术前焦虑水平对全麻下儿童口腔治疗术后牙痛的影响:基于倾向性评分匹配的队列研究

Effect of preoperative anxiety on postoperative toothache in children undergoing pediatric dental therapy under general anesthesia:a cohort study based on propensity score matching

目的探讨术前焦虑水平对全麻下儿童口腔治疗术后牙痛的影响。方法采用前瞻性队列研究,纳入2022年10月至2023年8月在空军军医大学口腔医院接受全麻下口腔治疗的3~7岁患儿。依据改良耶鲁术前焦虑量表,按照是否存在高度临床焦虑阳性体征将患儿分为低焦虑水平组和高焦虑水平组。以术后72 h牙痛发生率为主要结局指标,术后72 h牙痛最高评分为次要结局指标,记录患儿性别、年龄、营养状况、ASA分级、术中麻醉用药及口腔治疗情况等基线资料,并采用倾向性评分匹配法均衡两组间协变量,通过logistic回归分析匹配后术后72 h牙痛发生率和牙痛最高评分。结果共纳入231例患儿,其中低焦虑水平组158例,高焦虑水平组73例。倾向性评分匹配前,两组间年龄、ASA分级、术前牙痛评分有统计学差异(P<0.05),其余基线资料无统计学差异(P>0.05);倾向性评分匹配后,两组各纳入68例患儿,两组间基线资料均无统计学差异(P>0.05)。相较于低焦虑水平组,高焦虑水平组术后72 h发生牙痛的风险增加6.2%(OR:1.062,95%CI:1.039~2.092),两组患儿术后牙痛最高评分无统计学差异。结论术前高焦虑水平是全麻下儿童口腔治疗术后牙痛发生的危险因素,缓解患儿术前焦虑情绪可以降低其术后牙痛发生的风险。

Objective To investigate the effect of preoperative anxiety on postoperative toothache in children undergoing pediatric dental therapy under general anesthesia.Methods The prospective cohort study included children aged 3 to 7 years old who received dental therapy under general anesthesia in Stomatological Hospital,Air Force Medical University from October 2022 to August 2023.According to the modified Yale Preoperative Anxiety Scale,the children were divided into low-anxiety group and high-anxiety group according to whether there were positive signs of high clinical anxiety.The incidence of toothache and the highest score of toothache at 72 h after surgery were defined as the primary outcome and the secondary outcome,respectively.Baseline information including gender,age,nutritional status,ASA score,intraoperative anesthetics and dental therapy of the children were recorded.The covariates between the two groups were balanced by propensity score matching method.Logistic regression models were used to analyze the incidence of toothache and the highest score of toothache 72 h after surgery.Results A total of 231 children were enrolled in this study,including 158 in the low-anxiety group and 73 in the high-anxiety group.Before propensity score matching,there were statistical differences in age,ASA score and preoperative toothache score between the two groups(P<0.05),but no statistical differences in other baseline data(P>0.05).After propensity score matching,68 children in each group were included,and there was no statistical difference in baseline data between the two groups(P>0.05).Compared with the low-anxiety group,the risk of toothache 72 h after surgery in high-anxiety group was increased by 6.2%(OR:1.062,95%CI:1.0392.092),and there was no statistical difference in the highest score of postoperative toothache between the two groups.Conclusion High preoperative anxiety is a risk factor for postoperative toothache in children undergoing pediatric dental therapy under general anesthesia,and alleviating preoperative anxiety can lower the risk of postoperative toothache.