膝关节置换术前焦虑状态患者麻醉效果的影响因素分析

Analysis of influencing factors of anesthesia effect in patients with anxiety before knee replacement

目的研究不同术前心理干预(常规术前辅导、积极心理干预)和不同镇痛方案(术前连续股神经阻滞镇痛、持续静脉自控镇痛、术前连续股神经阻滞镇痛+持续静脉自控镇痛)对焦虑状态患者全身麻醉膝关节置换术后12 h内镇痛效果及精神状态的影响。探讨针对焦虑状态患者的最佳麻醉方法。方法首次择期拟行单膝全膝关节置换术的患者90例,随机分为6组,每组15人。记录六组患者拔管后12 h静息状态下视觉模拟评分、焦虑自评量表评分、镇痛补充治疗比例及不良事件发生情况。结果六组治疗前后焦虑评分比较差异有统计学意义(P<0.05)。各组患者拔管后12 h焦虑评分比较,差异有统计学意义(P<0.05);各组间患者拔管后12 h VAS评分比较,差异有统计学意义(P<0.05)。多因素方差分析显示,术前不同心理干预(F=7.327,P<0.05)与镇痛模式(F=33.258,P<0.05)对患者术后焦虑评分均有显著影响,且存在交互效应(F=5.681,P<0.05)。术前不同心理干预(F=4.811,P<0.05)与镇痛模式(F=6.723,P<0.05)对患者术后VAS评分均有显著影响,但不存在交互效应(F=1.167,P>0.05)。均数图显示,术前积极心理干预联合多模式镇痛组患者术后12 h焦虑评分和VAS评分最低。结论本研究各组配伍均可以安全地应用于焦虑状态患者全身麻醉膝关节置换术中,其中积极心理干预联合多模式镇痛组在患者拔管后12 h对减轻焦虑情绪以及降低静息状态VAS评分最为明显。

Objective To study the effect of different preoperative psychological intervention(routine preoperative counseling,positive psychological intervention)and different analgesic schemes(preoperative continuous femoral nerve block analgesia,continuous intravenous controlled analgesia,preoperative continuous femoral nerve block analgesia + continuous intravenous controlled analgesia)on analgesic effect and mental state of patients with anxiety within 12 h after general-anesthesia knee arthroplasty.Methods Totally 90 patients who were scheduled to undergo unilateral total knee arthroplasty for the first time were randomly divided into six groups,with 15 patients in each group.The visual analogue score,self-rating anxiety scale score,proportion of analgesic supplementary treatment and incidence of adverse events were recorded in 6 groups at 12 h after extubation.Results There were significant differences in anxiety scores among the six groups before and after treatment(P<0.05).There were significant differences in anxiety scores and VAS at 12 h after extubation among the groups(P<0.05).Multivariate analysis of variance showed that preoperative psychological intervention(F=7.327,P<0.05)and analgesic mode(F=33.258,P<0.05)had significant effects on postoperative anxiety score,and there was interaction effect(F=5.681,P<0.05).Preoperative psychological intervention(F=4.811,P<0.05)and analgesic mode(F=6.723,P<0.05)had significant effects on VAS scores of patients after operation,but there was no interaction effect(F=1.167,P>0.05).The mean figure showed that the scores of anxiety and VAS were the lowest in the group of positive psychological intervention combined with multimodal analgesia before operation.Conclusion The combination mode of each group can be safely applied to knee arthroplasty under general anesthesia for patients with anxiety.The effect of positive psychological intervention combined with multi-mode analgesia group is the most obvious in reducing anxiety and resting state VAS score 12 h after extubation.