老年心血管疾病患者心理状态与拔牙围手术期不良事件的相关性研究

Correlation between psychological state and adverse events in perioperative period of tooth extraction in elderly patients with cardiovascular disease

目的研究老年心血管疾病患者心理状态与拔牙围手术期不良事件发生的相关性。方法通过简单随机抽样,选取2020年5月—2021年3月于上海交通大学医学院附属第九人民医院门诊心电监护下拔牙的268例老年患者。收集患者拔牙术前的临床资料、相关实验室和辅助检查结果;通过一般健康问卷(GHQ-28)评估患者心理状态;记录患者术中和术后7 d内出现的不良事件。根据患者围手术期是否发生不良事件分为不良事件组(n=66)和无不良事件组(n=202)。分析老年患者拔牙围手术期发生不良事件的影响因素,通过受试者操作特征(ROC)曲线分析GHQ-28预测不良事件的价值。结果不良事件组GHQ-28总分高于无不良事件组[(27.38±8.31)分vs(23.19±8.06)分,P<0.001]。2组的年龄、体质量指数、收缩压、既往最高收缩压、高血压患者数、冠心病患者数和拔牙数差异均有统计学意义。校正混杂因素后,Logistic回归分析显示,高GHQ-28总分是老年患者拔牙围手术期出现不良事件的独立危险因素(OR=1.057,P=0.007)。GHQ-28预测拔牙不良事件的ROC曲线下面积为0.695,20.5分为最佳截断点,预测敏感度为83.10%、特异度为48.31%。结论不良心理状态与老年心血管疾病患者拔牙围手术期发生不良事件相关,因此应关注拔牙患者的心理状态,减少不良事件的发生。

Objective To investigate the correlation between psychological state and adverse events in perioperative period of tooth extraction in elderly patients with cardiovascular disease.Methods 268 elderly patients with cardiovascular disease who underwent tooth extraction under ECG monitoring in the Outpatient Department of Ninth People’s Hospital Affiliated to the Medical College of Shanghai Jiao tong University from May 2020 to March 2021 were selected by a simple random sampling method.The clinical data,relevant laboratory and auxiliary examination results of patients before tooth extraction were collected;the psychological status of patients was evaluated with General Health Questionnaire(GHQ-28);adverse events occurred during operation and within 7 days after operation were recorded.Patients were divided into adverse event group(n=66)and non-adverse event group(n=202)according to whether adverse events occurred during the perioperative period.The influencing factors of adverse events in the perioperative period of tooth extraction in elderly patients were analyzed.The value of GHQ-28 in predicting adverse events was analyzed by receiver operating characteristic(ROC)curve.Results The total score of GHQ-28 of the adverse event group was higher than that of the non-adverse event group[(27.38±8.31)vs(23.19±8.06),P<0.001].There were significant differences in age,body mass index,systolic blood pressure,previous highest systolic blood pressure,number of patients with hypertension,number of patients with coronary heart disease and number of tooth extraction between the two groups.After adjusting for confounding factors,logistic regression analysis showed that high GHQ-28 total score was an independent risk factor for adverse events in the perioperative period of tooth extraction in elderly patients(OR=1.057,P=0.007).The area under ROC curve of GHQ-28 for predicting adverse events of tooth extraction was 0.695.20.5 points was the optimal cut-off point,the prediction sensitivity was 83.10%and the specificity was 48.31%.Conclusion Adverse psychological state is related to adverse events in the perioperative period of tooth extraction in elderly patients with cardiovascular disease.Therefore,attention should be paid to the psychological state of tooth extraction patients to reduce the occurrence of adverse events.