术前焦虑程度与术中丙泊酚血浆和效应室靶浓度相关性的研究

目的 研究术前焦虑程度与麻醉过程中丙泊酚血浆和效应室靶浓度的相关性,并观察何种焦虑评估系统更适合在围术期应用.方法 择期行膝关节镜手术患者60例,ASA Ⅰ级,术前30 min采用状态-特质焦虑问卷(STAI)、Zung焦虑自评量表和VAS焦虑评分法评估患者的术前焦虑程度.采用椎管内阻滞,至麻醉平面固定于T10后,开始丙泊酚靶控输注(TCI),血浆浓度从1.5μg/ml开始,每30秒增加0.5μg/ml,至OAA/S评分达到2分时记为意识消失时点,记录BIS、丙泊酚血浆和效应室靶浓度(Cp1和Ce1).继续丙泊酚TCI 30 min,维持BIS于50左右,每5分钟记录丙泊酚血浆和效应室靶浓度,并分别计算平均值(Cp2和Ce2).结果 状态焦虑(SAI)评分、特质焦虑(TAI)评分、Zung评分、VAS评分和Cp1、Ce1之间存在正相关(P＜0.05或P＜0.01),SAI评分、TAI评分、Zung评分和患者意识消失时的BIS值之间存在负相关(P＜0.05),TAI评分和Cp2、Ce2之间存在正相关(P＜0.01),VAS评分和Ce2之间存在正相关(P＜0.05).SAI评分对Cp1、Ce1的贡献率分别为13.10％、11.76％,TAI评分对Cp2、Ce2的贡献率分别为15.05％、14.98％.SAI评分低、中度患者的Cp1和Ce1值低于重度患者,TAI评分低、中度患者的Cp2和Ce2低于重度患者.结论 患者的术前焦虑程度与麻醉诱导和维持时丙泊酚的血浆和效应室靶浓度均存在中度相关性;STAI更适合在围术期应用,其中SAI评分适合预测诱导时的丙泊酚靶浓度,TAI评分适合预测麻醉维持过程中的丙泊酚靶浓度.     

反馈靶控输注和自控输注丙泊酚用于硬膜外麻醉病人的镇静

目的 比较反馈靶控输注(TCI)和病人自控镇静(PCS)在硬膜外麻醉下择期手术病人中的应用。方法 选择50例ASAⅠ～Ⅱ级、年龄18～70岁的妇科择期手术病人,随机分成T组(TCI)和P组(PCS),每组25例。硬膜外穿刺成功后,使麻醉平面维持在T6以下,同时连接TCI系统和PCS系统并设置参数。切皮前5min开始系统给药,手术结束前5min停止给药,持续观察脑电双频指数(BIS)、频谱边界频率(SEF)、高频(HF)、低频(LF)的变化,并评定镇静深度(OAA／S评分法)。术毕记录丙泊酚的总用量及按压次数、苏醒时间和手术医师的满意度评分。结果 P组丙泊酚用量明显少于T组(P＜0．01),而各时间点MAP、BIS、SEF、HF、LF、LF／HF、HRV的变化无显著性差异(P＞0．05),两组病人及手术医师的满意度一致(P＞0．05)。结论 PCS和反馈TCI是两种安全有效的镇静方法。     

护理干预对急诊科低钾血症患者焦虑的影响

目的 探讨减轻低钾血症患者焦虑水平的护理干预方法.方法 将79例急诊低钾血症患者随机分为观察组(40例)和对照组(39例),对照组行常规治疗及护理,观察组在此基础上行针对性的心理干预、认知干预、行为干预.分别于患者刚进急诊科、护理3 h后采用状态-特质焦虑问卷(STAI)及分量表SAI进行问卷调查.结果 两组患者刚进急诊科时SAI及TAI评分比较,差异无显著性意义(均P＞0.05);但SAI评分显著高于TAI(均P＜0.01).护理3 h后观察组SAI评分显著低于对照组(P＜0.01).结论 急诊低钾血症患者就诊初期呈高焦虑水平,针对性的心理干预、认知干预、行为干预可有效缓解其焦虑情绪.     

牙颌面畸形患者正颌手术前后状态-特质焦虑程度与生活质量的相关性及筛选量表可行性分析

目的研究牙颌面畸形患者正颌手术前、后状态-特质焦虑程度与生活质量水平的相关性, 并探讨术前应用状态-特质焦虑量表(STAI)筛选术后低生活质量人群的可行性。方法以2019年9月至2021年3月在北京大学口腔医院行正颌手术的牙颌面畸形患者作为研究对象, 于术前、术后2周、术后3个月和术后6个月4个时期以STAI [包括状态焦虑量表(SAI)和特质焦虑量表(TAI)]及正颌生活质量量表(OQLQ)对患者进行调查。其中SAI、TAI总评分范围均为20～80分, 分数越高表示状态-特质焦虑程度越高;OQLQ包括社会功能、面部美学、口腔功能和美学感知4个维度, 总评分范围为22～88分, 分数越高表示生活质量水平越低。应用SPSS 26.0软件进行统计分析, 计量资料以±s表示。采用重复测量方差分析及Bonferroni法对不同时期SAI、TAI评分及OQLQ总分进行总体和事后比较;采用Pearson相关性分析探讨患者人口学特征(性别、年龄、诊断分类、教育程度、社交人数)与术前、后不同时期状态-特质焦虑程度和生活质量水平的相关性, 以及不同时期状态-特质焦虑程度与生活质量水平的相关性;采用受试者...     

手术前中重度焦虑发生的相关危险因素

目的研究择期全身麻醉手术患者手术前中重度焦虑的发生率以及相关危险因素。方法在徐州医科大学附属医院选择择期行全身麻醉的手术患者562例,男225例,女337例,年龄18～85岁,ASAⅠ～Ⅲ级,术前1d采用状态特质焦虑量表(STAI)评估患者的术前焦虑程度,按照状态焦虑量表(SAI)评分将患者分为轻度焦虑组(SAI评分≤37分,n=294)和中重度焦虑组(SAI评分37分,n=268)。采集与术前焦虑的发生可能相关的因素如年龄、性别、学历、婚姻状况、既往手术史、是否存在疼痛、术前是否诊断肿瘤及是否有高血压等。结果中重度术前焦虑的发生率为268例(47.7%)。多因素Logistic回归分析表明,女性(OR=1.846,95%CI 1.298～2.624)、单身(OR=2.208,95%CI 1.218～4.004)是中重度术前焦虑发生的危险因素。结论女性、单身可能是中重度术前焦虑发生的独立危险因素。     

术前焦虑状态对妇科手术患者痛阈和耐痛阈的影响

目的 评价术前焦虑状态对妇科手术患者痛周和耐痛阈的影响.方法 拟行妇科手术患者102例.年龄20～55岁,ASA Ⅰ或Ⅱ级,采用状态特质焦虑同卷(STAI)中的状态焦虑问卷部分(SAI)评价患者术前的焦虑状态,根据SAI评分分为高度焦虑组(SAI评分≥45分.n=53)和低度焦虑组(SAI评分<45分,n=49).采用电刺激法测定息者术前痛阈和耐痛阈.结果 两组术前痛阈差异无统计学意义(P>.05);高焦虑组术前耐痛阈低于低焦虑组(P<0.05).结论 术前高度焦虑状态可导致妇科手术患者耐痛阈降低.     

右旋美托咪啶的镇静效应及其对全麻镇静深度的影响

目的研究右旋美托咪啶(Dex)的镇静效应及其对全麻患者麻醉深度的影响。方法择期手术的患者60例(ASAⅠ～Ⅱ级),根据不同用药时期情况均分为镇静组和麻醉组,镇静组30例又分为Dex组(D1组)和对照组(C1组):D1组静脉泵注Dex负荷剂量0.4μg/kg(5min注完),然后以0.4μg·kg-1·h-1维持静注30min;C1组以同样方式输注生理盐水。记录不同时点的脑电双频指数(BIS)、MAP、HR,并对患者进行OAA/S、Ramesay镇静评分。麻醉组30例全麻患者也随机分为D2和C2组:D2组术中静脉Dex0.4μg/kg5min注完;C2组输注生理盐水。术中以丙泊酚靶控输注(TCI)和雷米芬太尼静脉维持麻醉,调节丙泊酚血浆靶控浓度(Ct),使BIS维持在50±3。结果D1组Dex负荷剂量输注后以及维持期间BIS比基础值降低17.0%～30.9%(P<0.05),镇静效应明显,OAA/S和Ramsay镇静评分明显降低(P<0.05);D2组患者麻醉前BIS为92±1,给予Dex后BIS由51±2降至42±16,C2组则仍为51±3。D2组丙泊酚的用量比C2组减少8%～14%(P<0.05)。结论Dex对清醒患者产生明显镇静效应,并能加深全麻患者的麻醉深度,减少丙泊酚TCI的用量。     

持续泵注曲马多对靶控输注异丙酚血药浓度的影响

目的 观察麻醉中持续泵注曲马多对靶控输注(TCI)异丙酚麻醉血药浓度的影响。方法 随机将ASAⅠ～Ⅱ级病人50例分为两组(各25例),Ⅰ组单纯TCI异丙酚麻醉,Ⅱ组TCI异丙酚麻醉复合曲马多3mg/kg后以0.5 mg·kg-1·h-1持续泵注。以BIS值50±10来调节TCI血药浓度。麻醉中连续观察BIS、MAP、HR、异丙酚血药浓度(CP)、心率变异性(HRV)、LF/HF等指标,以及术中异丙酚用量和麻醉苏醒时间。结果 两组间BIS差异无显著性。Ⅰ组CP仅在切皮和拔管时显著高于Ⅱ组(P<0.05),而异丙酚总用量,苏醒及手术时间两组间差异无统计学意义。Ⅰ组仅在术毕时HRV高于Ⅱ组;切皮时和术中Ⅰ组HR明显高于Ⅱ组;Ⅰ组LF/HF在切皮前及术中较Ⅱ组显著升高。结论 持续泵注曲马多对TCI异丙酚麻醉血药浓度无明显影响,但曲马多的镇痛作用使其较单纯TCI异丙酚麻醉术中自主神经反应性下降,术后恢复期更加平稳。     

护理干预对急诊科低钾血症患者焦虑的影响

目的探讨减轻低钾血症患者焦虑水平的护理干预方法。方法将79例急诊低钾血症患者随机分为观察组（40例）和对照组（39例）,对照组行常规治疗及护理,观察组在此基础上行针对性的心理干预、认知干预、行为干预。分别于患者刚进急诊科、护理3h后采用状态-特质焦虑问卷（STAI）及分量表SAI进行问卷调查。结果两组患者刚进急诊科时SAI及TAI评分比较,差异无显著性意义（均P〉0．05）;但SAI评分显著高于TAI（均P〈0．01）。护理3h后观察组SAI评分显著低于对照组（P〈0．01）。结论急诊低钾血症患者就诊初期呈高焦虑水平,针对性的心理干预、认知干预、行为干预可有效缓解其焦虑情绪。     

复合咪唑安定对丙泊酚靶控输注诱导的影响

目的 观察靶控输注(TCI)丙泊酚麻醉诱导中,维持脑电双频指数(BIS)为50时,复合咪唑安定对丙泊酚靶浓度及血流动力学的影响.方法 40例ASA Ⅰ或Ⅱ级拟行妇科腹腔镜手术病人,随机均分为丙泊酚(P)组和丙泊酚复合咪唑安定(M)组,记录BIS值降至50时的丙泊酚血浆及效应室靶浓度及病人诱导前、BIS值降至50时(诱导后)及气管插管即刻的HR和MAP.结果 当BIS值降至50时,M组丙泊酚的血浆及效应室靶浓度及用量均明显低于P组(P＜0.05或P＜0.01);两组病人诱导后的MAP均较诱导前明显降低(P＜0.01),P组诱导后、气管插管即刻的HR较诱导前明显减慢(P＜0.05或P＜0.01)且明显慢于M组(P＜0.05).结论 以BIS值降至50为指标.TCI丙泊酚诱导时复合咪唑安定可明显降低丙泊酚的血浆及效应室靶浓度;可减轻丙泊酚诱导所致HR减慢,但不能减轻丙泊酚诱导所致血压下降;对插管时血流动力学影响两者相似.     

How would patients prefer to spend the waiting time before their operations?

Many surgical patients are anxious while waiting to go to the operating theatre in spite of the best preparation with drugs, information and reassurance. It is possible that patients could be more comfortable if allowed a choice of activities before operations. The objective of this study was to find out how pre-operative patients might prefer to occupy their time. We distributed 200 questionnaires to elective surgery patients and 184 (92%) were available for analysis. Of the respondents, 54.1% wanted to be slightly sleepy, 72.0% preferred not to be fast asleep and 57.2% preferred not to be wide awake. Reading (56.8%), listening to music (57.1%) and chatting with other patients (39.9%) were preferred activities. It might be appropriate to ask patients how sedated they would wish to be before their surgery and perhaps have alternatives to sedation available.     

A randomized controlled study of whether the partner’s presence in the operating room during neuraxial anesthesia for cesarean delivery reduces patient anxiety

BackgroundThis study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner’s presence during neuraxial anesthesia placement affected patients’ overall anxiety levels.MethodsThree hundred fifteen patient-partner dyads were randomized to two groups: group 1 partners were present in the operating room during neuraxial anesthesia placement while group 2 partners remained outside the operating room during placement. Before surgery, all patient-partner dyads completed a survey of demographics, anesthetic experiences and baseline anxiety. Anxiety levels were rated using a visual analogue scale (VAS) and the state portion of the Spielberger State-Trait Anxiety Inventory.ResultsThe mean change in anxiety as measured by VAS among patients whose partners were present in the operating room for neuraxial anesthetic placement decreased from before to after the procedure (-4.5 ± 25.8; P=0.03; 95% CI -8.55, -0.45); the mean change in anxiety in patients whose partners were not present did not alter significantly (+1.9 ± 25.3; P=0.34; 95% CI 6.68, 12.12). Anxiety was increased among partners who were not present (+9.4, P<0.001).ConclusionAlthough patients whose partners were present in the operating room at the time of neuraxial anesthesia placement reported less anxiety over the time of the study than did patients whose partners were not present, these differences were small and are not considered to be clinically important. Increased anxiety among partners who were not present at neuraxial placements warrants further study.     

Relação entre ansiedade pré‐operatória e consciência durante a anestesia: estudo observacional

BackgroundAnxiety is a state of worry caused by the anticipation of external or internal danger. Awareness During Anesthesia (ADA) is an unexpected memory recall during anesthesia. In this study, we aimed to determine the factors that affect preoperative anxiety and observe the incidence of ADA, as well as to determine the anxiety levels of these patients with a history of ADA.MethodsThis study was planned to be prospective, observational, and cross‐sectional. Patients in whom septoplasty was planned, who was admitted to the anesthesiology outpatients between March 2018 and September 2018, were ASA I−II, and aged 18−70 years were included in the study. The demographic characteristics of patients were recorded. The State‐Trait Anxiety Inventory (STAI) was used to determine anxiety during a preoperative evaluation. The modified Brice awareness score was used simultaneously to determine previous ADA.ResultsThe anxiety scores of patients who were conscious during anesthesia were higher than other patients. The mean STAI score was 40.85±14.8 in the 799 patients who met the inclusion criteria of this study. When the anxiety scores were compared, the scores were higher in females than in males (p < 0.05). The mean STAI score was found as 40.3±13.8 in patients who dreamed during anesthesia.ConclusionIt is important to determine the anxiety levels of patients in the preoperative period to prevent the associated complications. Preoperative anxiety, besides preventing ADA, should be dealt with in a multidisciplinary manner. ADA should be carefully questioned while evaluating previous anesthesia experiences.     

Ⅲ_A型前列腺炎患者症状积分与焦虑症状相关性研究

目的 探讨ⅢA型前列腺炎患者的精神障碍状况.方法 对2007年11月-2008年3月我院泌尿外科门诊拟诊为ⅢA型前列腺炎的患者通过CCMD-3标准诊断焦虑精神障碍后,进行NIH-CPSI评分、焦虑自评量表SAS调查.选取NIH-CPSI评分9分以上患者,共36例,NIH-CPSI评分,年龄在(34.38±7.03)(21～51)岁,分析其SAS自评量表结果.结果 NIH-CPSI症状评分9分以上患者36例,27例伴有轻度以上焦虑,占75%,SAS量表T值51～65(56.00±4.50);NIH-CPSI评分与SAS量表T值无相关性,P＞0.01.结论 临床症状较明显的ⅢA型前列腺炎患者,可伴有焦虑心理障碍.然而本研究显示症状严重程度与精神障碍严重程度并无直接相关性.其具体机制及治疗效果尚待进一步研究.     

Assessing pediatric perioperative affect: A concise review of research and clinically relevant scales

Perioperative anxiety and distress are common in pediatric patients undergoing general anesthesia and increase the risk for immediate and long-term postoperative complications. This concise review outlines key research and clinically-relevant scales that measure pediatric perioperative affect. Strengths and weaknesses of each scale are highlighted. A literature review identified 11 articles with the following inclusion criteria: patients less than or equal to 18 years, perioperative anxiety or distress, and original studies with reliability or validity data. Although robust research-based assessment tools to measure anxiety have been developed, such as the Modified Yale Preoperative Anxiety Scale, they are too complex and time-consuming to complete by clinicians also providing anesthesia. Clinically-based anxiety measurement scales tend to be easier to use, however they require further testing before widespread standard utilization. The HRAD ± scale (Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation) may be a promising observational anxiety scale that is efficient and includes an assessment of compliance. Further studies are needed to refine a clinically-relevant anxiety assessment tool and appraise interventions that reduce perioperative distress.     

Drug patient information leaflets in anaesthesia: effect on anxiety and patient satisfaction

Background. Patient information leaflets are produced for allnew drugs, including anaesthetic drugs that are licensed solelyfor physician administration. The effect of this informationon patients’ satisfaction and anxiety has not been investigatedpreviously. Methods. Eighty-five patients were allocated randomly to receivea standard information leaflet about anaesthesia (Group 1) orthe standard leaflet plus the manufacturers’ patient informationleaflets for propofol and remifentanil (Group 2). Anxiety wasassessed using the state trait anxiety index (STAI) and a visualanalogue scale (VAS) for anxiety before and after this informationhad been read. Patients’ attitudes to this informationwere assessed by a short questionnaire. Results. There was no significant difference in STAI or VASscores for anxiety between the two groups before or after theinformation leaflets. Significantly more patients who receiveddrug patient information leaflets felt that they had receivedtoo much information (0% Group 1 vs 18% Group 2, P=0.003). Morethan 64% of patients in both groups said that they would notwish to receive detailed anaesthetic drug information. Therewas a correlation between the STAI and the VAS scores for anxiety(R=0.8). Conclusions. A minority of patients (up to 36%) wish to receivedetailed anaesthetic drug information before anaesthesia. Manufacturers’drug patient information leaflets do not alter preoperativeanxiety and may be safely issued to patients requesting suchinformation. Br J Anaesth 2004; 92: 854–8     

Preoperative anxiety and volume and acidity of gastric fluid in children

Forty-three patients aged 3-6 years, undergoing minor surgery were studied. Parents staying with their children were asked to evaluate the anxiety of their children and themselves by a visual-analogue scale the night before surgery (VAS-N) and just before premedication in the morning (VAS-M). After induction, gastric fluid was collected and the volume and pH were measured. Patients with a VAS-M lower than 5 were considered the low-anxiety group (L-group; n=24) and the remainder comprised the high-anxiety group (H-group; n=19). The gastric volume of the H-group was significantly lower than that of the L-group. No difference was found in pH. A significant overall correlation of VAS-N was found between patients and their parents. These results suggest that the low level anxiety of children and their parents could not reduce the volume and acidity of gastric fluid and consequently the risk of aspiration pneumonia.     

Risk factors for anxiety at induction of anesthesia in children: a prospective cohort study

BACKGROUND: In children anxiety at induction of anesthesia is a common and important aspect of the psychological impact of anesthesia and surgery. Previous studies examining risk factors for increased anxiety have found contradictory results. This may be due to using small, or highly selective population samples, or failure to adjust for confounding variables. Results may also be culturally or institutionally specific. The aim of this study was to identify possible risk factors in a large representative cohort of children. METHODS: One thousand two hundred fifty children aged 3-12 years were recruited. Anxiety at induction of anesthesia was assessed using the modified Yale preoperative anxiety scale. Children with an anxiety score of greater than 30 were classified as having high anxiety. Anesthetists were blinded to the assessment. Data recorded included age, gender, past healthcare history, family details, use of sedative premedication, anesthesia details, admission details, parental anxiety and child temperament. An unadjusted analysis was performed to identify possible risk factors for high anxiety. An adjusted regression analysis was then performed including the potential risk factors identified in the unadjusted analysis. RESULTS: The incidence of high anxiety at induction was 50.2%. In the adjusted analysis, younger age, behavioral problems with previous healthcare attendances, longer duration of procedure, having more than five previous hospital admissions and anxious parents at induction were all associated with high anxiety at induction. Hospital admission via the day stay ward was associated with less anxiety. Sedative premedication was associated with less anxiety in children with ASA status greater than one. However, the variability explained by factors included in the model was low (5.3%). CONCLUSIONS: Some simple preoperative questions can help identify children at risk of heightened anxiety at induction of anesthesia; however, it remains difficult to precisely predict which child will experience high anxiety.