Bellan Lorne, Gooi Adrian, Rehsia Sacha
Department of Ophthalmology, University of Manitoba, Winnipeg.
Can J Ophthalmol. 2002 Apr;37(3):155-60. doi: 10.1016/s0008-4182(02)80057-6.
All surgery provokes various degrees of anxiety for patients. The environment leading up to surgery can affect anxiety levels. We performed a prospective randomized study to compare environmental factors around the time of cataract surgery in order to identify interventions that would minimize stress for patients.
Patients scheduled to undergo cataract surgery at a university-affiliated hospital in Winnipeg were randomly assigned to 1) receive orally administered lorazepam or a placebo before surgery; 2) listen to relaxing music through headphones or routine background noise before surgery; 3) walk (or go by wheelchair if unable to walk) to the operating room or go by stretcher; and 4) listen to relaxing music through headphones or routine background noise during surgery. Randomization for part 1 was double blind; for parts 2 and 3 the surgeon and anesthetist were blinded, but the patient was not. Patients were asked to rate their anxiety, sedation, nausea and pain on arrival at the preoperative area, about 30 minutes after arrival, on arrival in the operating room and on arrival in the postoperative area, on a visual analogue scale graded from 0 ("None" [or "Wide awake" in the case of sedation]) to 10 ("Worst possible" [or "Asleep" in the case of sedation]). Patient satisfaction and willingness to repeat the exact same form of treatment were also rated.
Of the 19 surgeons in the department 18 agreed to participate; I withdrew during the study. Data were collected for 144 patients aged 26 to 93 years. Anxiety was highest on arrival at the institution and decreased progressively thereafter. Oral sedation and listening to music before surgery were associated with decreased anxiety and increased levels of sedation (p = 0.002). Walking to the operating room provided no benefit over going by stretcher. Listening to music through headphones during surgery was not accepted by many patients and, when used, negatively affected the surgeon's assessment of the patient's ability to cooperate. Surgeons reported movement more often among patients who received oral sedation than among those who did not (chi2 = 0.01). Levels of pain and nausea were extremely low in all patients, and satisfaction was very high. Patients who received regional local anesthesia had less pain and higher satisfaction than those who received topical anesthesia. Willingness to repeat the same treatment was extremely high.
For patients undergoing cataract surgery, efforts should be directed toward reducing anxiety on arrival at the institution, when it is highest, and not just during surgery. Oral sedation and listening to music before surgery appear to be beneficial. Listening to music through headphones during surgery was not found to be advantageous.
所有手术都会使患者产生不同程度的焦虑。手术前的环境会影响焦虑水平。我们进行了一项前瞻性随机研究，以比较白内障手术前后的环境因素，从而确定能将患者压力降至最低的干预措施。
计划在温尼伯一家大学附属医院接受白内障手术的患者被随机分为四组：1）手术前口服劳拉西泮或安慰剂；2）手术前通过耳机听舒缓音乐或听常规背景噪音；3）步行（若无法行走则坐轮椅）前往手术室或用担架抬送；4）手术期间通过耳机听舒缓音乐或听常规背景噪音。第一部分的随机分组是双盲的；第二和第三部分，外科医生和麻醉师不知情，但患者知情。要求患者在到达术前区域、到达约30分钟后、到达手术室以及到达术后区域时，用视觉模拟评分法对自己的焦虑、镇静、恶心和疼痛程度进行评分，评分范围从0（“无”[镇静情况为“完全清醒”]）到10（“最严重”[镇静情况为“睡着”]）。同时对患者满意度以及是否愿意重复接受相同治疗方式进行评分。
该科室的19位外科医生中有18位同意参与研究；我在研究期间退出。收集了144名年龄在26至93岁之间患者的数据。到达医疗机构时焦虑程度最高，此后逐渐降低。术前口服镇静剂和听音乐与焦虑减轻及镇静程度增加相关（p = 0.002）。步行前往手术室与用担架抬送相比并无优势。手术期间通过耳机听音乐未被许多患者接受，且使用时会对外科医生对患者合作能力的评估产生负面影响。外科医生报告说，接受口服镇静剂的患者比未接受的患者活动更多（卡方检验=0.01）。所有患者的疼痛和恶心程度极低，满意度很高。接受区域局部麻醉的患者比接受表面麻醉的患者疼痛更轻，满意度更高。愿意重复相同治疗的比例极高。
对于接受白内障手术的患者，应致力于在到达医疗机构时（此时焦虑程度最高）减轻焦虑，而不仅仅是在手术期间。术前口服镇静剂和听音乐似乎有益。未发现手术期间通过耳机听音乐有优势。
