的事 2.83±0.87 2.25±0.76 3.829 0.000 6. 想尽可能更多了解有关手术的事 3.08±0.86 2.46±0.75 4.230 0.000 APAIS 评分 14.12±1.83 11.83±1.49 7.454 0.000
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表 4 两组在准备间的APAIS评分（Mean±SD）
Table 4. APAIS score of preparation between two groups
条目 对照组（n=69） 干预组（n=59） t P 1. 对麻醉感到担忧 1.59±0.58 1.59±0.59 0.009 0.992 2. 一直在想麻醉的事 1.46±0.53 1.36±0.52 1.159 0.249 3. 想尽可能更多了解有关麻醉的事 1.59±0.52 1.53±0.54 0.732 0.465 4. 对手术感到担忧 3.23±0.71 2.64±0.74 4.587 0.000 5. 一直在想手术的事 2.87±0.66 2.25±0.76 4.907 0.000 6. 想尽可能更多了解有关手术的事 3.01±0.68 2.46±0.75 4.383 0.000 APAIS 评分 13.77±1.59 11.83±1.49 7.075 0.000
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表 5 两组间临床指标的比较（Mean±SD）
Table 5. Comparison of clinical indicators between two groups
指标 对照组（n=69） 干预组（n=59） χ2/t P 准备间收缩压（mmHg） 137.9±6.1 134.0±5.3 3.788 0.000 术中收缩压（mmHg） 144.5±6.9 141.0±7.4 2.754 0.007 出血量（mL） 10.4±3.1 8.8±2.8 3.089 0.002 手术时间（min） 99.3±14.0 94.0±14.7 2.088 0.039 术中加用镇痛药（是/否） 20/49 9/50 3.422 0.064 术后VAS评分（分） 1.4±1.0 1.4±0.9 0.278 0.782
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[1] Stamenkovic DM, Rancic NK, Latas MB, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history[J]. Minerva Anestesiol, 2018, 84(11): 1307-17. [2] Gu D, Zhou M, Han C, et al. Preoperative anxiety induces chronic postoperative pain by activating astrocytes in the anterior cingulate cortex region[J]. Rev Assoc Med Bras (1992), 2019, 65(9): 1174-80. doi: 10.1590/1806-9282.65.9.1174 [3] Nixon DC, Schafer KA, Cusworth B, et al. Preoperative anxiety effect on patient-reported outcomes following foot and ankle surgery[J]. Foot Ankle Int, 2019, 40(9): 1007-11. doi: 10.1177/1071100719850806 [4] Musa A, Wang JC, Acosta FL, et al. Attitudes of spine surgeons regarding management of preoperative anxiety: a cross-sectional study[J]. Clin Spine Surg, 2019, 32(1): E1-6. doi: 10.1097/BSD.0000000000000705 [5] Schlosser KA, Maloney SR, Prasad T, et al. The impact of preoperative anxiety, depression, and chronic pain on outcomes in abdominal wall reconstruction[J]. Hernia, 2019, 23(6): 1045-51. doi: 10.1007/s10029-019-02059-8 [6] Xu J, Twiggs J, Parker D, et al. The association between anxiety, depression, and locus of control with patient outcomes following total knee arthroplasty[J]. J Arthroplasty, 2019, 5403(19): 30980-5. [7] Moerman N, van Dam FS, Muller MJ, et a1. The amsterdam preoperative anxiety and information scale(APAIS)[J]. Anesth Analg, 1996, 82(3): 445-51. [8] 贾 真, 耿丽娜, 王 伟, 等. APAIS评分评估国人术前焦虑状态的可靠性[J]. 中华麻醉学杂志, 2015, 35(9): 1107-9. doi: 10.3760/cma.j.issn.0254-1416.2015.09.021 [9] 吴 昊, 刘延军, 马正良, 等. 阿姆斯特丹术前焦虑与信息量表中文版的信度、效度研究[J]. 中华行为医学与脑科学杂志, 2016, 25(2): 179-82. doi: 10.3760/cma.j.issn.1674-6554.2016.02.018 [10] Sadati L, Pazouki A, Mehdizadeh A, et al. Effect of preoperative nursing visit on preoperative anxiety and postoperative complications in candidates for laparoscopic cholecystectomy: a randomized clinical trial[J]. Scand J Caring Sci, 2013, 27(4): 994-8. doi: 10.1111/scs.12022 [11] Shao J, Xiao T, Shi M, et al. Effect of multimedia-based nursing visit on perioperative anxiety in esophageal squamous cell carcinoma patients undergoing video-assisted thoracoscopic surgery[J]. Psychol Health Med, 2019, 25(2): 1-9. [12] Ertuğ N, Ulusoylu L, Bal B, et al. Comparison of the effectiveness of two different interventions to reduce preoperative anxiety: a randomized controlled study[J]. Nurs Health Sci, 2017, 19(2): 250-6. doi: 10.1111/nhs.12339 [13] Jacobs CA, Hawk GS, Jochimsen KN, et al. Depression and anxiety are associated with increased health care costs and opioid use for patients with femoroacetabular impingement undergoing hip arthroscopy: analysis of a claims database[J]. Arthroscopy, 2020, 7(1): 30892-8. [14] Takenaka S, Hirose M. Preoperative anxiety and intraoperative nociception in patients undergoing thoracic surgery[J]. J Surg Res, 2020, 6(1): 13-17. [15] Szeverenyi C, Kekecs Z, Johnson A, et al. The use of adjunct psychosocial interventions can decrease postoperative pain and improve the quality of clinical care in orthopedic surgery: a systematic review and meta-analysis of randomized controlled trials[J]. J Pain, 2018, 19(11): 1231-52. doi: 10.1016/j.jpain.2018.05.006 [16] Gezer D, Arslan S. The effect of education on the anxiety level of patients before thyroidectomy[J]. J Perianesth Nurs, 2019, 34(2): 265-71. doi: 10.1016/j.jopan.2018.05.017 [17] Park JW, Nahm FS, Kim JH, et al. The effect of mirroring display of virtual reality tour of the operating theatre on preoperative anxiety: a randomized controlled trial[J]. IEEE J Biomed Health Inform, 2019, 23(6): 2655-60. doi: 10.1109/JBHI.2019.2892485 [18] Myung JK, Heung-Kwon Oh, Keun CL, et al. Effects of an Internet-based informational video on preoperative anxiety in patients with colorectal cancer[J]. Ann Surg Treat Res, 2019, 96(6): 290-5. doi: 10.4174/astr.2019.96.6.290 [19] Delcambre M, Haynes D, Hajar T, et al. Using a multimedia tool for informed consent in mohs surgery: a randomized trial measuring effects on patient anxiety, knowledge, and satisfaction[J]. Dermatol Surg, 2019, 37(11): 2213-25. [20] Omezli MM, Torul D, Kahveci K. Does watching videos increase the perioperative anxiety in patients undergoing third molar surgery? a randomized trial[J]. J Oral Maxillofac Surg, 2019, 391(19): 31159-70. [21] Strøm J, Bjerrum MB, Nielsen CV, et al. Anxiety and depression in spine surgery-a systematic integrative review[J]. Spine J, 2018, 18(7): 1272-85. doi: 10.1016/j.spinee.2018.03.017 [22] Lee CH, Liu JT, Lin SC, et al. Effects of educational intervention on state anxiety and pain in people undergoing spinal surgery: a randomized controlled tTrial[J]. Pain Manag Nurs, 2018, 19(2): 163-71. doi: 10.1016/j.pmn.2017.08.004 [23] Sharma A, Pant R, Priyadarshi S, et al. Cardiovascular changes due to dental anxiety during local anesthesia injection for extraction[J]. J Maxillofac Oral Surg, 2019, 18(1): 80-7. doi: 10.1007/s12663-018-1085-4 [24] Lemaître S, González CM. Evaluation of anxiety and pain in eyelid surgery patients: a pilot study[J]. Can J Ophthalmol, 2019, 54(6): 723-26. doi: 10.1016/j.jcjo.2019.02.006 [25] Socea SD, Abualhasan H, Magen O, et al. Preoperative anxiety levels and pain during cataract surgery[J]. Curr Eye Res, 2019, 96(18): 1-6. [26] Yang JH, Ryu JJ, Nam E, et al. Effects of preoperative virtual reality magnetic resonance imaging on preoperative anxiety in patients undergoing arthroscopic knee surgery: a randomized controlled study[J]. Arthroscopy, 2019, 35(8): 2394-9. doi: 10.1016/j.arthro.2019.02.037 -
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