术前焦虑对术后疼痛的影响研究进展

Research progress of the effect of preoperative anxiety on postoperative pain

术前焦虑是由于患者对手术情况不甚了解而产生的一种模糊不安的心理反应,是不可预知和控制的。大多数行外科手术患者术前焦虑程度受麻醉和手术的不确定性及患者的经历、性格和应对方式等影响。虽然术前焦虑并不属于精神疾病的范畴,不会给患者带来病理性损伤,但是其会造成患者术后疼痛加重、睡眠障碍、血流动力学指标波动和术后恢复延迟等不良后果。术前焦虑可激活下丘脑-垂体-肾上腺轴产生大量的糖皮质激素,这不仅降低突触前膜γ-氨基丁酸的释放,还可抑制突触后膜γ-氨基丁酸受体功能,导致术后出现疼痛加剧、镇痛效果差和慢性疼痛等。术后疼痛会严重影响患者术后恢复,增加术后阿片类药物使用量和住院费用,降低生活质量,甚至增加患者围手术期病死率。随着社会的发展和生活水平的提高,舒适化医疗已成为医疗服务的新趋势,临床医生渐渐意识到减轻甚至消除术前焦虑从而减轻术后疼痛、改善患者预后的必要性。目前,关于术前焦虑加重术后疼痛的具体机制和术前焦虑的干预措施尚无定论。基于此,本文就术前焦虑对术后疼痛的影响、原因分析、预测量表和相关治疗方法进行综述,以期为术前焦虑的防治提供参考。

Preoperative anxiety is a vague and uneasy psychological reaction caused by not knowing about the surgical situation,which is unpredictable and uncontrollable.The preoperative anxiety level of most patients underwent surgery is affected by the uncertainty of anesthesia and surgery,as well as the patient′s experience,personality and coping style.Although preoperative anxiety does not belong to the category of psychiatric diseases and will not cause pathological damage to patients,but it can cause adverse consequences such as increased postoperative pain,sleep disturbance,hemodynamic fluctuations and delayed postoperative recovery etc.Preoperative anxiety can activate the hypothalamic-pituitary-adrenal axis to produce a large amount of glucocorticoids,which can not only reduce the release of presynapticγ-aminobutyric acid,but also inhibit the postsynapticγ-aminobutyric acid receptor function,resulting in increased postoperative pain,poor analgesic effect and chronic pain.Postoperative pain can seriously affect patients′postoperative recovery,increase postoperative opioid use and hospitalization costs,reduce quality of life,and even increase perioperative mortality.With the development of society and the improvement of living standards,comfortable medical care has become a new trend in medical services,and clinicians have gradually realized the necessity of reducing or even eliminating preoperative anxiety so as to relieve postoperative pain and improve patient′s prognosis.At present,the specific mechanism of preoperative anxiety exacerbating postoperative pain and the intervention measures for preoperative anxiety are still inconclusive.Based on this,this article reviews the effect of preoperative anxiety on postoperative pain,cause analysis,predictive scales and related treatment methods,in order to provide reference for the prevention and treatment of preoperative anxiety.