手术室环境对膝关节镜检查术患者等待期应激反应的影响

Influence of operating room environment on stress response during waiting period in patients undergoing knee arthroscopy

目的探讨不同手术室环境对膝关节镜检查术等待期患者焦虑情绪、血清皮质醇、促肾上腺皮质激素水平和血压、心率的影响。方法选取2021年6月—2022年5月在本院进行择期单侧膝关节镜检查术患者109例,按就诊时间顺序将手术室环境改造升级前手术的53例设为对照组,改造升级后56例设为研究组。观察2组患者在术前访视日(T0)和入手术室后即刻(T2)的焦虑自评和血清皮质醇、促肾上腺皮质激素水平;监测患者术前访视日(T0)、术晨在病房(T1)、入手术室后即刻(T2)和麻醉前(T3)的血压、心率。结果2组患者焦虑评分、血清皮质醇和促肾上腺皮质激素水平比较,差异有统计学意义(P<0.05);时间点与组间交互效应显著(P<0.05);简单效应分析:T0比较差异均无统计学意义,T2均有统计学意义(P<0.05);随着时间推移,2组患者焦虑评分、血清皮质醇和促肾上腺皮质激素水平呈上升趋势,两两比较结果显示,T2研究组均低于对照组,差异有统计学意义(P<0.05)。2组患者血压比较,差异有统计学意义(P<0.05);时间点与组间交互效应显著(P<0.001);简单效应分析:T0、T1、T22组血压比较,差异无统计学意义(P>0.05),T32组血压比较,差异有统计学意义(P<0.05);随着时间推移,2组患者血压呈上升趋势,两两比较结果显示,T3研究组均低于对照组,差异有统计学意义(P<0.05)。2组患者心率比较,差异有统计学意义(P<0.05);时点与组间交互效应显著(P<0.001);简单效应分析:T0和T12组心率比较,差异无统计学意义(P>0.05),T2和T32组心率比较,差异有统计学意义(P<0.05);随着时间推移,2组患者心率呈上升趋势,两两比较结果显示,T2和T3研究组均低于对照组,差异有统计学意义(P<0.05)。结论改造升级后的手术室环境能有效平复膝关节镜检查术患者等待期焦虑情绪,减轻手术应激反应,稳定血压及心率。

Objective To explore the influence of different operating room environment on anxiety,serum corticosterone,adrenocorticotro,blood pressure,and heart rate of perioperative patients during waiting period when undergoing knee arthroscopy.Methods One hundred and nine patients undergoing elective knee arthroscopy in our hospital from June 2021 to May 2022 were divided into control group(n=53)and study group(n=56)according to the visiting time.Self-rated anxiety and serum cortisol and corticotropin level in both groups on the preoperative visit day(T0)and right after entering the operating room(T2)were observed;blood pressure and heart rate on the preoperative visit day(T0),the morning of the operation in the ward(T1),right after entering the operation room(T2)and before anesthesia(T3)were monitored.Results There was statistically significance in terms of anxiety score,serum cortisol,and adrenocorticotropin level between the two groups(P<0.05).The interaction effect between time points and groups was significant(P<0.05).Further simple effect analysis showed that there was no statistically significance at T0,but the difference was significant at T2(P<0.05).As time passed,there was an upward trend in anxiety score,serum cortisol,and adrenocorticotropin level.Pairwise comparison showed that anxiety score,serum cortisol,and adrenocorticotropin level in the study group was lower than those in the control group,showing statistical significance(P<0.05).The difference in blood pressure between the two groups was statistically significant(P<0.05).The interaction effect between time points and groups was significant(P<0.001).Further simple effect analysis showed that there was no statistically significant difference in blood pressure in the two groups at T0 and T1 and T2(P>0.05),but it showed difference at T3 in the two groups(P<0.05).As time passed,there was an upward trend in blood pressure,and pairwise comparison showed that blood pressure at T3 in the study group was lower than that in the control group,showing statistical significance(P<0.05).The difference in heart rate between the two groups was statistically significant(P<0.05).The interaction effect between time points and groups was significant(P<0.001).Further simple effect analysis showed that there was no statistical difference in heart rate between the two groups at T0 and T1(P>0.05),but the difference between the two groups at T2 and T3 was statistically significant(P<0.05).As time passed,there was an upward trend,and pairwise comparison showed that heart rate in the study group at T2 and T3 was lower than that in the control group,showing statistical significance(P<0.05).Conclusion The upgraded operating room can effectively alleviate the anxiety,reduce surgical stress reactions,and stabilize blood pressure and heart rate of patients undergoing knee arthroscopy during the waiting period.