老年慢性鼻—鼻窦炎患者接受功能性鼻内镜手术治疗术前恐惧性焦虑评估及影响因素研究

Analysis of evaluation and influencing factors of phobic anxiety in elderly patients with chronic rhinosinusitis before functional endoscopic sinus surgery

目的评估老年慢性鼻—鼻窦炎(CRS)患者接受功能性鼻内镜手术治疗术前恐惧性焦虑情况,并探讨影响因素。方法采用便利抽样法,选取2022年1月—2023年6月新疆医科大学第一附属医院收治的296例老年CRS患者作为研究对象。采用一般资料调查问卷、焦虑自评量表(SAS)、匹兹堡睡眠质量指数量表(PSQI)进行问卷调查,采用二元多因素Logistic回归分析影响老年CRS患者功能性鼻内镜手术治疗术前恐惧性焦虑的因素。结果296例老年CRS患者的SAS评分为(43.86±13.51)分,95例(32.09%)存在术前恐惧性焦虑,其中84例轻度焦虑、9例中度焦虑、2例重度焦虑;296例老年CRS患者根据术前恐惧性焦虑情况分为恐惧性焦虑组(SAS评分≥50分,95例)与非恐惧性焦虑组(SAS评分<50分,201例);术前恐惧性焦虑组与非恐惧性焦虑组性别、年龄、受教育程度、病程、对病情了解情况、Lund-Mackay评分、既往手术史、术前睡眠障碍差异均有统计学意义(P<0.05);Logistic回归模型分析显示,女性[OR(95%CI):1.939(1.354,2.775)]、年龄>70岁[OR(95%CI):1.891(1.342,2.664)]、受教育程度为初中及以下[OR(95%CI):2.136(1.399,3.262)]、病程≥3年[OR(95%CI):2.319(1.451,3.704)]、对病情了解情况较差[OR(95%CI):2.000(1.359,2.942)]、Lund-Mackay评分≥10分[OR(95%CI):1.777(1.291,2.446)]、无既往手术史[OR(95%CI):2.246(1.436,3.511)]、术前睡眠障碍[OR(95%CI):2.492(1.500,4.140)]均为老年CRS患者术前恐惧性焦虑的独立危险因素P<0.01;老年CRS患者术前恐惧性焦虑预测模型的ROC曲线下面积为0.799,敏感度为84.21%,特异度为80.10%。结论老年CRS患者在功能性鼻内镜手术治疗前,存在一定程度的术前恐惧性焦虑,其发生与多种因素有关,临床应重视影响因素,以减轻术前恐惧性焦虑。

Objective To evaluate phobic anxiety and explore its influencing factors in elderly patients with chronic rhinosinusitis(CRS)before functional endoscopic sinus surgery.Methods According to convenience sampling method,296 elderly patients with CRS admitted to First Affiliated Hospital of Xinjiang Medical University from January 2022 to June 2023 were selected as the study subjects.They were investigated by general data questionnaire,Self-Rating Anxiety Scale(SAS)and Pittsburgh Sleep Quality Index(PSQI).The influencing factors for phobic anxiety in these patients before functional endoscopic sinus surgery were analyzed by binary multivariate logistic regression.Results In the 296 elderly patients with CRS,SAS score was(43.86±13.51)points.Among them,there were 95 cases(32.09%)with preoperative phobic anxiety,including 84 ones with mild anxiety,9 ones with moderate anxiety and 2 ones with severe anxiety.296 elderly CRS patients were divided into anxiety group(SAS score≥50,95 cases)and non-anxiety group(SAS score<50,201 cases)based on preoperative phobic anxiety.There were significant differences between the two groups in gender,age,education level,course of disease,disease cognition,Lund-Mackay score,history of previous surgery and preoperative sleep disorder(P<0.05).Logistic regression model analysis showed that female[OR(95%CI):1.939(1.354,2.775)],age>70 years[OR(95%CI):1.891(1.342,2.664)],education level of junior high school or below[OR(95%CI):2.136(1.399,3.262)],course of disease≥3 years[OR(95%CI):2.319(1.451,3.704)],low disease cognition[OR(95%CI):2.000(1.359,2.942)],Lund-Mackay score≥10 points[OR(95%CI):1.777(1.291,2.446)],no history of previous surgery[OR(95%CI):2.246(1.436,3.511)]and preoperative sleep disorder[OR(95%CI):2.492(1.500,4.140)]were independent risk factors for phobic anxiety in elderly patients with CRS before functional endoscopic sinus surgery(P<0.01).The area under ROC curve(AUC),sensitivity and specificity of prediction model for predicting phobic anxiety were 0.799,84.21%and 80.10%,respectively.Conclusion Elderly CRS patients may experience a certain degree of preoperative phobic anxiety before functional endoscopic sinus surgery,which is related to many factors.Clinical attention should be paid to these influencing factors to alleviate preoperative phobic anxiety of patients.