术前焦虑对肝癌患者麻醉苏醒与术后恢复的影响

doi:10.11958/20231376

摘要/Abstract

摘要：

目的探讨术前焦虑对肝脏肿瘤切除手术患者术后苏醒和短期预后的影响。方法选择行择期开腹肝癌切除术的患者96例，美国麻醉师协会（ASA）Ⅰ—Ⅱ级，据汉密尔顿焦虑量表（HAMA）将患者分为对照组41例（HAMA<7分）和焦虑组55例（HAMA≥7分）。记录患者入手术室心率（HR）、平均动脉压（MAP）、手术时间、术中出血量、术中补液量、术中瑞芬太尼消耗量；记录苏醒时间，拔管时间，苏醒期躁动（EA）评分，拔出气管导管后5 min（T₁），术后6 h（T₂）、12 h（T₃）、24 h（T₄）、48 h（T₅）静息及活动疼痛视觉模拟（VAS）评分，以及患者自控静脉镇痛（PCIA）累计有效按压次数、镇痛药物补救情况、术后胃肠道反应情况、术后排气时间、术后5 d血清丙氨酸转氨酶（ALT）与天冬氨酸转氨酶（AST）值和术后住院天数。结果与对照组相比，焦虑组入手术室HR和MAP增高，苏醒时间、拔管时间延长；术中瑞芬太尼消耗量，EA评分，T₁、T₂、T₃静息及活动VAS评分，T₄活动VAS评分，PCIA按压次数，镇痛药物补救次数均增加，术后胃肠道反应的发生率升高，术后下床时间、排气时间、进食时间和术后住院天数延长（P<0.05）。结论术前焦虑不利于肝脏肿瘤切除术患者麻醉苏醒和短期预后。

关键词: 癌, 肝细胞, 焦虑, 麻醉苏醒延迟, 手术后并发症

Abstract:

Objective To investigate the effect of preoperative anxiety on postoperative recovery and short-term prognosis in patients with liver cancer resection. Methods A total of 96 patients underwent elective open hepatocellular carcinoma resection, with American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ were included in this study. Patients were divided into the control group (41 cases, HAMA < 7 points) and the anxiety group (55 cases, HAMA ≥7 points) according to Hamilton Anxiety Scale (HAMA). Heart rate (HR), mean arterial pressure (MAP) after entering the operating room, operative time, intraoperative bleeding, intraoperative fluid infusion and intraoperative remifentanil consumption were monitored in patients. Recovery time, extubation time, Emergence Agitation (EA) score, the resting and dynamic visual analogue scale ( VAS ) at 5 min after extubation (T₁), 6 h (T₂), 12 h (T₃), 24h (T₄) and 48 h (T₅) after surgery, the cumulative effective pressing times of patient controlled analgesia (PCA), the remedy times of analgesic drugs, the postoperative gastrointestinal reaction, exhaust time, hospital stay, the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at the 5th day after operation were recorded. Results Compared with the control group, the heart rate and MAP in the anxious group were significantly increased after entering operating room, and the recovery time and extubation time were significantly prolonged (P<0.05). The incidence of intraoperative remifentanil consumption, EA score, T₁, T₂, T₃ resting and dynamic VAS score, T₄ dynamic VAS score, PCA pressing times, analgesic drug remedy times and postoperative gastrointestinal reactions were significantly higher in the anxious group than those in the control group (P<0.05), and incidence of gastrointestinal reactions, postoperative out of bed time, exhaust time, feeding time and hospital stay were significantly prolonged (P<0.05). Conclusion Preoperative anxiety is not conducive to anesthesia recovery and short-term prognosis in patients with liver tumor resection.

Key words: carcinoma, hepatocellular, anxiety, delayed emergence from anesthesia, postoperative complications

中图分类号:

R749.72，R735.7

图/表 4

参考文献 17

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组别	n		年龄/岁	性别（男/女）		BMI/（kg/m²）		ASA分级（Ⅰ/Ⅱ）		Child-pugh（A/B）			术前ALT/（U/L）
对照组	41		55.12±9.79	27/14		23.20±3.06		3/38		6/35			19（15，31）
焦虑组	55		57.42±9.33	43/21		24.10±3.12		2/53		13/42			21（15，31）
t、Z或χ²			1.168	0.165		1.402		0.645		1.199			0.226
组别		术前AST/（U/L）			肝段切除3段以上		高血压		冠心病		糖尿病	吸烟史		饮酒史
对照组		26（19，36）			3（7.3）		7（17.1）		1（2.4）		9（21.9）	9（21.9）		10（24.3）
焦虑组		26（21，33）			9（16.3）		16（29.1）		5（9.1）		8（14.5）	12（21.8）		15（27.3）
t、Z或χ²		0.334			1.758		1.862		1.774		0.997	0.006		0.101

组别	n		年龄/岁	性别（男/女）		BMI/（kg/m²）		ASA分级（Ⅰ/Ⅱ）		Child-pugh（A/B）			术前ALT/（U/L）
对照组	41		55.12±9.79	27/14		23.20±3.06		3/38		6/35			19（15，31）
焦虑组	55		57.42±9.33	43/21		24.10±3.12		2/53		13/42			21（15，31）
t、Z或χ²			1.168	0.165		1.402		0.645		1.199			0.226
组别		术前AST/（U/L）			肝段切除3段以上		高血压		冠心病		糖尿病	吸烟史		饮酒史
对照组		26（19，36）			3（7.3）		7（17.1）		1（2.4）		9（21.9）	9（21.9）		10（24.3）
焦虑组		26（21，33）			9（16.3）		16（29.1）		5（9.1）		8（14.5）	12（21.8）		15（27.3）
t、Z或χ²		0.334			1.758		1.862		1.774		0.997	0.006		0.101

组别	n		HR/（次/min）			MAP/mmHg			手术时间/h
对照组	41		75.98±10.25			93.10±11.32			3.42±0.59
焦虑组	55		81.60±11.49			97.82±10.11			3.21±0.65
t			2.284^＊			2.081^＊			1.673
组别	苏醒时间/min			拔管时间/min				EA评分/分
对照组	12.29±1.96			15.44±1.30				1.15±0.34
焦虑组	13.31±2.13			16.12±1.71				1.44±0.52
t	2.387^＊			2.150^＊				2.192^＊
组别		术中补液量/ （mL/kg）			术中出血量/ mL		瑞芬太尼消耗量/ （μg/kg）
对照组		37.66±9.67			300（150，400）		24.55±3.04
焦虑组		41.18±13.42			300（200，400）		27.45±6.82
t或Z		0.062			0.377		2.536^＊

组别	n		HR/（次/min）			MAP/mmHg			手术时间/h
对照组	41		75.98±10.25			93.10±11.32			3.42±0.59
焦虑组	55		81.60±11.49			97.82±10.11			3.21±0.65
t			2.284^＊			2.081^＊			1.673
组别	苏醒时间/min			拔管时间/min				EA评分/分
对照组	12.29±1.96			15.44±1.30				1.15±0.34
焦虑组	13.31±2.13			16.12±1.71				1.44±0.52
t	2.387^＊			2.150^＊				2.192^＊
组别		术中补液量/ （mL/kg）			术中出血量/ mL		瑞芬太尼消耗量/ （μg/kg）
对照组		37.66±9.67			300（150，400）		24.55±3.04
焦虑组		41.18±13.42			300（200，400）		27.45±6.82
t或Z		0.062			0.377		2.536^＊

组别		n				静息VAS/分
组别		n	T₁			T₂		T₃			T₄	T₅
对照组		41	1.32±0.42			1.67±0.41		1.60±0.62			1.78±0.61	1.02±0.12
焦虑组		55	1.75±0.58			2.07±055		1.95±0.46			1.95±0.52	1.13±0.21
t			2.351^＊			2.153^＊		2.015^＊			1.419	0.867
组别				活动VAS/分						PICA有效按压/次			镇痛药物补救
组别	T₁			T₂	T₃		T₄		T₅	PICA有效按压/次			镇痛药物补救
对照组	2.51±0.35			2.73±0.73	2.07±0.60		1.87±0.66		2.22±0.56	2（1，5）			3（7.3）
焦虑组	3.02±0.69			3.07±0.57	2.34±0.65		2.17±0.70		2.29±0.53	4（1，8）			12（21.8）
t、Z或χ²	2.108^＊			2.369^＊	2.053^＊		2.113^＊		0.630	2.095^＊			4.042^＊