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尼泊尔成年心脏手术等待患者的焦虑评估:一项前瞻性观察研究。

Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study.

作者信息

Sigdel Shailendra, Ozaki Akihiko, Basnet Madindra, Kobashi Yurie, Pradhan Bishwas, Higuchi Asaka, Uprety Anup

机构信息

Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.

Department of Breast Cancer, Jyoban Hospital of Tokiwa Foundation, Iwaki.

出版信息

Medicine (Baltimore). 2020 Feb;99(9):e19302. doi: 10.1097/MD.0000000000019302.

Abstract

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.

摘要

围手术期焦虑会对手术结果产生负面影响,长期以来人们一直认为心脏病是焦虑发生的独立危险因素。然而,对于等待手术的尼泊尔成年心脏病患者的术前焦虑情况却知之甚少。本研究的主要目的是:(1)明确等待心脏直视手术的尼泊尔成年心脏病患者的术前焦虑水平;(2)确定与术前焦虑相关的因素;(3)评估与患者获取心脏手术相关信息意愿的任何可能因素。

这是一项针对尼泊尔加德满都一家核心医疗机构已安排心脏手术的患者的前瞻性观察研究。我们从患者的病历中收集了他们的社会人口学和临床特征,并使用阿姆斯特丹术前焦虑和信息量表评估他们的术前焦虑情况。我们对收集到的数据进行了描述性分析。此外,我们采用回归模型来评估研究目标。

共有140名患者参与,其中123名(87.9%)患者的数据用于分析。58.5%的参与者有术前焦虑。女性(比值比0.31,95%置信区间0.15 - 0.65,P < 0.001)和既往有麻醉经历(比值比2.38,95%置信区间1.01 - 5.62,P < 0.05)被确定为心脏手术前发生焦虑的危险因素。此外,女性(发病率比值比0.80,95%置信区间0.67 - 0.94,P < 0.001)、较高的教育水平(发病率比值比1.18,95%置信区间1.01 - 1.40,P < 0.05)和较高的术前焦虑水平(发病率比值比1.44,95%置信区间1.21 - 1.73,P < 0.001)会导致获取手术相关信息的意愿更高。

该研究得出结论,超过一半的心脏手术患者经历术前焦虑;女性和既往有麻醉经历是危险因素。焦虑的患者更渴望了解手术相关知识。因此,应在高危人群中对术前焦虑进行评估和适当管理。

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