术前焦虑对腹腔镜胆囊切除患者术后疼痛及麻醉后复苏的影响

目的 观察腹腔镜胆囊切除患者术前焦虑对术后疼痛及麻醉后复苏的影响. 方法 选择82例择期行腹腔镜胆囊切除术患者,术前依照贝克焦虑量表(Beck's anxiety inventory,BAI)评测结果将患者分为两组:正常组(50例)和焦虑组(32例).焦虑组患者伴有焦虑症状,正常组患者无焦虑症状.观察记录手术时间、麻醉时间、改良Aldrete评分(modified Aldrete score,MAS)达9分的时间和副作用.术后疼痛控制采用芬太尼患者自控静脉镇痛的方法,记录患者术后VAS评分、芬太尼用量和补充镇痛药物使用情况. 结果 患者术前焦虑症发生率为39％.焦虑组患者改良Aldrete评分达9分的时间为(6.3± 1.5)s,明显长于正常组(5.0±1.4)s(P＜0.05),术后副作用发生率也高于正常组(P＜0.05).术后4、8、12h焦虑组患者VAS评分高于正常组[4 h:(3.5±0.7)分比(2.6±1.0)分;8 h:(3.3±0.9)分比(2.2±0.8)分;12 h:(3.1±0.5)分比(2.4±0.6)分](P＜0.05).患者术前BAI评分与术后8、12 h VAS评分呈正相关(8 h:r=0.422;12 h:r=0.526)(P＜0.05).焦虑组患者术后芬太尼用量和追加氯诺昔康补充镇痛的需求均高于正常组(P＜0.05). 结论 术前焦虑对麻醉后复苏以及术后镇痛有着负面影响,对于焦虑患者需增加术后镇痛力度才能达到良好的止痛效果.

Preoperative anxiety has a negative effect on palinesthesia and postoperative analgesia in patients undergoing laparascopic cholecystectomy

Objective To investigate the effect of preoperative anxiety on postoperative pain control and palinesthesia in patients undergoing laparoscopic cholecystectomy.Methods A total of 82 patients undergoing laparoscopic cholecystectomy were enrolled.Beck's anxiety inventory (BAI) was administered to the patients:patients with anxiety were included in the group anxious patient (n=32) and patients without anxiety were enrolled in the group control (n=50).Duration of surgery,duration of anesthesia,adverse effects and the time for the modified Aldrete score to reach 9 were recorded.During the postoperative period,patientcontrolled analgesia with fentanyl was used for pain control.VAS scores,fentanyl consumption and extra analgesic requirements were recorded.Results Among all patients,32(39％) patients had preoperative anxiety according to preoperative score of BAI.Compared with the group control,the time for the modified Aldrete score to reach 9 was seen as significantly longer [(5.0±1.4) s vs (6.3±1.5) s (P＜0.05)],and more postoperative side effects were determined in the group anxious patient.Also in the group anxious patient postoperative VAS score[4 h:(3.5±0.7) vs (2.6±1.0),8 h:(3.3±0.9) vs (2.2±0.8),12 h:(3.1±0.5) vs (2.4±0.6)](P＜0.05) and fentanyl consumption were remarkably higher,and more lornoxicam was needed (P＜0.05).Preoperative score of BAI exhibited a positive correlation with VAS scores after surgery (8 h:r=0.422,12 h:r=0.526)(P＜0.05).Conclusions In this study,preoperative anxiety negatively affects recovery from anesthesia and control of postoperative pain.In this group anxious patient,the increased need for postoperative analgesia must be adequately met.