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Article(id=1198558268630069692, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558265329152414, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2149.2023.0427, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1665936000000, receivedDateStr=2022-10-17, revisedDate=null, revisedDateStr=null, acceptedDate=1672588800000, acceptedDateStr=2023-01-02, onlineDate=1763688159377, onlineDateStr=2025-11-21, pubDate=1722096000000, pubDateStr=2024-07-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1763688159377, onlineIssueDateStr=2025-11-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1763688159377, creator=13701087609, updateTime=1763688159377, updator=13701087609, issue=Issue{id=1198558265329152414, tenantId=1146029695717560320, journalId=1189873630562394117, year='2024', volume='49', issue='7', pageStart='733', pageEnd='854', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1763688158589, creator=13701087609, updateTime=1763689196450, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1198562618517581944, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558265329152414, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1198562618517581945, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1198558265329152414, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=754, endPage=760, ext={EN=ArticleExt(id=1198558269007557061, articleId=1198558268630069692, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Evaluation of perioperative anxiety state and analysis of influencing factors in burn patients, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To evaluate the perioperative anxiety state and analyze the influencing factors of burned patients. Methods A total of 110 burned patients undergoing selective surgery under general anesthesia were included in the Fourth Medical Center of Chinese PLA General Hospital from February to August 2022. All patients were evaluated with self-rating anxiety scale (SAS), visual analogue scale-anxiety (VAS-a), visual analogue scale-pain (VAS-p), mini-mental state examination (MMSE), and Ramsay sedation score 1-day before and after operation. The patients' parameters were recorded including mean arterial pressure (MAP) and heart rate (HR) at admission (T0), before anesthesia induction (T1), 2 min after intubation (T2), 15 min after surgery (T3), during surgery (T4), at surgery end (T5), and immediately after leaving the operating room (T6). The occurrence and the influencing factors of perioperative anxiety in burn patients were analyzed using the univariate and multivariate logistic regression. Results The incidence of preoperative and postoperative anxiety in burn patients was 29.1% and 22.3% respectively. Univariate logistic analysis showed that gender (P=0.002), burn time (P=0.046), burn area (P=0.005), burn site (P=0.035), and degree of preoperative pain (P=0.001) were related with preoperative anxiety status in burn patients; while burn time (P=0.030), burn area (P=0.001), burn site (P=0.016), degree of preoperative pain (P=0.021), and preoperative anxiety status (P<0.001) were related with postoperative anxiety state in burn patients. Multivariate logistic regression analysis showed that gender and degree of preoperative pain were the independent influencing factors of preoperative anxiety status in burn patients (P=0.002, 0.022), and preoperative anxiety status was the independent influencing factor of postoperative anxiety status in burn patients (P<0.001). Compared with the preoperative non-anxious patients (n=73), preoperative anxious patients (n=30) showed no significant difference in MAP at each time point (P>0.05), but HR was accelerated (P<0.05), and the dosage of sufentanil, remifentanil and propofol increased significantly during the operation (P<0.05). Conclusions The anxiety state of burn patients was significantly higher before operation than that after operation, and their consumption of anesthetic drugs during operation was higher, and there was no significant correlation with the type and number of operation. Gender, degree of preoperative pain and anxiety state were the independent influencing factors of perioperative anxiety state in burn patients. Early intervention against relevant factors will help patients recover quickly.

, correspAuthors=Meng-Meng Li, authorNote=null, correspAuthorsNote=
E-mail:
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目的 评估烧伤患者围手术期焦虑状态并分析其影响因素。方法 选择2022年2-8月解放军总医院第四医学中心拟在全身麻醉下择期手术的烧伤患者110例，术前1 d及术后1 d对患者进行焦虑自评量表(SAS)、焦虑视觉模拟量表(VAS-a)、疼痛视觉模拟量表(VAS-p)、简易精神状态检查量表(MMSE)和Ramsay镇静评分评估，并记录入院时(T0)、麻醉诱导前(T1)、插管后2 min(T2)、手术开始后15 min(T3)、术中(T4)、手术结束(T5)和离开手术室即刻(T6)的平均动脉压(MAP)和心率(HR)，分析烧伤患者围手术期焦虑发生情况，并采用单因素及多因素logistic回归分析烧伤患者围手术期焦虑状态的影响因素。结果 烧伤患者术前及术后焦虑发生率为29.1%和22.3%。单因素logistic回归分析结果显示，性别(P=0.002)、烧伤时间(P=0.046)、烧伤面积(P=0.005)、烧伤部位(P=0.035)及术前疼痛程度(P=0.001)与烧伤患者术前焦虑状态有关；烧伤时间(P=0.030)、烧伤面积(P=0.001)、烧伤部位(P=0.016)、术前疼痛程度(P=0.021)及术前焦虑状态(P<0.001)与烧伤患者术后焦虑状态有关。多因素logistic回归分析结果显示，性别、术前疼痛程度是烧伤患者术前焦虑状态的独立影响因素(P=0.002、0.022)，而术前焦虑状态是烧伤患者术后焦虑状态的独立影响因素(P<0.001)。与术前非焦虑患者(n=73)比较，术前焦虑患者(n=30)术中各时间点MAP无明显差异(P>0.05)，但HR均加快(P<0.05)，且术中舒芬太尼、瑞芬太尼及丙泊酚用量明显增加(P<0.05)。结论 烧伤患者术前焦虑发生率明显高于术后，焦虑患者术中麻醉药物用量增加，但与手术类型、手术次数无关；性别、术前疼痛程度及术前焦虑状态为烧伤患者围手术期焦虑状态的独立影响因素，针对相关因素进行早期干预，有利于患者快速康复。

, correspAuthors=李萌萌, authorNote=null, correspAuthorsNote=
李萌萌，E-mail：
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任舒婷，硕士研究生，主要从事围手术期精神认知方面的研究

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任舒婷，硕士研究生，主要从事围手术期精神认知方面的研究

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任舒婷，硕士研究生，主要从事围手术期精神认知方面的研究

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BMC Anesthesiol, 2020, 20(1): 34., articleTitle=The effect of preoperative anxiety level on mean platelet volume and propofol consumption, refAbstract=null), Reference(id=1198589379175350969, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, doi=null, pmid=null, pmcid=null, year=2021, volume=118, issue=7, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[22], rfOrder=21, authorNames=Wenzel M, Leunig A, Han S, journalName=Proc Natl Acad Sci U S A, refType=null, unstructuredReference=Wenzel M, Leunig A, Han S, et al. Prolonged anesthesia alters brain synaptic architecture[J]. Proc Natl Acad Sci U S A, 2021, 118(7): e2023676118., articleTitle=Prolonged anesthesia alters brain synaptic architecture, refAbstract=null), Reference(id=1198589379267625659, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, doi=null, pmid=null, pmcid=null, year=2022, volume=48, issue=4, pageStart=816, pageEnd=823, url=null, language=null, rfNumber=[23], rfOrder=22, authorNames=Ayhan H, Savsar A, Sahin SY, journalName=Burns, refType=null, unstructuredReference=Ayhan H, Savsar A, Sahin SY, et al. Investigation of the relationship between social appearance anxiety and perceived social support in patients with burns[J]. Burns, 2022, 48(4): 816-823., articleTitle=Investigation of the relationship between social appearance anxiety and perceived social support in patients with burns, refAbstract=null), Reference(id=1198589379364094655, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, doi=null, pmid=null, pmcid=null, year=2019, volume=2019, issue=null, pageStart=1761693, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=Xu F, Yin JW, Xiong EF, journalName=Dis Markers, refType=null, unstructuredReference=Xu F, Yin JW, Xiong EF, et al. Correlation between preoperative anxiety and ABO blood types: evidence from a clinical cross-sectional study[J]. Dis Markers, 2019, 2019: 1761693., articleTitle=Correlation between preoperative anxiety and ABO blood types: evidence from a clinical cross-sectional study, refAbstract=null)], funds=[Fund(id=1198589375610192475, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, awardId=82001456, language=EN, fundingSource=National Natural Science Foundation of China(82001456), fundOrder=null, country=null), Fund(id=1198589375736021598, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, awardId=82001456, language=CN, fundingSource=国家自然科学基金(82001456), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1198589369633309015, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, xref=1, ext=[AuthorCompanyExt(id=1198589369641697624, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, companyId=1198589369633309015, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1College of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi 030000, China), AuthorCompanyExt(id=1198589369654280537, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, companyId=1198589369633309015, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1山西医科大学麻醉学院，山西太原 030000)]), AuthorCompany(id=1198589369742360927, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, xref=2, ext=[AuthorCompanyExt(id=1198589369750749536, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, companyId=1198589369742360927, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Anesthesiology, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China), AuthorCompanyExt(id=1198589369759138145, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, companyId=1198589369742360927, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2解放军总医院第四医学中心麻醉科，北京 100048)])], figs=[ArticleFig(id=1198589374398038574, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=EN, label=Fig.1, caption=Effects of preoperative anxiety state on intraoperative MAP and HR in burn patients, figureFileSmall=s2XZ10/K2xG4wUhaYTOuQw==, figureFileBig=uO0Sm4DA7OsCceClfGPEPw==, tableContent=null), ArticleFig(id=1198589374494507570, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=CN, label=图1, caption=烧伤患者术前焦虑状态对术中MAP和HR的影响

MAP. 平均动脉压；HR. 心率；T0. 入院时；T1. 麻醉诱导前；T2. 麻醉诱导插管后2 min；T3. 手术开始后15 min；T4. 术中；T5. 手术结束时；T6. 离开手术室即刻；与术前非焦虑患者比较，(1)P<0.05

, figureFileSmall=s2XZ10/K2xG4wUhaYTOuQw==, figureFileBig=uO0Sm4DA7OsCceClfGPEPw==, tableContent=null), ArticleFig(id=1198589374666474039, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=EN, label=Tab.1, caption=

Relationship of preoperative/postoperative anxiety and non-anxiety state with intraoperative anesthetic use and surgical time in burn patients ($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
指标术前术后
焦虑患者(n=30)非焦虑患者(n=73)P焦虑患者(n=23)非焦虑患者(n=80)P
舒芬太尼(μg)23.38±9.0819.69±7.900.04126.87±8.7419.01±7.450.000
瑞芬太尼(mg)1.30±0.830.73±0.490.0011.21±0.710.80±0.620.008
丙泊酚(mg)360.60±185.15251.12±136.590.001369.26±205.54258.21±18.790.003
罗库溴铵(mg)49.17±17.4245.99±11.130.27151.52±18.7945.59±10.990.058
手术时间(min)151.13±84.32105.16±69.130.005162.96±85.25105.79±69.080.001
麻醉时间(min)189.67±17.59139.51±8.960.006199.87±105.95140.96±74.310.003
), ArticleFig(id=1198589374796497469, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=CN, label=表1, caption=

烧伤患者术前/术后焦虑与非焦虑状态与术中麻醉用药及手术时间的关系($\bar{x}±s$)

, figureFileSmall=null, figureFileBig=null, tableContent=
指标术前术后
焦虑患者(n=30)非焦虑患者(n=73)P焦虑患者(n=23)非焦虑患者(n=80)P
舒芬太尼(μg)23.38±9.0819.69±7.900.04126.87±8.7419.01±7.450.000
瑞芬太尼(mg)1.30±0.830.73±0.490.0011.21±0.710.80±0.620.008
丙泊酚(mg)360.60±185.15251.12±136.590.001369.26±205.54258.21±18.790.003
罗库溴铵(mg)49.17±17.4245.99±11.130.27151.52±18.7945.59±10.990.058
手术时间(min)151.13±84.32105.16±69.130.005162.96±85.25105.79±69.080.001
麻醉时间(min)189.67±17.59139.51±8.960.006199.87±105.95140.96±74.310.003
), ArticleFig(id=1198589374901355072, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=EN, label=Tab.2, caption=

Univariate analysis of perioperative anxiety state in burn patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例(%)术前SAS评分(分, $\bar{x}±s$)P术前术后SAS评分(分, $\bar{x}±s$ )P术后
性别0.0020.116
男68(66.0)38.00±13.6235.65±12.77
女35(34.0)45.76±15.0041.06±13.02
年龄0.8220.595
<45岁(青年)57(55.3)39.91±14.6336.52±12.21
45~60岁(中年)36(35.0)40.80±14.3038.15±14.05
>60岁(老年)10(9.7)44.18±15.5840.63±14.72
血型0.0620.189
A型25(24.3)39.15±12.3437.00±11.43
B型19(18.4)36.38±15.5632.96±10.06
O型39(37.9)41.71±15.2439.06±14.71
AB型20(19.4)44.43±16.9039.34±13.79
职业0.8600.563
职员42(40.9)39.90±13.4034.32±11.05
工人25(24.3)45.90±15.3843.25±15.19
农民9(8.7)39.17±12.5837.08±11.73
退休7(6.8)49.82±16.6243.21±15.37
学生4(3.8)48.75±13.0342.81±10.77
军人3(2.9)29.16±7.2225.0±0.00
无业13(12.6)38.78±13.8735.10±12.35
BMI(kg/m2)0.5050.679
18~2452(50.5)42.21±15.9838.57±14.55
24~27.536(34.9)37.38±11.6935.58±11.19
>27.515(14.6)43.00±11.8138.33±11.92
并发症0.5170.503
有43(41.8)42.06±15.1639.15±14.98
无60(58.2)39.61±14.0636.30±11.46
烧伤时间0.0460.030
初次就诊55(53.4)43.30±15.2539.79±13.90
瘢痕修复48(46.6)37.59±13.1234.85±11.60
烧伤面积0.0050.001
≤10%46(44.7)35.51±10.4932.82±9.87
10%~30%17(16.5)49.04±15.0944.19±14.54
30%~50%15(14.6)45.50±16.9140.35±13.38
>50%25(24.2)41.42±15.9539.80±15.05
烧伤部位0.0350.016
头面颈部66(64.1)43.30±15.6140.31±14.07
躯干37(35.9)35.87±10.9632.45±9.18
手术次数(次)0.7750.279
130(29.1)42.42±15.6739.37±14.49
2~541(39.8)42.00±14.1938.19±12.62
6~912(11.7)40.52±15.5136.46±13.38
>920(19.4)35.25±12.3933.86±11.58
住院时间0.9710.714
<10 d53(51.5)43.03±15.0939.44±13.86
10 d~1个月26(25.2)38.75±12.8035.72±10.59
1~3个月8(7.8)35.63±17.8333.90±16.22
3~6个月4(3.8)32.50±11.2229.38±8.75
6个月~1年5(4.9)37.25±17.2336.50±16.36
>1年7(6.8)42.32±11.6738.71±11.37
手术类型0.1100.161
削痂植皮术58(56.3)42.69±15.2339.04±13.33
瘢痕松解术30(29.1)37.73±14.4135.95±14.03
清创术15(14.6)38.50±10.8834.57±9.28
术前疼痛程度0.0010.021
VAS-p评分>2分43(41.8)47.05±15.7839.42±13.97
VAS-p评分≤2分60(58.2)36.04±11.6332.31±8.39
术前焦虑状态(分)-<0.001
是--53.90±9.03
否--30.74±7.08
), ArticleFig(id=1198589375006212676, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=CN, label=表2, caption=

烧伤患者围手术期焦虑状态影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目例(%)术前SAS评分(分, $\bar{x}±s$)P术前术后SAS评分(分, $\bar{x}±s$ )P术后
性别0.0020.116
男68(66.0)38.00±13.6235.65±12.77
女35(34.0)45.76±15.0041.06±13.02
年龄0.8220.595
<45岁(青年)57(55.3)39.91±14.6336.52±12.21
45~60岁(中年)36(35.0)40.80±14.3038.15±14.05
>60岁(老年)10(9.7)44.18±15.5840.63±14.72
血型0.0620.189
A型25(24.3)39.15±12.3437.00±11.43
B型19(18.4)36.38±15.5632.96±10.06
O型39(37.9)41.71±15.2439.06±14.71
AB型20(19.4)44.43±16.9039.34±13.79
职业0.8600.563
职员42(40.9)39.90±13.4034.32±11.05
工人25(24.3)45.90±15.3843.25±15.19
农民9(8.7)39.17±12.5837.08±11.73
退休7(6.8)49.82±16.6243.21±15.37
学生4(3.8)48.75±13.0342.81±10.77
军人3(2.9)29.16±7.2225.0±0.00
无业13(12.6)38.78±13.8735.10±12.35
BMI(kg/m2)0.5050.679
18~2452(50.5)42.21±15.9838.57±14.55
24~27.536(34.9)37.38±11.6935.58±11.19
>27.515(14.6)43.00±11.8138.33±11.92
并发症0.5170.503
有43(41.8)42.06±15.1639.15±14.98
无60(58.2)39.61±14.0636.30±11.46
烧伤时间0.0460.030
初次就诊55(53.4)43.30±15.2539.79±13.90
瘢痕修复48(46.6)37.59±13.1234.85±11.60
烧伤面积0.0050.001
≤10%46(44.7)35.51±10.4932.82±9.87
10%~30%17(16.5)49.04±15.0944.19±14.54
30%~50%15(14.6)45.50±16.9140.35±13.38
>50%25(24.2)41.42±15.9539.80±15.05
烧伤部位0.0350.016
头面颈部66(64.1)43.30±15.6140.31±14.07
躯干37(35.9)35.87±10.9632.45±9.18
手术次数(次)0.7750.279
130(29.1)42.42±15.6739.37±14.49
2~541(39.8)42.00±14.1938.19±12.62
6~912(11.7)40.52±15.5136.46±13.38
>920(19.4)35.25±12.3933.86±11.58
住院时间0.9710.714
<10 d53(51.5)43.03±15.0939.44±13.86
10 d~1个月26(25.2)38.75±12.8035.72±10.59
1~3个月8(7.8)35.63±17.8333.90±16.22
3~6个月4(3.8)32.50±11.2229.38±8.75
6个月~1年5(4.9)37.25±17.2336.50±16.36
>1年7(6.8)42.32±11.6738.71±11.37
手术类型0.1100.161
削痂植皮术58(56.3)42.69±15.2339.04±13.33
瘢痕松解术30(29.1)37.73±14.4135.95±14.03
清创术15(14.6)38.50±10.8834.57±9.28
术前疼痛程度0.0010.021
VAS-p评分>2分43(41.8)47.05±15.7839.42±13.97
VAS-p评分≤2分60(58.2)36.04±11.6332.31±8.39
术前焦虑状态(分)-<0.001
是--53.90±9.03
否--30.74±7.08
), ArticleFig(id=1198589375144624713, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=EN, label=Tab.3, caption=

The assignment of multifactorial variables influencing anxiety state of burn patients were included

, figureFileSmall=null, figureFileBig=null, tableContent=
因素变量类型赋值
性别二分类1：男；2：女
烧伤时间二分类1：初次就诊；2：瘢痕修补
烧伤面积连续1：≤10%；2：11%~30%；3：31%~50%；4：>50%
烧伤部位二分类1：头面部；2：躯干
疼痛程度二分类0：>2分；1：≤2分
术前焦虑状态二分类0：焦虑状态；1：非焦虑状态
), ArticleFig(id=1198589375232705101, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=CN, label=表3, caption=

烧伤患者焦虑状态影响因素纳入多因素分析变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
因素变量类型赋值
性别二分类1：男；2：女
烧伤时间二分类1：初次就诊；2：瘢痕修补
烧伤面积连续1：≤10%；2：11%~30%；3：31%~50%；4：>50%
烧伤部位二分类1：头面部；2：躯干
疼痛程度二分类0：>2分；1：≤2分
术前焦虑状态二分类0：焦虑状态；1：非焦虑状态
), ArticleFig(id=1198589375333368401, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=EN, label=Tab.4, caption=

Multivariate logistic analysis of related influencing factors of perioperative anxiety state in burn patients （n=103）

, figureFileSmall=null, figureFileBig=null, tableContent=
因素BSEOR95%CIP
术前
性别1.7290.5705.6371.845~17.2270.002
烧伤时间1.2430.6503.4670.970~12.3890.056
烧伤面积-0.5470.2680.5780.342~0.9790.051
烧伤部位1.2470.7563.4790.791~15.3030.099
术前疼痛程度1.3380.5863.8111.210~12.0100.022
术后
术前焦虑状态3.3340.75130.3726.315~150.353<0.001
烧伤时间1.1890.7673.2820.730~14.7500.121
烧伤面积-0.4930.3320.6110.319~1.1710.137
烧伤部位0.8950.9572.4480.346~15.9590.349
术后疼痛程度1.0781.2002.9400.280~30.9180.369
), ArticleFig(id=1198589375421448789, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1198558268630069692, language=CN, label=表4, caption=

烧伤患者围手术期焦虑状态影响因素的多因素logistic回归分析结果（n=103）

, figureFileSmall=null, figureFileBig=null, tableContent=
因素BSEOR95%CIP
术前
性别1.7290.5705.6371.845~17.2270.002
烧伤时间1.2430.6503.4670.970~12.3890.056
烧伤面积-0.5470.2680.5780.342~0.9790.051
烧伤部位1.2470.7563.4790.791~15.3030.099
术前疼痛程度1.3380.5863.8111.210~12.0100.022
术后
术前焦虑状态3.3340.75130.3726.315~150.353<0.001
烧伤时间1.1890.7673.2820.730~14.7500.121
烧伤面积-0.4930.3320.6110.319~1.1710.137
烧伤部位0.8950.9572.4480.346~15.9590.349
术后疼痛程度1.0781.2002.9400.280~30.9180.369
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烧伤患者围手术期焦虑状态评估及其影响因素分析
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任舒婷 1, 2 , 李萌萌 2, * , 边雅楠 1, 2 , 徐雯 1, 2 , 顾国鑫 2 , 孙雨 2 , 冉明梓 2
解放军医学杂志 | 临床研究 2024,49(7): 754-760
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解放军医学杂志 | 临床研究 2024, 49(7): 754-760
烧伤患者围手术期焦虑状态评估及其影响因素分析
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任舒婷1, 2, 李萌萌2, * , 边雅楠1, 2, 徐雯1, 2, 顾国鑫2, 孙雨2, 冉明梓2
作者信息
  • 1山西医科大学麻醉学院，山西太原 030000
  • 2解放军总医院第四医学中心麻醉科，北京 100048

    • 任舒婷，硕士研究生，主要从事围手术期精神认知方面的研究

通讯作者:

李萌萌，E-mail：
Evaluation of perioperative anxiety state and analysis of influencing factors in burn patients
Shu-Ting Ren1, 2, Meng-Meng Li2, * , Ya-Nan Bian1, 2, Wen Xu1, 2, Guo-Xin Gu2, Yu Sun2, Ming-Zi Ran2
Affiliations
  • 1College of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi 030000, China
  • 2Department of Anesthesiology, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
出版时间: 2024-07-28 doi: 10.11855/j.issn.0577-7402.2149.2023.0427
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摘要
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目的 评估烧伤患者围手术期焦虑状态并分析其影响因素。方法 选择2022年2-8月解放军总医院第四医学中心拟在全身麻醉下择期手术的烧伤患者110例，术前1 d及术后1 d对患者进行焦虑自评量表(SAS)、焦虑视觉模拟量表(VAS-a)、疼痛视觉模拟量表(VAS-p)、简易精神状态检查量表(MMSE)和Ramsay镇静评分评估，并记录入院时(T0)、麻醉诱导前(T1)、插管后2 min(T2)、手术开始后15 min(T3)、术中(T4)、手术结束(T5)和离开手术室即刻(T6)的平均动脉压(MAP)和心率(HR)，分析烧伤患者围手术期焦虑发生情况，并采用单因素及多因素logistic回归分析烧伤患者围手术期焦虑状态的影响因素。结果 烧伤患者术前及术后焦虑发生率为29.1%和22.3%。单因素logistic回归分析结果显示，性别(P=0.002)、烧伤时间(P=0.046)、烧伤面积(P=0.005)、烧伤部位(P=0.035)及术前疼痛程度(P=0.001)与烧伤患者术前焦虑状态有关；烧伤时间(P=0.030)、烧伤面积(P=0.001)、烧伤部位(P=0.016)、术前疼痛程度(P=0.021)及术前焦虑状态(P<0.001)与烧伤患者术后焦虑状态有关。多因素logistic回归分析结果显示，性别、术前疼痛程度是烧伤患者术前焦虑状态的独立影响因素(P=0.002、0.022)，而术前焦虑状态是烧伤患者术后焦虑状态的独立影响因素(P<0.001)。与术前非焦虑患者(n=73)比较，术前焦虑患者(n=30)术中各时间点MAP无明显差异(P>0.05)，但HR均加快(P<0.05)，且术中舒芬太尼、瑞芬太尼及丙泊酚用量明显增加(P<0.05)。结论 烧伤患者术前焦虑发生率明显高于术后，焦虑患者术中麻醉药物用量增加，但与手术类型、手术次数无关；性别、术前疼痛程度及术前焦虑状态为烧伤患者围手术期焦虑状态的独立影响因素，针对相关因素进行早期干预，有利于患者快速康复。

烧伤  /  围手术期  /  焦虑  /  疼痛

Objective To evaluate the perioperative anxiety state and analyze the influencing factors of burned patients. Methods A total of 110 burned patients undergoing selective surgery under general anesthesia were included in the Fourth Medical Center of Chinese PLA General Hospital from February to August 2022. All patients were evaluated with self-rating anxiety scale (SAS), visual analogue scale-anxiety (VAS-a), visual analogue scale-pain (VAS-p), mini-mental state examination (MMSE), and Ramsay sedation score 1-day before and after operation. The patients' parameters were recorded including mean arterial pressure (MAP) and heart rate (HR) at admission (T0), before anesthesia induction (T1), 2 min after intubation (T2), 15 min after surgery (T3), during surgery (T4), at surgery end (T5), and immediately after leaving the operating room (T6). The occurrence and the influencing factors of perioperative anxiety in burn patients were analyzed using the univariate and multivariate logistic regression. Results The incidence of preoperative and postoperative anxiety in burn patients was 29.1% and 22.3% respectively. Univariate logistic analysis showed that gender (P=0.002), burn time (P=0.046), burn area (P=0.005), burn site (P=0.035), and degree of preoperative pain (P=0.001) were related with preoperative anxiety status in burn patients; while burn time (P=0.030), burn area (P=0.001), burn site (P=0.016), degree of preoperative pain (P=0.021), and preoperative anxiety status (P<0.001) were related with postoperative anxiety state in burn patients. Multivariate logistic regression analysis showed that gender and degree of preoperative pain were the independent influencing factors of preoperative anxiety status in burn patients (P=0.002, 0.022), and preoperative anxiety status was the independent influencing factor of postoperative anxiety status in burn patients (P<0.001). Compared with the preoperative non-anxious patients (n=73), preoperative anxious patients (n=30) showed no significant difference in MAP at each time point (P>0.05), but HR was accelerated (P<0.05), and the dosage of sufentanil, remifentanil and propofol increased significantly during the operation (P<0.05). Conclusions The anxiety state of burn patients was significantly higher before operation than that after operation, and their consumption of anesthetic drugs during operation was higher, and there was no significant correlation with the type and number of operation. Gender, degree of preoperative pain and anxiety state were the independent influencing factors of perioperative anxiety state in burn patients. Early intervention against relevant factors will help patients recover quickly.

burns  /  perioperative  /  anxiety  /  pain
任舒婷, 李萌萌, 边雅楠, 徐雯, 顾国鑫, 孙雨, 冉明梓. 烧伤患者围手术期焦虑状态评估及其影响因素分析. 解放军医学杂志, 2024 , 49 (7) : 754 -760 . DOI: 10.11855/j.issn.0577-7402.2149.2023.0427
Shu-Ting Ren, Meng-Meng Li, Ya-Nan Bian, Wen Xu, Guo-Xin Gu, Yu Sun, Ming-Zi Ran. Evaluation of perioperative anxiety state and analysis of influencing factors in burn patients[J]. Medical Journal of Chinese People’s Liberation Army, 2024 , 49 (7) : 754 -760 . DOI: 10.11855/j.issn.0577-7402.2149.2023.0427
正文
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2019年全球范围内烧伤发病率和病死率持续降低，但新的烧伤病例数仍较高[1]。尽管烧伤患者的感染率得到控制[2]，但烧伤后瘢痕所致外观改变、功能障碍、慢性疼痛、创伤应激综合征甚至烧伤本身，均是引起烧伤患者心理健康问题的重要原因[3-4]。德国一项针对2015-2018年18 200例烧伤患者的临床研究发现，烧伤后5年，近30%的烧伤患者被诊断至少有一种精神疾患，如抑郁症、焦虑症、创伤后应激障碍或躯体形式障碍等[5]。烧伤患者的抑郁状态会影响创面愈合，延长康复时间[6]。目前烧伤后患者的精神状态已成为研究热点，但此类研究多通过随访、患者就诊心理诊所次数等方式进行，对烧伤患者神经焦虑状态的系统性研究尚少，因此，探讨在烧伤后早期采取干预措施能否为患者带来更好的转归具有重要临床意义。本研究对烧伤后患者围手术期的焦虑状态进行量化分析，探讨烧伤后焦虑状态的相关影响因素，以期为进一步研究其保护措施提供临床依据。
1 资料与方法
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1.1 研究对象
选取2022年2-8月解放军总医院第四医学中心拟于全身麻醉下择期手术治疗的110例烧伤患者。纳入标准：年龄>18岁；美国麻醉医师协会(American Society of Anesthesiologists，ASA)分级Ⅰ-Ⅲ级；心功能分级Ⅰ或Ⅱ级；无严重系统性疾病；意识清楚，依从性好；普通话交流顺畅。排除标准：有神经和精神系统疾病或服用相关药物；围手术期发生重要脏器损害或抢救；不能完成量表评估等其他原因中途退出。剔除标准：术中使用抗胆碱药物及血管活性药物；术后进入重症监护室(ICU)。本研究通过解放军总医院第四医学中心伦理委员会批准(2022KY065-KS001)，并在中国临床试验注册中心注册(ChiCTR2300067860)，患者均签署知情同意书。
1.2 麻醉方式
所有患者均未使用术前药物，采用静吸复合全身麻醉。入室后，开放静脉通路，常规监测心电图(electrocardiogram，ECG)、脉搏血氧饱和度(pulse oxygen saturation，SpO2)和有创血压。麻醉诱导使用咪达唑仑0.03 mg/kg、依托咪酯0.1 mg/kg、舒芬太尼0.2 μg/kg、丙泊酚1~2 mg/kg、罗库溴铵0.8 mg/kg；气管插管后行机械通气，设定潮气量6~8 ml/kg，呼吸频率10~15次/min，呼气末二氧化碳分压35~45 mmHg，术中维持泵注瑞芬太尼和丙泊酚，吸入七氟烷，根据患者循环情况调整麻醉药物用量，维持平均动脉压(mean arterial pressure，MAP)与心率(heart rate，HR)在20%以内变化，监测脑电双频指数(Bispectral index，BIS)在40~60。术后使用患者自控静脉镇痛泵(patient controlled intravenous analgesia，PCIA；舒芬太尼2 μg/kg+地塞米松10 mg)。
1.3 资料收集
(1)收集患者基本资料，包括性别、年龄、身高、体重、血型、职业、体重指数(body mass index，BMI)、烧伤情况(烧伤部位、烧伤时间、烧伤面积)、手术相关信息(手术次数、手术类型)及实验室检查结果等；其中，烧伤部位分为头面颈部和躯干部；烧伤时间分为初次就诊和瘢痕修复；手术类型包括削痂植皮、瘢痕松解术及清创异种皮覆盖。(2)记录患者入院时(T0)、麻醉诱导前(T1)、麻醉诱导插管后2 min(T2)、手术开始后15 min(T3)、术中(T4)、手术结束(T5)和离开手术室即刻(T6)时的MAP和HR。(3)记录手术及麻醉相关情况，包括手术时间、麻醉用药等。
1.4 围手术期精神状态评估
术前1 d及术后1 d由同一评估人员对患者进行问卷调查，包括焦虑自评量表(self-rating anxiety scale，SAS)、焦虑视觉模拟量表(visual analogue scale-anxiety，VAS-a)[7]、疼痛视觉模拟量表(visual analogue scale-pain，VAS-p)[8]、简易精神状态检查量表(mini-mental state examination，MMSE)[9]和Ramsay镇静评分[10]，其中SAS量表包含20个问题，评估个体焦虑严重程度及焦虑的变化情况，评分<50分为无焦虑状态，50~59分为轻度焦虑，60~69分为中度焦虑，≥70分为重度焦虑；VAS-a是一条长10 cm的线段，最左端代表无焦虑，最右边为最严重的焦虑，没有交流障碍者均适用，是简单易行的焦虑评估量表，由患者自行评价；VAS-p评估患者围手术期疼痛情况，与VAS-a类似，是一条长10 cm的线段，最左端代表无疼痛，最右边为最严重的疼痛，由患者自主评价疼痛程度。MMSE量表与Ramsay镇静评分分别评估患者的认知功能及镇静状态。
1.5 烧伤患者围手术期疼痛与焦虑的相关性分析
使用Spearman相关分析及线性回归分析烧伤患者围手术期疼痛程度与焦虑状态的相关性。
1.6 烧伤患者围手术期焦虑状态的影响因素分析
采用单因素及多因素logistic回归分析烧伤患者围手术期焦虑状态的影响因素。
1.7 统计学处理
采用SPSS 24.0软件进行统计分析。计量资料以$\bar{x}±s$表示，术前/术后患者SAS评分组间比较采用配对t检验；术中循环情况应用重复测量的方差分析；计数资料以例(%)表示。P<0.05为差异有统计学意义。
2 结果
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2.1 一般情况
110例烧伤患者中，1例术后非计划转入ICU，3例术前MMSE评估异常，3例术后访视不能配合，予以排除，最终纳入103例。
103例烧伤患者中，男68例(66.0%)，女35例(34.0%)，年龄(42.0±13.0)岁；青年患者57例(55.3%)，中年患者36例(35.0%)，老年患者10例(9.7%)；BMI (24.37±3.01) kg/m2；初次就诊55例(53.4%)，瘢痕修复48例(46.6%)；烧伤原因：火焰伤44例(42.7%)，爆炸伤15例(14.6%)，热水烫伤16例(15.5%)，化学灼伤15例(14.6%)，电击伤13例(12.6%)；头面颈部烧伤66例(64.1%)，躯干部烧伤37例(35.9%)；初次手术30例(29.1%)；接受削痂植皮术58例(56.3%)，陈旧性瘢痕松解术30例(29.1%)，清创异种皮覆盖15例(14.6%)。手术时间(118±76) min，麻醉时间(154±85) min。
2.2 烧伤患者术前及术后精神状态评估结果
术前1 d，103例患者MMSE评分为(28.87±3.14)分，均不存在术前认知功能障碍；Ramsay评分为(2.01±0.99)分，均处于清醒状态，无烦躁或嗜睡状态。
与术前比较，术后患者VAS-a和SAS评分均明显降低[VAS-a评分：(1.34±1.56)分 vs. (1.72±1.86)分，P<0.05；SAS评分：(37.49±13.05)分 vs. (40.64±14.51)分，P<0.05]，但Ramsay评分差异无统计学意义[(1.99±0.297)分 vs. (2.01±0.99)分，P=0.482]。
术前存在焦虑(SAS≥50分)者30例(29.1%)，SAS评分为(57.81±9.95)分；术后存在焦虑者23例(22.3%)，SAS评分为(52.82±9.87)分，其中3例为术后新发焦虑，其余20例术前即存在焦虑。术后存在焦虑患者少于术前，差异有统计学意义(P<0.05)。
2.3 烧伤患者围手术期疼痛程度与焦虑状态的相关性
Spearman相关分析显示，烧伤患者围手术期VAS-p评分与SAS评分呈正相关(术前r=0.550，术后r=0.485)，即VAS-p评分越高，SAS评分越高(P<0.05)。
2.4 术前焦虑状态对烧伤患者术中循环及麻醉用药的影响
与术前非焦虑患者(n=73)比较，术前焦虑患者(n=30)术中各时间点MAP差异均无统计学意义(P>0.05)，但HR从入院至手术结束7个时间点均明显升高(P<0.05，图1)。
与非焦虑患者比较，术前、术后焦虑患者术中舒芬太尼、瑞芬太尼及丙泊酚用量均增加，手术时间及麻醉时间均延长，差异均有统计学意义(P<0.05，表1)。
2.5 烧伤患者围手术期焦虑状态的影响因素分析
单因素logistic回归分析结果显示，性别(OR=3.996，P=0.002)、烧伤时间(OR=2.171，P=0.046)、烧伤面积(OR=3.527，P=0.005)、烧伤部位(OR=2.952，P=0.035)及术前疼痛程度(OR=4.348，P=0.001)可能与烧伤患者术前焦虑状态有关；烧伤时间(OR=3.130，P=0.030)、烧伤面积(OR=3.482，P=0.001)、烧伤部位(OR=4.928，P=0.016)、术前疼痛程度(OR=11.208，P=0.021)及术前焦虑状态(OR=46.667，P<0.001)可能与烧伤患者术后焦虑状态有关。年龄、血型、职业、BMI、术前并发症、手术次数、住院时间及手术类型与烧伤患者围手术期焦虑状态无关(P>0.05)(表2)。
将单因素分析中P<0.05的因素(性别、烧伤时间、烧伤面积、烧伤部位、术前疼痛程度、术前焦虑状态)赋值(如表3所示)后纳入多因素logistic回归分析，结果显示，性别、术前疼痛程度是烧伤患者术前焦虑状态的独立影响因素(OR=5.637，P=0.002；OR=3.811，P=0.022)，而术前焦虑状态是烧伤患者术后焦虑状态的独立影响因素(OR=30.372，P<0.001；表4)。
3 讨论
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烧伤患者需多次手术，痊愈过程较长，加之恢复后外观畸形、瘢痕所致功能障碍等导致精神压力较大；救治的整个过程中，焦虑、抑郁情绪可直接影响免疫系统功能，致使创面愈合时间延长[11]；另外，焦虑患者对必要的医疗救治配合度欠佳，影响烧伤后快速康复。本研究发现，烧伤患者术前、术后焦虑发生率分别为29.1%和22.3%，与国内类似研究报道的25%相近[12]。根据中国精神卫生调查成果高峰论坛，我国普通人群焦虑发生率仅为4.98%，而烧伤使其风险增加4~5倍。研究发现，烧伤患者术后焦虑状态明显改善，可能与术前对手术、麻醉、疼痛及烧伤后转归的担忧有关；当患者从麻醉中苏醒，手术麻醉顺利，甚至术后疼痛程度减轻，其焦虑随之减弱[13]。
本研究多因素logistic回归分析发现，性别、术前疼痛程度是烧伤患者术前焦虑状态的独立影响因素。术前疼痛者焦虑风险增加4.35倍，而术后疼痛者焦虑风险增加11.21倍，围手术期VAS评分与焦虑评分呈正相关，与既往研究结果一致[14-15]。研究发现，术前焦虑状态与术后焦虑状态密切相关[16]，本研究结果显示术前焦虑状态为术后焦虑状态的独立影响因素，但两者相关性有待进一步验证。有研究报道，术前焦虑可增加术后疼痛风险，早期使用干预措施缓解焦虑，可减轻术后疼痛[17]，但本研究未发现术前焦虑与术后疼痛的相关性，与Andersson等[16]的观察性研究结果一致。根据中国精神卫生调查成果高峰论坛，女性是焦虑症的高发人群，焦虑的发生率随着年龄增长先增高后降低，以50~64岁发生风险最高。本研究发现，性别是烧伤患者术前焦虑状态的独立影响因素，女性焦虑发生风险是男性的5.64倍，可能与女性更在意外貌有关[12,18-19]；但本研究未发现烧伤患者围手术期焦虑与年龄的相关性。
本研究结果显示，术前焦虑患者术中HR加快，丙泊酚及阿片类药物用量增加，与既往研究结果一致[20-21]。研究发现，术后焦虑与长时间麻醉及丙泊酚用量增加相关[22]。本研究发现，头面颈部烧伤患者更容易产生焦虑情绪。但有研究报道，头面部烧伤仅与女性焦虑相关，而男性烧伤患者的焦虑与下肢烧伤相关[15]，可能女性更倾向于容貌焦虑，而男性由于下肢烧伤所致运动障碍、行动不便等引起焦虑[23]。本研究在烧伤面积的分层比较中发现，烧伤面积为10%~30%的患者SAS评分较高，而当烧伤面积>50%时，其SAS评分反而下降，考虑与大面积烧伤患者创伤严重，机体炎症反应较重，尽管其MMSE评分正常，意识状态尚清楚，但其认知的细微变化可能影响焦虑自评的准确性有关。另外，本研究发现，AB血型烧伤患者术前SAS评分略高于其他血型患者，但差异无统计学意义；而Xu等[24]发现，AB血型患者更易发生术前焦虑。因此，焦虑与血型是否具有相关性有待进一步多中心及大样本研究探讨。另外本研究还发现，手术类型及手术次数与烧伤患者围手术期焦虑状态无明显相关性。
本研究存在一定局限性：为单中心研究，样本量仅103例，且仅初步探索了烧伤患者围手术期的神经精神状态，未来仍需进行更深入和更广泛的临床研究加以探讨。
综上所述，烧伤患者术前焦虑发生率明显高于术后，焦虑患者围手术期麻醉药物用量增加，且与手术类型、手术次数无关；性别、术前疼痛程度及术前焦虑状态为烧伤患者围手术期焦虑状态的独立影响因素。针对风险因素优化围手术期管理，有望改善烧伤患者围手术期精神状态，促进创面恢复及烧伤患者快速康复。
基金
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  • 国家自然科学基金(82001456)
文献
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2024年第49卷第7期
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doi: 10.11855/j.issn.0577-7402.2149.2023.0427
  • 接收时间：2022-10-17
  • 首发时间：2025-11-21
  • 出版时间：2024-07-28
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  • 收稿日期：2022-10-17
  • 录用日期：2023-01-02
基金
National Natural Science Foundation of China(82001456)
国家自然科学基金(82001456)
作者信息
    1山西医科大学麻醉学院，山西太原 030000
    2解放军总医院第四医学中心麻醉科，北京 100048

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