基于可穿戴设备评估咪达唑仑对腹腔镜胆囊切除术患者术前焦虑的影响

Evaluation of the Effect of Midazolam on Preoperative Anxiety in Patients Undergoing Laparoscopic Cholecystectomy Based on Wearable Devices

目的基于可穿戴设备及传统评估焦虑的方法分析咪达唑仑对腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)患者术前焦虑的影响。方法选取2022年1-10月在本院实施LC的108例患者进行试验。随机分为M0组、M1组和M2组。M0组不施加镇静干预;M1组、M2组咪达唑仑使用剂量分别为0.03 mg/kg、0.06 mg/kg。患者在术前1日填写焦虑视觉模拟量表(Anxiety Of Visual Analogue Scale,VAS-A)和状态-特质焦虑问卷(State-Trait Anxiety Inventoiy,STAI),手术当天穿戴监护设备,采集血样并再次填写焦虑量表。对比干预前后精神压力及自主神经活性相关的指标,血清中γ-氨基丁酸(GABA)、皮质醇(Cor)的浓度及焦虑量表情况。结果与M0组比较,M2组自主神经活性、均衡指数和精神压力数值降低(P<0.05),身体疲劳数值升高(P<0.05);低频谱能量和低频高频比值降低(P<0.05),极低频谱能量和高频谱能量升高(P<0.05);血清GABA浓度升高(P<0.05),Cor浓度降低(P<0.05);VAS-A评分及SAI评分降低(P<0.05)。与M1组比较,M2组身体疲劳数值升高(P<0.05),极低频谱能量升高(P<0.05),血清GABA浓度、Cor浓度及VAS-A评分、SAI评分差异无统计学意义(P>0.05)。结论较0.03 mg/kg咪达唑仑,0.06 mg/kg的剂量更能抑制交感神经活动,使迷走神经活动相对增强,降低患者的焦虑情绪。基于可穿戴设备从精神压力及自主神经活性方面评估咪达唑仑对LC患者术前焦虑的影响,与焦虑量表及血清中递质含量测定的结果一致,且具有无创、便携、相对客观等优势。

Objective To study the effect of midazolam on preoperative anxiety in patients undergoing laparoscopic cholecystectomy(LC)based on wearable devices and traditional methods of anxiety assessment.Methods A total of 108 patients who underwent LC in our hospital from January to October 2022 were studied.The subjects were randomly divided into three groups:control group(group M0),experimental group 1(group M1)and experimental group 2(group M2).No sedative intervention was administered in group M0.The midazolam dose in group M1 and M2 was 0.03 mg/kg and 0.06 mg/kg,respectively.Patients shall complete the anxiety of visual analogue scale(VAS-A)and the state-trait anxiety inventoiy(STAI)on the 1 day before surgery.On the day of surgery,the monitoring device was worn 2h before anesthesia.Blood samples were collected before and after administration.The anxiety scale was again filled out by the patient after the second blood collection.Indicators related to mental stress and autonomic nerve activity and anxiety related scales were compared before and after the intervention.Serum corticosterone(Cor)concentration and-aminobutyric acid(GABA)concentration of patients were determined by ELISA.Results Compared with group MO,the values of autonomic nerve activity,homeostasis index and mental stress in group M2 were significantly decreased(P<0.05),body fatigue was significantly increased(P<0.05),low frequency power(LF)and LF/high frequency power(HF)were significantly decreased(P<0.05),very low frequency power(VLF)and HF were significantly increased(P<0.05),GABA concentration in serum was significantly decreased(P<0.05),Cor concentration was significantly increased(P<0.05),VAS-A score and SAI score were significantly decreased(P<0.05).Compared with the group Ml,the physical fatigue value in the group M2 was significantly increased(P<0.05),the VLF was significantly rised(P<0.05),and there was no significant difference in the serum GABA concentration and Cor concentration,and not in the VAS-A score and SAI score.Conclusions Compared with 0.03 mg/kg midazolam,0.06 mg/kg midazolam can more effectively inhibit the sympathetic nerve activity,enhance the vagus nerve activity and reduce the anxiety of patients.The effects of midazolam on the preoperative anxiety of LC patients were evaluated from the aspects of mental stress and autonomic nerve activity based on the wearable device,which was consistent with the results of anxiety scale and serum transmitter content measurement.It is non-invasive,portable and relatively objective.