术前抗焦虑的专家共识

许力（共同执笔人），罗天元（共同执笔人），喻田（负责人/共同执笔人），王东信，王振，邓小明，黄宇光

焦虑是围术期最为常见的情绪问题。焦虑症状的核心是过分担心，表现为对未来可能发生的、难以预料的某种危险或不幸事件的担心。个体在压力状况下都有可能出现焦虑反应，适度焦虑有益于激活人体的应激机制，提高应对能力，但病理性焦虑常伴有过度的自主神经功能紊乱和运动性不安，常伴主观痛苦感和社会功能受损。

术前焦虑为患者因疾病、住院、麻醉与手术或不明原因的担心而导致的不安或紧张状态，可以表现为急性焦虑发作和慢性、广泛性的焦虑情绪,发生率达25%~80%。术前焦虑可增加术中麻醉药用量、加重术后疼痛、增加术后并发症和死亡率。

幼儿、70 years undergoing cardiac surgery. Am J Cardiol 2013, 111: 137-142.

[4] Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 2001, 45: 298-307.

[5]  Wada S, Inoguchi H, Sadahiro R, Matsuoka YJ, Uchitomi Y, Sato T, et al. Preoperative Anxiety as a Predictor of Delirium in Cancer Patients: A Prospective Observational Cohort Study. World J Surg 2019, 43: 134-142.

[6] Facco E, Stellini E, Bacci C, Manani G, Pavan C, Cavallin F, et al. Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Minerva Anestesiol 2013, 79: 1389-1395.

[7] Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg.1996，82: 445-451.

[8] Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 2011, 63 Suppl 11: S467-472.

[9] Thung A, Tumin D, Uffman JC, Tobias JD, Buskirk T, Garrett W, et al. The Utility of the Modified Yale Preoperative Anxiety Scale for Predicting Success in Pediatric Patients Undergoing MRI Without the Use of Anesthesia. J Am Coll Radiol 2018, 15: 1232-1237.

[10] Ayyadhah Alanazi A. Reducing anxiety in preoperative patients: a systematic review. Br J Nurs 2014, 23: 387-393.

[11] Haugen AS, Eide GE, Olsen MV, Haukeland B, Remme AR, Wahl AK. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. J Clin Nurs 2009, 18: 2301-2310.

[12] Alvarez-Garcia C, Yaban ZS. The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complement Ther Clin Pract 2020, 38: 101077.

[13 ] Bae H, Bae H, Min BI, Cho S. Efficacy of acupuncture in reducing preoperative anxiety: a meta-analysis. Evid Based Complement Alternat Med 2014, 2014: 850367.

[14] De Witte JL, Alegret C, Sessler DI, Cammu G. Preoperative alprazolam reduces anxiety in ambulatory surgery patients: a comparison with oral midazolam. Anesth Analg 2002, 95: 1601-1606, table of contents.

[15] Shimony N, Amit U, Minz B, Grossman R, Dany MA, Gonen L, et al. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg 2016, 125: 1513-1522.

[16] Hansen MV, Halladin NL, Rosenberg J, Gogenur I, Moller AM. Melatonin for pre- and postoperative anxiety in adults. Cochrane Database Syst Rev 2015: CD009861.

[17] Kain ZN, Mayes LC, Wang SM, Caramico LA, Krivutza DM, Hofstadter MB. Parental presence and a sedative premedicant for children undergoing surgery: a hierarchical study. Anesthesiology 2000, 92: 939-946.

[18] Liguori S, Stacchini M, Ciofi D, Olivini N, Bisogni S, Festini F. Effectiveness of an App for Reducing Preoperative Anxiety in Children: A Randomized Clinical Trial. JAMA Pediatr 2016, 170: e160533.

[19] Liu PP, Sun Y, Wu C, Xu WH, Zhang RD, Zheng JJ, et al. The effectiveness of transport in a toy car for reducing preoperative anxiety in preschool children: a randomised controlled prospective trial. Br J Anaesth 2018, 121: 438-444.

[20] Vagnoli L, Caprilli S, Robiglio A, Messeri A. Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics 2005, 116: e563-567.

[21] Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, Olkkola KT. Bioavailability of dexmedetomidine  after intranasal administration. Eur J Clin Pharmacol. 2011;67:825–831.

[22] Jun JH, Kim KN, Kim JY, Song SM. The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis. Can J Anaesth 2017, 64: 947-961.

来源：中华麻醉在线 

版权归中华医学会麻醉学分会所有