焦虑抑郁状态对妇科腹腔镜手术患者术后疼痛的影响

Influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery

目的探讨妇科腹腔镜手术患者术前焦虑抑郁状态对术后疼痛的影响。方法选择腹腔镜下卵巢囊肿剥除术或子宫肌瘤剜除术患者90例,年龄18~65岁,BMI 18~30 kg/m2,ASAⅠ或Ⅱ级,术前访视时采用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)进行焦虑状态评分。以HADS 9分为界将患者分为低评分组(HARDS≤9分,L组)和高评分组(HADS>9分,H组)。记录患者术后30、60 min、6、12、24 h的视觉疼痛模拟评分(VAS评分)。分别对术后不同时点VAS评分与术前HADS评分作相关性分析。记录两组镇痛药物使用量、术后排气时间和恶心、呕吐、头晕、肩背部疼痛等不良反应的发生情况。结果与H组比较,L组术后6 h VAS评分明显降低;术后30 min、60 min、12 h、24 h两组VAS评分差异无统计学意义。术后6 h VAS评分与术前HADS评分有明显相关性(r=0.634,P=0.01);其余时点VAS评分与术前HADS评分无明显相关性。H组术后排气时间明显长于L组(P<0.05)。两组术后恶心、呕吐、头晕、肩背部疼痛的发生率差异无统计学意义。结论妇科腹腔镜手术患者术前焦虑状态影响术后6 h疼痛评分,二者呈正相关;同时影响术后排气时间。

Objective To investigate the influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery. Methods Ninety patients, aged 18-65 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ, undergoing gynecologic laparoscope surgery were included in this single-center observational study. All the patients were interviewed by anesthetists the afternoon before surgery and completed a Hospital Anxiety and Depression Scale （HADS） to evaluate the anxiety-depression status. Then the patients were divided into two groups, low HADS group （group L） （HADS score≤9） and high HADS group （group H） （HADS score〉9）. Patients’ visual analogue scores （VAS） were recorded at the time 30 min, 60 min, 6 h, 12 h, 24 h after operation. The correlation analysis between HADS before operation and VAS scores at different time point was performed. The use of analgesia medicine, exhausting time and complications such as nausea, vomiting, dizzy, pain of shoulder and back were also recorded. Results Compared to group H, VAS score was lower in group L at 6 hour after surgery but no significant different was found at 30 min, 60 min, 12 h, 24 h after surgery. There was a significant association between preoperative HADS scores and VAS at 6 hour after surgery （r=0.634, P=0.01）; but no significant association was found between preoperative HADS scores and VAS at the other time point after surgery. The exhausting time was significantly longer in group H than group L （P〈0.05）. There was no significant difference in the incidence of nausea, vomiting, dizzy or pain of shoulder and back between the two groups. Conclusion Preoperative anxiety-depression status has a positive influence on postoperative pain at 6 hour after gynecologic laparoscope surgery, and also can delay the recovery of gastrointestinal function.