口腔颌面部肿瘤患者手术恐惧现状及影响因素分析

Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors

目的调查口腔颌面部肿瘤患者手术恐惧的发生率及严重程度。方法选取拟行手术的口腔颌面部肿瘤患者作为调查对象。采用一般资料调查表、外科手术恐惧问卷(SFQ)、患者健康问卷抑郁量表(PHQ-9)及广泛性焦虑量表(GAD-7)进行调查。结果研究共纳入203例患者。173例(85.22%)患者存在手术恐惧,SFQ得分的中位数为20,四分位数为(6,36)。恐惧水平分为无、轻度、中度、重度水平,性别、糖尿病、术前明显不适症状、PHQ-9、GAD-7得分为各恐惧水平具有统计学差异的变量。多因素分析显示,女性中度恐惧(OR=2.19,P=0.03)和重度恐惧(OR=2.72,P=0.01)较多,糖尿病患者重度恐惧(OR=3.33,P=0.02)较多,术前有明显不适症状的患者无恐惧(OR=4.73,P=0.02)较多。203例患者的抑郁、焦虑发生率分别为31.03%和24.63%,重度恐惧患者合并焦虑及抑郁的发生率为40.00%。手术恐惧分布与焦虑(r=0.491,P<0.001)、抑郁(r=0.514,P<0.001)呈中度正相关。结论口腔颌面部肿瘤患者普遍存在手术恐惧且恐惧程度分布于各水平段。医护人员可根据影响因素筛选和评估中、重度手术恐惧人群,根据恐惧来源采取针对性的干预措施以减轻手术恐惧和焦虑、抑郁情绪。

Objective This study aimed to investigate the incidence and severity of surgical fear in patients with oral and maxillofacial tumors.Methods The survey participants were composed of patients with oral and maxillofacial tumors,who were scheduled to undergo surgery.A general information questionnaire,the Surgical Fear Questionnaire(SFQ),the Patient Health Questionnaire(PHQ)-9,and the Generalized Anxiety Disorder(GAD)-7 score were used for the investigation.Results A total of 203 patients were investigated.Among them,85.22% had fear of surgery.The median score of SFQ was 20,and the quartile was(6,36).The patients were categorized into none,mild,moderate,and severe groups according fear level.Gender,diabetes,obvious discomfort before surgery,PHQ-9,and GAD-7 scores were the variables with statistical difference in each fear level.Multifactor analysis showed that women were more likely to have moderate and severe fear than men(OR=2.19,P=0.03;OR=2.72,P=0.01),patients with obvious preoperative discomfort symptoms were more inclined to have no fear(OR=4.73,P=0.02),and patients with diabetes were more likely to have severe fear(OR=3.33,P=0.02).The incidence rates of depression and anxiety were 31.03% and 24.63%,respectively.The incidence of anxiety and depression in patients with severe fear was 40.00%.Surgical fear was moderately positively correlated with anxiety(r=0.491,P<0.001)and depression(r=0.514,P<0.001).Conclusion The fear of surgery in patients with oral and maxillofacial tumors is common and distributed in all levels.Medical staff can screen and assess patients with moderate and severe fear of surgery in accordance with the influencing factors and implement targeted interventions to reduce fear of surgery,anxiety,and depression on the basis of the source of fear.