阿普唑仑对肺癌根治术患者术前焦虑水平和术后应激反应的影响

Effect of alprazolam on preoperative anxiety level and postoperative stress response in patients undergoing radical operation of lung cancer

目的观察阿普唑仑在肺癌根治术中的应用效果及对患者术前焦虑水平和术后应激反应的影响。方法本文为前瞻性随机对照试验。选择2020年10月至2022年12月在河南大学第一附属医院接受肺癌根治术治疗的125例肺癌患者作为研究对象,应用抽签法对其进行分组,对照组62例中男42例,女20例,年龄(60.44±5.36)岁,实施常规干预;观察组63例中男40例,女23例,年龄(61.25±5.41)岁,术前采用阿普唑仑片辅助手术治疗。比较两组患者的术前心理状态、术前术后应激情况、术后恢复情况及药物不良反应发生情况。统计学方法采用独立样本t检验、χ^(2)检验、Fisher确切概率法。结果观察组术前1 d焦虑自评量表(SAS)评分及状态-特质焦虑问卷(STAI)中状态焦虑评分、特质焦虑评分均低于对照组[(41.22±5.76)分比(44.49±5.33)分、(40.36±5.33)分比(44.46±5.49)分、(41.35±5.46)分比(45.11±5.47)分],差异均有统计学意义(t=3.293、4.237、3.846,均P<0.05)。术前1 d,两组患者的应激指标差异均无统计学意义(均P>0.05);术后首日,观察组的去甲肾上腺素、皮质醇、催乳素水平均低于对照组[(4.32±1.06)mg/kg比(5.77±1.36)mg/kg、(376.45±50.61)nmol/L比(405.33±50.12)nmol/L(14.23±5.16)mmol/L比(17.44±5.28)mmol/L],差异均有统计学意义(t=6.655、3.205、3.438,均P<0.05)。观察组的术后视觉模拟评分法(VAS)评分[(4.11±1.24)分比(5.63±1.27)分]、术后24 h内胸腔引流量[(88.45±10.47)ml比(93.11±10.36)ml]、拔管时间[(3.61±1.22)d比(4.77±1.48)d]、住院时间[(6.64±1.23)d比(7.88±1.46)d]均低于对照组,差异均有统计学意义(t=6.771、2.501、4.785、5.174,均P<0.05)。术后首日,观察组的药物相关不良反应总发生率略高于对照组[6.35%(4/63)比4.84%(3/62)],但差异无统计学意义(P>0.05)。结论采用阿普唑仑辅助肺癌根治术可降低患者术前焦虑水平、减轻术后应激反应,有利于患者术后康复,未增加不良反应的发生率。

Objective To observe the effect of alprazolam in radical operation of lung cancer and its effects on preoperative anxiety and postoperative stress response.Methods This was a prospective randomized controlled trial.A total of 125 patients with lung cancer who received radical resection in The First Affiliated Hospital of Henan University from October 2020 to December 2022 were selected as the subjects,and were divided into two groups by the lottery method.In the control group,there were 42 males and 20 females,aged(60.44±5.36)years.In the observation group,there were 40 males and 23 females,aged(61.25±5.41)years.The control group only received routine intervention,and the observation group received alprazolam tablets assisted surgical treatment before surgery.The preoperative psychological state,preoperative and postoperative stresses,postoperative recovery,and occurrence of adverse drug reactions were compared between the two groups.Independent sample t test,χ^(2) test,and Fisher exact probability method were used for statistical analysis.Results The scores of preoperative Self-rating Anxiety Scale(SAS)and state anxiety and trait anxiety of the State-Trait Anxiety Inventory(STAI)in the observation group were lower than those in the control group[(41.22±5.76)points vs.(44.49±5.33)points,(40.36±5.33)points vs.(44.46±5.49)points,(41.35±5.46)points vs.(45.11±5.47)points],with statistically significant differences(t=3.293,4.237,and 3.846;all P<0.05).Before surgery,there were no statistically significant differences in the stress indexes between the two groups(all P>0.05).After surgery,the levels of norepinephrine(NE),cortisol(Cor),and prolactin(PRL)in the observation group were lower than those in the control group[(4.32±1.06)mg/kg vs.(5.77±1.36)mg/kg,(376.45±50.61)nmol/L vs.(405.33±50.12)nmol/L,(14.23±5.16)mmol/L vs.(17.44±5.28)mmol/L],with statistically significant differences(t=6.655,3.205,and 3.438;all P<0.05).After surgery,the Visual Analog Scale(VAS)score[(4.11±1.24)points vs.(5.63±1.27)points],intrathoracic drainage volume within 24 after surgery[(88.45±10.47)ml vs.(93.11±10.36)ml],extubation time[(3.61±1.22)d vs.(4.77±1.48)d],and length of hospital stay[(6.64±1.23)d vs.(7.88±1.46)d]in the observation group were all lower than those in the control group,with statistically significant differences(t=6.771,2.501,4.785,and 5.174;all P<0.05).The incidence of drug-related adverse reactions in the observation group was slightly higher than that in the control group[6.35%(4/63)vs.4.84%(3/62)],but the difference was not statistically significant(P>0.05).Conclusion Alprazolam assisted radical resection of lung cancer can reduce the patients'preoperative anxiety level and postoperative stress response,which is conducive to the patients'postoperative rehabilitation and does not increase the incidence of adverse reactions.