全膝关节置换术前焦虑对术后疼痛及麻醉恢复的影响

Effects of preoperative anxiety on early postoperative pain and anesthesia recovery in total knee arthroplasty

目的探讨初次全膝关节置换术(TKA)患者术前焦虑状态对术后镇痛效果及麻醉恢复情况的影响。方法纳入长征医院骨科2012年9月至2013年9月间84例行TKA手术的住院患者进行前瞻性队列研究,通过术前贝克焦虑量表(BAI)将患者分为高焦虑组(A组)和低焦虑组(B组)。对比两组的一般资料、手术时间、麻醉时间、拔管时间及麻醉后副反应,分别于术后1、2、4、8、12、24 h进行视觉模拟量表(VAS)评分并记录12、24 h的曲马多用量。结果共有38(45.24%)的患者术前处于高焦虑状态,两组间的一般资料、手术及麻醉时间没有统计学差异,但B组拔管时间、麻醉后副反应少于A组,术后2、4、8、12h的VAS评分低于A组,术后曲马多用量少于A组,结果有统计学意义(P<0.05)。结论 TKA患者术后疼痛程度与术前焦虑情绪有关。高焦虑状态会影响麻醉恢复及镇痛效果,增加药物用量。

Objective To evaluate the impacts of preoperative anxiety on postoperative pain and recovery from anesthesia in the patients undergoing total knee arthroplasty（ TKA）. Methods A total of84 patients with osteoarthritis who underwent unilateral TKA between September 2012 and September 2013 were separated into two groups according to Beck＇s anxiety inventory（ BAI） ： the patients with anxiety were enrolled in the high-anxious patient group（ group A） and the patients without anxiety were enrolled in the low-anxious group（ group B）. During the perioperative period,all the patients received patient-controlled analgesia（ PCA） for 24 h postoperatively. General information,duration of surgery,duration of anesthesia,extubation time,adverse effects,drug dosage for 12 and 24 h,and Visual analog score（ VAS） were assessed and compared between the two groups. Results Among all the patients,38 patients（ 45. 24%）had preoperative anxiety according to the preoperative score of BAI. There was no significant difference in the general information,the duration of surgery and anesthesia between the two groups. The extubation time was significantly longer and more postoperative side effects were determined in group A than in group B. In group A,the postoperative VAS scores at 2,4,8,12 h and tramadol consumption were significantly higher（ P〈0. 05）. Conclusion The results of this study suggest that high preoperative anxiety level does negatively influence the experience of postoperative pain and recovery from anesthesia,it also increases the need for postoperative analgesia.