| 摘要: |
| ［摘要］ 目的 探讨认知行为疗法(CBT)联合艾司西酞普兰缓解结直肠癌老年患者围术期焦虑状态的效果及对术后谵妄(POD)发生的影响。方法 招募2021年11月至2022年8月于淮南东方医院集团总医院接受腹腔镜结直肠癌根治术的老年患者110例，采用随机数字表法将其分为观察组和对照组，每组55例。对照组患者自入院当天至术前1 d给予艾司西酞普兰，观察组在对照组干预方案基础上联合CBT。主要观察指标为术后3 d内的POD发生率。次要观察指标包括：入院当天、术前1 d，以及术后1 d、3 d和7 d汉密尔顿焦虑量表（HAMA）评分和简易精神状态检查（MMSE）评分；术后48 h内数字评分量表(NRS)评分和Ramsay镇静评分；术后不良事件发生率；术后1 d和2 d的15项恢复质量问卷(QoR-15)评分。记录患者首次下地活动时间及住院时间。结果 与入院当天相比，两组MMSE评分和HAMA评分均呈下降趋势，观察组的HAMA评分下降幅度较对照组更大，在术前1 d，以及术后1 d、3 d、7 d，观察组HAMA评分较对照组更低，差异有统计学意义（P<0.05）。两组MMSE评分变化幅度差异无统计学意义（P>0.05）。两组术后NRS评分均呈下降趋势，Ramsay镇静评分呈升高趋势，但两组变化幅度差异无统计学意义(P>0.05)。在术后3 d内，观察组的POD发生率显著低于对照组（10.91% vs 30.91%； χ2=6.652，P=0.010），两组POD严重程度评分及POD持续时间比较差异无统计学意义(P>0.05)。在术后1 d、2 d，观察组患者QoR-15评分显著高于对照组(P<0.05)。与对照组比较，观察组患者首次下地活动时间更早，差异有统计学意义(P<0.05)。结论 CBT联合艾司西酞普兰可减轻腹腔镜结直肠癌根治术老年患者围术期的焦虑状态，降低POD发生率，有利于患者快速康复。 |
| 关键词: 认知行为治疗 艾司西酞普兰 焦虑 术后谵妄 老年患者 |
| DOI：10.3969/j.issn.1674-3806.2023.06.12 |
| 分类号:R 619 |
| 基金项目:河南省医学科技攻关计划-联合共建项目（编号：LHGJ20220799） |
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| Cognitive behavioral therapy combined with escitalopram to alleviate perioperative anxiety in elderly patients with colorectal cancer and its effect on postoperative delirium |
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XUE Ling, ZOU Xu, XIA Ji-chang, et al.
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Department of Anesthesiology, General Hospital of Huainan Oriental Hospital Group(Affiliated Hospital of Anhui University of Science and Technology), Anhui 232000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the efficacy of cognitive behavioral therapy(CBT) combined with escitalopram in alleviating postoperative anxiety in elderly patients with colorectal cancer and its effect on the occurrence of postoperative delirium(POD). Methods A total of 110 elderly patients who received laparoscopic radical resection of colorectal cancer in General Hospital of Huainan Oriental Hospital Group from November 2021 to August 2022 were recruited and divided into observation group and control group by random number table method, with 55 cases in each group. The patients in the control group were given escitalopram from the day of admission to the day before surgery, and the observation group received CBT plus the same treatment as the control group. The incidence of POD within three days after surgery was the main observation indicator. The secondary observation indicators included the following: the Hamilton Anxiety Scale(HAMA) scores and Mini-Mental State Examination(MMSE) scores on the day of admission, 1 day before surgery, and 1, 3 and 7 days after surgery; the Numerical Rating Scale(NRS) scores and Ramsay sedation scores within 48 hours after surgery; the incidence of postoperative adverse events; 15-Item Quality of Recovery Questionnaire(QoR-15) scores 1 and 2 days after surgery. The off-bed ambulation time and the length of hospital stay were recorded in the patients. Results Compared with those on the day of admission, the MMSE scores and HAMA scores in the two groups showed a downward trend, and the HAMA scores of the observation group decreased more than those of the control group, and the HAMA scores of the observation group were lower than those of the control group 1 day before surgery, and 1, 3 and 7 days after surgery, and the differences were statistically significant(P<0.05). There was no significant difference in the range of MMSE scores between the two groups(P>0.05). The postoperative NRS scores showed a downward trend, and the Ramsay sedation scores showed an upward trend in the two groups, but there were no statistically significant differences in the ranges of the changes between the two groups(P>0.05). Within 3 days after surgery, the incidence of POD in the observation group was significantly lower than that in the control group(10.91% vs 30.91%; χ2=6.652, P=0.010), and there were no significant differences in POD severity score and POD duration between the two groups(P>0.05). The QoR-15 scores of the observation group were significantly higher than those of the control group on the first day and the second day after surgery(P<0.05). Compared with the control group, the observation group had earlier off-bed ambulation time, and the difference was statistically significant(P<0.05). Conclusion CBT combined with escitalopram can reduce perioperative anxiety in elderly patients undergoing laparoscopic radical resection of colorectal cancer, reduce the incidence of POD, and facilitate rapid recovery of the patients. |
| Key words: Cognitive behavioral therapy(CBT) Escitalopram Anxiety Postoperative delirium Elderly patients |
