The impact of preoperative anxiety on anesthesia and postoperative recovery in patients with liver cancer

doi:10.11958/20231376

Abstract

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

CLC Number:

R749.72，R735.7

Figures/Tables 4

References 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^＊