术前焦虑水平对儿童口腔颌面部日间全麻手术后疼痛的影响

doi:10.19438/j.cjoms.2025.02.008

摘要/Abstract

摘要： 目的：探讨术前焦虑水平与儿童口腔颌面部日间全麻手术后疼痛的相关性。方法：纳入3~12岁口腔颌面部日间全麻手术患儿769例,根据术后FLACC疼痛评估量表得分,将患儿分为术后疼痛组（FLACC≥ 4）和非术后疼痛组（FLACC < 4）,采用单因素和协变量矫正后的多因素回归分析,以及亚组分析,探讨术前焦虑水平与患儿术后疼痛的相关性。采用R 4.2.3软件包对数据进行统计学分析。结果：全麻下行口腔颌面部日间手术的患儿,术后疼痛发生率为25.88%。单因素回归分析显示,患儿改良耶鲁术前焦虑量表（mYPAS）评分（OR=3.31,95%CI: 2.15~5.15,P<0.001）和家长状态焦虑量表（SAI）评分（OR=2.04,95%CI: 1.14~3.69, P=0.017）与术后疼痛风险增高有关;进一步校正年龄、性别、BMI、既往史、芬太尼用量、舒芬太尼用量、氯胺酮用量、麻醉时长后,多因素回归分析显示,患儿mYPAS评分（OR=2.04,95%CI: 1.27~3.3,P=0.003）与发生术后疼痛的风险增高有关。家长特质焦虑量表（TAI）评分与患儿发生术后疼痛的风险增高无明显相关性。亚组分析结果提示,无既往疾病史和手术史患儿mYPAS评分增高,整形外科手术与既往有手术史的家长SAI评分增高,与患儿术后疼痛风险增加相关。术前患儿mYPAS与家长的SAI-TAI对术后疼痛的交互作用仅呈现趋势意义,未表现出统计学差异。结论：术前患儿焦虑水平与家长状态焦虑水平是儿童口腔颌面部日间手术后疼痛的危险因素,有效的术前焦虑干预措施有助于优化此类患者的术后疼痛管理。

关键词: 全身麻醉, 儿科, 术前焦虑, 术后疼痛, 口腔颌面部日间手术

Abstract: PURPOSE: To explore the association between preoperative anxiety levels and postoperative pain in children undergoing general anesthesia of oral and maxillofacial day surgery. METHOD: A total of 769 children aged 3-12 years undergoing general anesthesia of oral and maxillofacial day surgery were included. According to the postoperative FLACC Pain Assessment Scale score, the children were divided into a postoperative pain group (FLACC≥ 4) and a non-pain group (FLACC< 4). Univariate and multivariate regression analyses were conducted on demographic data, preoperative anxiety levels of the children and their parents, surgical type, perioperative anesthetics and analgesics between the groups to explore the association of preoperative anxiety levels and postoperative pain in these children. R 4.2.3 software package was used for data analysis. RESULTS: The incidence of postoperative pain in children under general anesthesia of oral and maxillofacial day surgery was 25.88%. Univariate regression suggested the preoperative Modified Yale Preoperative Anxiety Inventory(mYPAS) in pediatric patients (OR=3.31, 95%CI: 2.15-5.15, P< 0.001) and preoperative State Anxiety Inventory (SAI) score in parents (OR=2.04, 95%CI: 1.14-3.69, P=0.017) were associated with an increased risk of postoperative pain. After further adjusting for age, gender, BMI, medical history, fentanyl dosage, sufentanil dosage, ketamine dosage, and anesthesia duration, multiple regression analysis showed that higher mYPAS(OR=2.04, 95%CI: 1.27-3.3, P=0.003) in pediatric patients was associated with an increased risk of postoperative pain. There was no significant correlation between parental preoperative Trait Anxiety Inventory (TAI) score and the increased risk of postoperative pain in children. Subgroup analysis results showed that increased mYPAS scores in children without medical or surgery history, as well as increased SAI in parents who underwent plastic surgery or with surgery histories of their children, were associated with the higher risk of postoperative pain. The interaction between preoperative mYPAS and parental SAI-TAI on postoperative pain only showed a trend significance and did not show statistical differences. CONCLUSIONS: Preoperative anxiety levels in children and the parental state anxiety were association with high risk of postoperative pain in children undergoing oral and maxillofacial day surgery. Therefore, effective interventions to reduce preoperative anxiety may improve postoperative pain management in this pediatric population.

Key words: General anesthesia, Pediatric, Preoperative anxiety, Postoperative pain, Oral and maxillofacial day surgery

中图分类号:

R782.05

沈晓敏, 钟林宏, 李静洁, 刘锦星, 仇琳. 术前焦虑水平对儿童口腔颌面部日间全麻手术后疼痛的影响[J]. 中国口腔颌面外科杂志, 2025, 23(2): 152-158.

SHEN Xiao-min, ZHONG Lin-hong, LI Jing-jie, LIU Jin-xing, QIU Lin. Association of preoperative anxiety level and postoperative pain in children undergoing general anesthesia of oral and maxillofacial day surgery[J]. China J Oral Maxillofac Surg, 2025, 23(2): 152-158.

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