术前焦虑对椎体成形术后疗效的影响研究
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摘要
目的探讨术前焦虑对于接受椎体成形术(PVP)患者术后疗效的影响。方法前瞻性研究2015年6月—2017年6月接受PVP的骨质疏松性椎体压缩骨折(OVCF)患者125例,收集患者一般资料,术前采用焦虑自评量表(SAS)测评患者情绪,根据评分分为焦虑组(SAS≥50)55例和非焦虑组(SAS<50)70例;通过VAS评分评定术前、术后疼痛,ODI评分评定术前、术后机体功能,比较两组患者疼痛、功能改善情况,并采用Logistic回归分析这些因素与术前焦虑的相关性。结果焦虑组患者术前VAS、ODI评分(7.84±1.09,43.02±8.74)较非焦虑组(6.10±1.84,36.46±4.25)明显增高,且术后改善率显著低于非焦虑组,差异有统计学意义(P<0.05)。进一步分析表明患者高龄(OR=1.726,95%CI 1.139～2.384,P<0.05)、对手术认知程度低(OR=2.138,95%CI 1.215～3.468,P<0.05)以及自费患者(OR=1.958,95%CI 2.037～4.058,P<0.05)与术前焦虑密切相关。结论术前焦虑容易导致PVP患者术后改善不佳,其中高龄、手术认知程度低、自费为术前焦虑的风险因素,今后临床决策应加以重视。
Objective To explore the influence of preoperative anxiety on the outcome of percutaneous vertebroplasty(PVP). Methods From Jun. 2015 to Jun. 2017,patients with osteoporotic vertebral compression fracture(OVCF) receiving PVP treatment were prospectively enrolled. General information of patients was collected. The self-rating anxiety scale(SAS) was used to evaluate the patients' psychological states,who were divided into anxiety group(SAS≥50,n=55) and nonanxiety group(SAS<50,n=70),respectively. The visual analogue scale(VAS) for pain assessment and Oswestry disability index(ODI) for function assessment were recorded and compared between groups to evaluate the improvement of pain and body function. Furthermore,the Logistic regression analysis was used to reveal the relevant factors with preoperative anxiety. Results The VAS and ODI scores in anxiety group(7.84±1.09,43.02±8.74) were significantly higher than those in nonanxiety group(6.104±1.84,36.46±4.25)(P<0.05). In addition,the improvement of VAS and ODI scores were significantly better in nonanxiety group,and the difference was statistically significant(P<0.05). Furthermore,regression analysis indicated that age(OR=1.726,95% CI 1.139～2.384,P<0.05),the low level of awareness of operation(OR=2.138,95% CI 1.215～3.468,P<0.05) and out-of-pocket expenditure(OR=1.958,95% CI 2.037～4.058,P<0.05) were statistically related with operative anxiety. Conclusion Preoperative anxiety is easy to cause the poor outcome of PVP treatment,especially advanced age,low level of awareness of operation and out-of-pocket expenditure are the risk factors for preoperative anxiety,which should be paid close attention in clinical decision in the future.
Objective To explore the influence of preoperative anxiety on the outcome of percutaneous vertebroplasty(PVP). Methods From Jun. 2015 to Jun. 2017,patients with osteoporotic vertebral compression fracture(OVCF) receiving PVP treatment were prospectively enrolled. General information of patients was collected. The self-rating anxiety scale(SAS) was used to evaluate the patients' psychological states,who were divided into anxiety group(SAS≥50,n=55) and nonanxiety group(SAS<50,n=70),respectively. The visual analogue scale(VAS) for pain assessment and Oswestry disability index(ODI) for function assessment were recorded and compared between groups to evaluate the improvement of pain and body function. Furthermore,the Logistic regression analysis was used to reveal the relevant factors with preoperative anxiety. Results The VAS and ODI scores in anxiety group(7.84±1.09,43.02±8.74) were significantly higher than those in nonanxiety group(6.104±1.84,36.46±4.25)(P<0.05). In addition,the improvement of VAS and ODI scores were significantly better in nonanxiety group,and the difference was statistically significant(P<0.05). Furthermore,regression analysis indicated that age(OR=1.726,95% CI 1.139～2.384,P<0.05),the low level of awareness of operation(OR=2.138,95% CI 1.215～3.468,P<0.05) and out-of-pocket expenditure(OR=1.958,95% CI 2.037～4.058,P<0.05) were statistically related with operative anxiety. Conclusion Preoperative anxiety is easy to cause the poor outcome of PVP treatment,especially advanced age,low level of awareness of operation and out-of-pocket expenditure are the risk factors for preoperative anxiety,which should be paid close attention in clinical decision in the future.
引文
[1] Zuo XH,Zhu XP,Bao HG,et al.Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects[J].Medicine(Baltimore),2018,97(29):e11544.
[2] Buchbinder R,Osborne RH,Ebeling PR,et al.A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures[J].N Engl J Med,2009,361(6):557-568.
[3] Kallmes DF,Comstock BA,Heagerty PJ,et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures[J].N Engl J Med,2009,361(6):569-579.
[4] Netto MB,Barranco ABS,Oliveira KWK,et al.Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery[J].Rev Bras Orthop,2018,53(1):38-44.
[5] 莫小毅,沈皆亮,张晓军,等.不同手术时机行经皮椎体成形术治疗骨质疏松性椎体压缩骨折临床疗效对比[J].创伤外科杂志,2018,20(7):490-494.
[6] 乐霄,赵体玉,旷婉.术前焦虑测评量表的研究进展[J].护理学报,2017,24(9):26-30.
[7] 王忠玲,王丽娜.高龄患者术前焦虑危险因素[J].中国老年学杂志,2013,33(20):5083-5084.
[8] 任少东,杨学军.术前焦虑与腰椎疾病术后疗效相关性的研究现状[J].中国矫形外科杂志,2018,26(9):835-839.
[9] Coronado RA,George SZ,Devin CJ,et al.Pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery [J].Arch Phys Med Rehabil,2015,96(10):1763-1770.
[10] 乐凌,方仕婷,王卫红,等.认知行为疗法对减轻老年患者术前焦虑的效果[J].护理与康复,2016,15(3):280-282.
[2] Buchbinder R,Osborne RH,Ebeling PR,et al.A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures[J].N Engl J Med,2009,361(6):557-568.
[3] Kallmes DF,Comstock BA,Heagerty PJ,et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures[J].N Engl J Med,2009,361(6):569-579.
[4] Netto MB,Barranco ABS,Oliveira KWK,et al.Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery[J].Rev Bras Orthop,2018,53(1):38-44.
[5] 莫小毅,沈皆亮,张晓军,等.不同手术时机行经皮椎体成形术治疗骨质疏松性椎体压缩骨折临床疗效对比[J].创伤外科杂志,2018,20(7):490-494.
[6] 乐霄,赵体玉,旷婉.术前焦虑测评量表的研究进展[J].护理学报,2017,24(9):26-30.
[7] 王忠玲,王丽娜.高龄患者术前焦虑危险因素[J].中国老年学杂志,2013,33(20):5083-5084.
[8] 任少东,杨学军.术前焦虑与腰椎疾病术后疗效相关性的研究现状[J].中国矫形外科杂志,2018,26(9):835-839.
[9] Coronado RA,George SZ,Devin CJ,et al.Pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery [J].Arch Phys Med Rehabil,2015,96(10):1763-1770.
[10] 乐凌,方仕婷,王卫红,等.认知行为疗法对减轻老年患者术前焦虑的效果[J].护理与康复,2016,15(3):280-282.