成人术前焦虑 - 特定恐惧和危险因素的横断面研究。
Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors.
机构信息
Philipps-University Marburg, Biegenstraße 10, 35037, Marburg, Germany.
Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus, Baldingerstraße, 35033, Marburg, Germany.
出版信息
BMC Psychiatry. 2020 Mar 30;20(1):140. doi: 10.1186/s12888-020-02552-w.
BACKGROUND
Preoperative anxiety comprising anesthesia and surgery related anxiety is common and perceived by many patients as the worst aspect of the surgical episode. The aim of this study was to identify independent predictors of these three anxieties dimensions and to quantify the relevance of specific fears particularly associated with anesthesia.
METHODS
This study was part of a cross-sectional survey in patients scheduled to undergo elective surgery. Anxiety levels were measured with the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Modified numeric rating scales (mNRS, range 0-10) were used to assess the severity of eight selected specific fears which were predominantly analyzed descriptively. Multivariate stepwise linear regression was applied to determine independent predictors of all three anxiety dimensions (APAIS anxiety subscales).
RESULTS
3087 of the 3200 enrolled patients were analyzed. Mean (SD) total preoperative anxiety (APAIS-A-T, range 4-20) was 9.9 (3.6). High anxiety (APAIS-A-T > 10) was reported by 40.5% of subjects. Mean (SD) levels of concern regarding the eight studied specific fears ranged from 3.9 (3.08) concerning "Anesthesiologist error" to 2.4 (2.29) concerning "Fatigue and drowsiness" with an average of 3.2 (2.84) concerning all specific fears. Ranking of all specific fears according to mean mNRS scores was almost identical in patients with high versus those with low anxiety. Among nine independent predictors of anxiety, only 3 variables (female gender, negative and positive anesthetic experience) independently predicted all three APAIS anxiety subscales. Other variables had a selective impact on one or two APAIS anxiety subscales only. Female gender had the strongest impact on all three APAIS anxiety subscales. Adjusted r values of the three models were all below 13%.
CONCLUSIONS
The high variability of importance assigned to all specific fears suggests an individualized approach is advisable when support of anxious patients is intended. Considering independent predictors of anxiety to estimate each patient's anxiety level is of limited use given the very low predictive capacity of all three models. The clinical benefit of dividing patients into those with high and low anxiety is questionable.
TRIAL REGISTRATION
German Registry of Clinical Trials (DRKS00016725), retrospectively registered.
背景
术前焦虑包括与麻醉和手术相关的焦虑，在许多患者中很常见，被认为是手术过程中最糟糕的方面。本研究的目的是确定这些三个焦虑维度的独立预测因素，并量化与麻醉特别相关的特定恐惧的相关性。
方法
这是一项在计划接受择期手术的患者中进行的横断面调查的一部分。焦虑程度用阿姆斯特丹术前焦虑和信息量表（APAIS）进行测量。使用改良数字评分量表（mNRS，范围 0-10）评估了 8 种选定的特定恐惧的严重程度，主要进行描述性分析。多元逐步线性回归用于确定所有三个焦虑维度（APAIS 焦虑分量表）的独立预测因素。
结果
在纳入的 3200 名患者中，3087 名患者进行了分析。术前总焦虑（APAIS-A-T，范围 4-20）的平均值（SD）为 9.9（3.6）。40.5%的患者报告有高度焦虑（APAIS-A-T＞10）。对所研究的 8 种特定恐惧的担忧程度的平均值（SD）范围从 3.9（3.08）（“麻醉师失误”）到 2.4（2.29）（“疲劳和昏昏欲睡”），平均为 3.2（2.84）（“所有特定恐惧”）。根据平均 mNRS 评分对所有特定恐惧进行排名，在焦虑程度高的患者与焦虑程度低的患者之间几乎相同。在焦虑的九个独立预测因素中，只有 3 个变量（女性性别、负面和积极的麻醉体验）独立预测了所有三个 APAIS 焦虑分量表。其他变量仅对一个或两个 APAIS 焦虑分量表有选择性影响。女性性别对所有三个 APAIS 焦虑分量表的影响最大。三个模型的调整 r 值均低于 13%。
结论
所有特定恐惧的重要性分配的高度可变性表明，当旨在支持焦虑患者时，建议采用个体化方法。考虑到焦虑的独立预测因素来估计每个患者的焦虑水平，由于所有三个模型的预测能力都非常低，因此用途有限。将患者分为焦虑程度高和低的患者的临床获益值得怀疑。
试验注册
德国临床试验注册处（DRKS00016725），回溯注册。
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