Kadom Nadja, Nguyen Xuan V, Jensen Mark P, Lang Elvira V
Department of Radiology and Imaging Sciences, Emory University School of Medicine and Children's Healthcare of Atlanta, 1405 Clifton Rd. NE, Atlanta, GA 30322.
Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Vasc Interv Radiol. 2017 Dec;28(12):1732-1738. doi: 10.1016/j.jvir.2017.07.014. Epub 2017 Sep 1.
To assess how a patient's affect on presentation relates to the likelihood of adverse events during their subsequent interventional image-guided procedures.
A secondary analysis was performed of an existing dataset from a clinical trial with 230 patients who underwent percutaneous peripheral vascular and renal interventions and who had completed the positive affect (PA) negative affect (NA) schedule (PANAS) before their procedures. Summary PANAS scores were split over the median and used to classify the participants into those with high vs low PA and high vs low NA. Associations between affect and the absence or presence of adverse medical events were examined by two-sided Fisher exact tests.
Patients with high baseline NA were significantly more likely to have adverse events during their procedures than those with low baseline NA (18% vs 8%; P = .030). High baseline PA was not associated with a significantly higher frequency of subsequent adverse events compared with low PA (15% vs 9%; P = .23). Patients with high NA requested and received significantly more sedative and opioid agents than those with low NA (2.0 vs 1.0 units requested [P = .0009]; 3.0 vs 1.0 units received [P = .0004]). PA levels did not affect medication use.
High NA, but not PA, was associated with an increased likelihood of adverse events. Improving patients' NA before procedures seems a more suitable target than attempting to boost PA to improve the procedural experience.
评估患者就诊时的情绪状态与随后介入性影像引导手术期间发生不良事件的可能性之间的关系。
对一项临床试验的现有数据集进行二次分析,该试验纳入了230例接受经皮外周血管和肾脏介入治疗的患者,这些患者在手术前完成了积极情绪(PA)消极情绪(NA)量表(PANAS)。将PANAS总分按中位数进行划分,并据此将参与者分为高PA与低PA以及高NA与低NA组。通过双侧Fisher精确检验来研究情绪与不良医疗事件的有无之间的关联。
基线NA较高的患者在手术期间发生不良事件的可能性显著高于基线NA较低的患者(18%对8%;P = .030)。与低PA相比,高基线PA与随后不良事件的发生率显著升高无关(15%对9%;P = .23)。与低NA患者相比,高NA患者要求并接受的镇静剂和阿片类药物显著更多(要求使用量:2.0对1.0单位[P = .0009];接受使用量:3.0对1.0单位[P = .0004])。PA水平不影响药物使用。
高NA而非高PA与不良事件的增加可能性相关。在手术前改善患者的NA似乎比试图提高PA以改善手术体验更合适。