Zietek P, Zarzycka B, Zietek J, Stepien-Slodkowska M, Sienko-Awierianow E, Kotrych D, Dobiecki K
Department of Orthopaedics, Traumatology and Oncology of Pomeranian Medical University, Szczecin, Poland.
Acta Chir Orthop Traumatol Cech. 2017;84(4):292-298.
PURPOSE OF THE STUDY Anxiety may have negative repercussions on the surgery including poorer outcomes. On the other hand, the majority of patients reporting preoperative anxiety fear not receiving enough attention from a caregiver. In patients undergoing fast-track knee arthroplasty, we determined the relationship between patients' preoperative anxiety and the anxiety the patient's caregiver. We also analyzed the influence of selected psychosocial and demographic variables on the relationship between caregivers' and patients' anxiety. MATERIAL AND METHODS We conducted a prospective, descriptive study in which baseline assessments of patients scheduled to undergo fast-track total knee arthroplasty between 1st November 2014 and 30th April 2015 were compared with those of their caregivers. Patients were recruited from a large teaching hospital through the orthopedics joint replacement clinic. Information on sex, age, body mass index (BMI), educational status, employment status, marital status, and living status was recorded for all patients. Patients and their caregivers completed the Spielberger State-Trait Anxiety Inventory. Baseline trait anxiety was assessed with STAI scores in the initial interview, 2 weeks before hospitalization, and state anxiety was assessed the day before the surgery. The patients' caregivers were contacted during a scheduled postoperative clinic visit and asked to complete the STAI and to provide information on their age, degree of consanguinity with patient, and living status. RESULTS The mean age was 66.4 years for the 118 patients and 55.7 years for the 93 caregivers. In male caregivers, caregiver anxiety and patient anxiety were positively related but not statistically so, and in women was not significant. In male patients, a relationship between caregiver's anxiety and patient's anxiety was positive, although not statistically significant, and in women was neither present nor significant. DISCUSSION Given the widespread impacts of anxiety before knee arthroplasty, it is critical for surgeons to gain a better understanding of how to identify and reduce preoperative anxiety in operated patients. We found that male sex among caregivers was associated with more preoperative anxiety among patients than was female sex and that male patients more quickly accepted anxiety from their caregivers than did female patients. CONCLUSIONS Anxious male caregivers appear to impart their anxiety to male patients but not to female patients. The anxiety of unrelated caregivers is associated with low preoperative anxiety among patients. Preoperative interventions should focus on caregivers, especially male caregivers, and to related caregivers to help patients cope with anxiety before knee arthroplasty. Key words: knee arthroplasty. knee replacement. fast track, anxiety, caregiver, preoperative stress.
研究目的 焦虑可能会对手术产生负面影响，包括导致更差的手术结果。另一方面，大多数报告术前焦虑的患者担心未得到护理人员足够的关注。在接受快速康复膝关节置换术的患者中，我们确定了患者术前焦虑与患者护理人员焦虑之间的关系。我们还分析了选定的社会心理和人口统计学变量对护理人员与患者焦虑关系的影响。 材料与方法 我们进行了一项前瞻性描述性研究，将2014年11月1日至2015年4月30日期间计划接受快速康复全膝关节置换术的患者及其护理人员的基线评估进行比较。患者通过骨科关节置换诊所从一家大型教学医院招募。记录了所有患者的性别、年龄、体重指数（BMI）、教育程度、就业状况、婚姻状况和生活状况。患者及其护理人员完成了斯皮尔伯格状态-特质焦虑量表。在初次访谈、住院前2周时用状态-特质焦虑量表（STAI）评分评估基线特质焦虑，在手术前一天评估状态焦虑。在术后预定的门诊随访期间联系患者的护理人员，要求他们完成状态-特质焦虑量表并提供其年龄、与患者的血缘关系程度和生活状况等信息。 结果 118例患者的平均年龄为66.4岁，93名护理人员的平均年龄为55.7岁。在男性护理人员中，护理人员焦虑与患者焦虑呈正相关，但无统计学意义，在女性中则不显著。在男性患者中，护理人员焦虑与患者焦虑之间存在正相关关系，尽管无统计学意义，在女性中既不存在这种关系也不显著。 讨论 鉴于膝关节置换术前焦虑的广泛影响，外科医生更好地了解如何识别和降低手术患者的术前焦虑至关重要。我们发现，护理人员中的男性比女性更容易使患者产生更多的术前焦虑，而且男性患者比女性患者更快地接受护理人员的焦虑情绪。 结论 焦虑的男性护理人员似乎会将其焦虑情绪传递给男性患者，而不会传递给女性患者。非亲属护理人员的焦虑与患者术前低焦虑相关。术前干预应侧重于护理人员，尤其是男性护理人员，以及亲属护理人员，以帮助患者应对膝关节置换术前的焦虑。关键词：膝关节置换术；膝关节置换；快速康复；焦虑；护理人员；术前应激
