烧伤患者围手术期焦虑状态评估及其影响因素分析OA北大核心CSTPCD
Evaluation of perioperative anxiety state and analysis of influencing factors in burn patients
目的 评估烧伤患者围手术期焦虑状态并分析其影响因素.方法 选择2022年2-8月解放军总医院第四医学中心拟在全身麻醉下择期手术的烧伤患者110例,术前1 d及术后1 d对患者进行焦虑自评量表(SAS)、焦虑视觉模拟量表(VAS-a)、疼痛视觉模拟量表(VAS-p)、简易精神状态检查量表(MMSE)和Ramsay镇静评分评估,并记录入院时(T0)、麻醉诱导前(T1)、插管后2 min(T2)、手术开始后15 min(T3)、术中(T4)、手术结束(T5)和离开手术室即刻(T6)的平均动脉压(MAP)和心率(HR),分析烧伤患者围手术期焦虑发生情况,并采用单因素及多因素logistic回归分析烧伤患者围手术期焦虑状态的影响因素.结果 烧伤患者术前及术后焦虑发生率为29.1%和22.3%.单因素logistic回归分析结果显示,性别(P=0.002)、烧伤时间(P=0.046)、烧伤面积(P=0.005)、烧伤部位(P=0.035)及术前疼痛程度(P=0.001)与烧伤患者术前焦虑状态有关;烧伤时间(P=0.030)、烧伤面积(P=0.001)、烧伤部位(P=0.016)、术前疼痛程度(P=0.021)及术前焦虑状态(P＜0.001)与烧伤患者术后焦虑状态有关.多因素logistic回归分析结果显示,性别、术前疼痛程度是烧伤患者术前焦虑状态的独立影响因素(P=0.002、0.022),而术前焦虑状态是烧伤患者术后焦虑状态的独立影响因素(P＜0.001).与术前非焦虑患者(n=73)比较,术前焦虑患者(n=30)术中各时间点MAP无明显差异(P＞0.05),但HR均加快(P＜0.05),且术中舒芬太尼、瑞芬太尼及丙泊酚用量明显增加(P＜0.05).结论 烧伤患者术前焦虑发生率明显高于术后,焦虑患者术中麻醉药物用量增加,但与手术类型、手术次数无关;性别、术前疼痛程度及术前焦虑状态为烧伤患者围手术期焦虑状态的独立影响因素,针对相关因素进行早期干预,有利于患者快速康复.
Objective To evaluate the perioperative anxiety state and analyze the influencing factors of burned patients.Methods A total of 110 burned patients undergoing selective surgery under general anesthesia were included in the Fourth Medical Center of Chinese PLA General Hospital from February to August 2022.All patients were evaluated with self-rating anxiety scale(SAS),visual analogue scale-anxiety(VAS-a),visual analogue scale-pain(VAS-p),mini-mental state examination(MMSE),and Ramsay sedation score 1-day before and after operation.The patients'parameters were recorded including mean arterial pressure(MAP)and heart rate(HR)at admission(T0),before anesthesia induction(T1),2 min after intubation(T2),15 min after surgery(T3),during surgery(T4),at surgery end(T5),and immediately after leaving the operating room(T6).The occurrence and the influencing factors of perioperative anxiety in burn patients were analyzed using the univariate and multivariate logistic regression.Results The incidence of preoperative and postoperative anxiety in burn patients was 29.1%and 22.3%respectively.Univariate logistic analysis showed that gender(P=0.002),burn time(P=0.046),burn area(P=0.005),burn site(P=0.035),and degree of preoperative pain(P=0.001)were related with preoperative anxiety status in burn patients;while burn time(P=0.030),burn area(P=0.001),burn site(P=0.016),degree of preoperative pain(P=0.021),and preoperative anxiety status(P＜0.001)were related with postoperative anxiety state in burn patients.Multivariate logistic regression analysis showed that gender and degree of preoperative pain were the independent influencing factors of preoperative anxiety status in burn patients(P=0.002,0.022),and preoperative anxiety status was the independent influencing factor of postoperative anxiety status in burn patients(P＜0.001).Compared with the preoperative non-anxious patients(n=73),preoperative anxious patients(n=30)showed no significant difference in MAP at each time point(P＞0.05),but HR was accelerated(P＜0.05),and the dosage of sufentanil,remifentanil and propofol increased significantly during the operation(P＜0.05).Conclusions The anxiety state of burn patients was significantly higher before operation than that after operation,and their consumption of anesthetic drugs during operation was higher,and there was no significant correlation with the type and number of operation.Gender,degree of preoperative pain and anxiety state were the independent influencing factors of perioperative anxiety state in burn patients.Early intervention against relevant factors will help patients recover quickly.
任舒婷;李萌萌;边雅楠;徐雯;顾国鑫;孙雨;冉明梓
山西医科大学麻醉学院,山西太原 030000||解放军总医院第四医学中心麻醉科,北京 100048解放军总医院第四医学中心麻醉科,北京 100048
临床医学
烧伤围手术期焦虑疼痛
burnsperioperativeanxietypain
《解放军医学杂志》 2024 (007)
754-760 / 7
This work was supported by the National Natural Science Foundation of China(82001456) 国家自然科学基金(82001456)
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