认知行为疗法对胸外科手术前焦虑老年患者术后谵妄的影响  

Effect of cognitive-behavioral therapy on postoperative delirium in elderly patients with preoperative anxiety before thoracic surgery

作　　者：曹秀丽 奚高原[1] 周俊辉[1] 陈远远 赵丽姣 CAO Xiu-li;XI Gao-yuan;ZHOU Jun-hui;CHEN Yuan-yuan;ZHAO Li-jiao(Department of Thoracic Surgery,Henan Provincial Chest Hospital,Affiliated Chest Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院,郑州大学附属胸科医院胸外科,郑州450000

出　　处：《医药论坛杂志》2023年第19期57-62,共6页Journal of Medical Forum

摘　　要：目的探讨认知行为疗法(cognitive-behavioral therapy,CBT)对胸外科手术前焦虑老年患者术后谵妄(postoperative delirium,POD)的影响。方法招募于河南省胸科医院手术室择期行全身麻醉下胸腔镜肺癌根治术的老年患者220例,年龄65~79岁,汉密尔顿焦虑量表(HAMA)评分>14分,依据随机数字表法将其分成对照组和研究组,每组110例。术前对照组患者给予常规抗焦虑治疗,研究组患者在对照组的基础上给予CBT。术后3 d内采用重症监护室(ICU)意识障碍评估法(CAM-ICU)进行POD的评估。使用15项恢复质量问卷(QoR-15)在术后第1 d和第2 d评估恢复质量。记录首次下地活动时间及住院时间。记录患者术前及术后1 d、3 d时的血常规。记录术中及术后并发症包括窦性心动过缓或低血压/高血压、术后感染等发生率。结果术后3 d内,研究组和对照组患者分别有23例(20.9%)和38例(34.5%)发生了POD,分别有87例(79.1%)和72例(65.5%)未发生POD,组间比较差异有统计学意义(P<0.05)。术后第1 d和第2 d时,研究组患者QoR-15评分较对照组均显著升高(P<0.05)。与对照组比较,研究组患者首次下地活动时间显著缩短(P<0.05)。两组患者在术后住院时间上无显著差异(P>0.05)。两组术后1 d、3 d时白细胞计数、中性粒细胞计数和中性粒细胞百分比较术前均增高,但研究组均显著低于对照组(P<0.05)。与对照组比较,研究组术中窦性心动过缓和低血压发生率均显著下降(P<0.05)。结论CBT可减低胸外科手术前焦虑的老年患者术后早期炎性反应,降低POD发生率,改善早期临床预后。Objective To investigate the effect of cognitive-behavioral therapy(CBT)on postoperative delirium in eld⁃erly patients with preoperative anxiety before thoracic surgery.Methods Totally 220 patients,aged 65-79 years,with Hamilton Anxiety Scale(HAMA)score>14,and who underwent thoracoscopic radical mastectomy for lung cancer un⁃der general anesthesia in the operating room of Henan Provincial Chest Hospital,were recruited and divided into control group and test group,110 cases in each group,according to the random number table method.The patients in the con⁃trol group were given routine anti-anxiety treatment before operation,and the patients in the test group were given CBT on the basis of the control group.POD was assessed by the intensive care unit(ICU)consciousness disturbance assess⁃ment method(CAM-ICU)within 3 days after the operation.The quality of recovery was assessed on the first and sec⁃ond day postoperative using the 15-item Quality of Recovery Questionnaire(QoR-15).The time of first ground mo⁃tion and postoperative hospital stay were recorded.Peripheral venous blood was drawn on 1 day before operation and 1 day and 3 days after operation,and blood routine was determined.The incidence rate of intraoperative and postoperative complications including sinus bradycardia or hypotension/hypertension,postoperative infection,etc.were recorded.Results Within 3 days after operation,POD occurred in 23 patients(20.9%)and 38 patients(34.5%)in test group and control group,respectively,and 87 patients(79.1%)and 72 patients(65.5%)did not develop POD,respectively,and the difference between groups was statistically significant(P<0.05).On the first day and the second day after surgery,the QoR-15 scores of patients in the test group were significantly higher than those of the control group(P<0.05).Compared with the control group,the time of first ground motion in the test group was significantly shorter(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).The w

关 键 词：认知行为疗法 焦虑 术后谵妄 炎性反应 胸外科手术 老年人 

分 类 号：R619[医药卫生—外科学]