口腔颌面部肿瘤患者手术恐惧现状及影响因素分析

doi:10.7518/hxkq.2024.2024039

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (4): 494-501.doi: 10.7518/hxkq.2024.2024039

口腔颌面部肿瘤患者手术恐惧现状及影响因素分析

张宇¹^,²(), 况黎霞¹, 毕小琴²(), 詹学莉², 张天雨²

^1.四川大学华西护理学院，成都 610041
^2.口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041

收稿日期:2024-01-25 修回日期:2024-02-26 出版日期:2024-08-01 发布日期:2024-07-17
通讯作者: 毕小琴 E-mail:2051620394@qq.com;hxbxq@163.com
作者简介:张宇，护士，硕士，E-mail：2051620394@qq.com
基金资助:
四川省科技计划项目(2022JDKP0007);成都市医学科研课题(2022015)

Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors

Zhang Yu¹^,²(), Kuang Lixia¹, Bi Xiaoqin²(), Zhan Xueli², Zhang Tianyu²

^1.West China School of Nursing, Sichuan University, Chengdu 610041, China
^2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2024-01-25 Revised:2024-02-26 Online:2024-08-01 Published:2024-07-17
Contact: Bi Xiaoqin E-mail:2051620394@qq.com;hxbxq@163.com
Supported by:
Science and Technology Program of Sichuan Province(2022JDKP0007);Chengdu Medical Research Project(2022015)

摘要/Abstract

摘要：

目的调查口腔颌面部肿瘤患者手术恐惧的发生率及严重程度。方法选取拟行手术的口腔颌面部肿瘤患者作为调查对象。采用一般资料调查表、外科手术恐惧问卷（SFQ）、患者健康问卷抑郁量表（PHQ-9）及广泛性焦虑量表（GAD-7）进行调查。结果研究共纳入203例患者。173例（85.22%）患者存在手术恐惧，SFQ得分的中位数为20，四分位数为（6，36）。恐惧水平分为无、轻度、中度、重度水平，性别、糖尿病、术前明显不适症状、PHQ-9、GAD-7得分为各恐惧水平具有统计学差异的变量。多因素分析显示，女性中度恐惧（OR=2.19，P=0.03）和重度恐惧（OR=2.72，P=0.01）较多，糖尿病患者重度恐惧（OR=3.33，P=0.02）较多，术前有明显不适症状的患者无恐惧（OR=4.73，P=0.02）较多。203例患者的抑郁、焦虑发生率分别为31.03%和24.63%，重度恐惧患者合并焦虑及抑郁的发生率为40.00%。手术恐惧分布与焦虑（r=0.491，P<0.001）、抑郁（r=0.514，P<0.001）呈中度正相关。结论口腔颌面部肿瘤患者普遍存在手术恐惧且恐惧程度分布于各水平段。医护人员可根据影响因素筛选和评估中、重度手术恐惧人群，根据恐惧来源采取针对性的干预措施以减轻手术恐惧和焦虑、抑郁情绪。

关键词: 口腔颌面部肿瘤, 手术恐惧, 焦虑, 抑郁, 影响因素

Abstract:

Objective This study aimed to investigate the incidence and severity of surgical fear in patients with oral and maxillofacial tumors. Methods The survey participants were composed of patients with oral and maxillofacial tumors, who were scheduled to undergo surgery. A general information questionnaire, the Surgical Fear Questionnaire (SFQ), the Patient Health Questionnaire (PHQ)-9, and the Generalized Anxiety Disorder (GAD)-7 score were used for the investigation. Results A total of 203 patients were investigated. Among them, 85.22% had fear of surgery. The median score of SFQ was 20, and the quartile was (6, 36). The patients were categorized into none, mild, moderate, and severe groups according fear level. Gender, diabetes, obvious discomfort before surgery, PHQ-9, and GAD-7 scores were the variables with statistical difference in each fear level. Multifactor analysis showed that women were more likely to have moderate and severe fear than men (OR=2.19, P=0.03; OR=2.72, P=0.01), patients with obvious preoperative discomfort symptoms were more inclined to have no fear (OR=4.73, P=0.02), and patients with diabetes were more likely to have severe fear (OR=3.33, P=0.02). The incidence rates of depression and anxiety were 31.03% and 24.63%, respectively. The incidence of anxiety and depression in patients with severe fear was 40.00%. Surgical fear was moderately positively correlated with anxiety (r=0.491, P<0.001) and depression (r=0.514, P<0.001). Conclusion The fear of surgery in patients with oral and maxillofacial tumors is common and distributed in all levels. Medical staff can screen and assess patients with moderate and severe fear of surgery in accordance with the influencing factors and implement targeted interventions to reduce fear of surgery, anxiety, and depression on the basis of the source of fear.

Key words: oral and maxillofacial tumor, fear of surgery, anxiety, depression, influencing factor

中图分类号:

R739.8

张宇, 况黎霞, 毕小琴, 詹学莉, 张天雨. 口腔颌面部肿瘤患者手术恐惧现状及影响因素分析[J]. 华西口腔医学杂志, 2024, 42(4): 494-501.

Zhang Yu, Kuang Lixia, Bi Xiaoqin, Zhan Xueli, Zhang Tianyu. Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors[J]. West China Journal of Stomatology, 2024, 42(4): 494-501.

图/表 9

表 1

图 1

图 2

表 2

图 3

图 4

表 3

各恐惧水平具有统计学差异的变量

变量	无恐惧	轻度恐惧	中度恐惧	重度恐惧	$χ 2 / H$ 值	P值
性别					8.35	0.03
男	20（17.24%）	45（38.79%）	30（25.86%）	21（18.10%）
女	10（11.49%）	21（24.14%）	32（36.78%）	24（27.59%）
是否患糖尿病					8.21	0.04
是	7（23.33%）	7（23.33%）	5（16.67%）	11（36.67%）
否	23（13.29%）	59（34.10%）	57（32.95%）	34（19.65%）
术前有无明显不适症状					9.72	0.02
有	27（19.01%）	42（29.58%）	46（32.39%）	27（19.01%）
无	3（4.92%）	24（39.34%）	16（26.23%）	18（29.51%）
PHQ-9	0（0，2）	1.5（0，4）	3（1，6）	5（3，8）	10.04	<0.01
GAD-7	0（0，1）	1（0，4）	3（0，6）	4（0，7.5）	7.49	<0.01

表 3

表 4

图 5

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变量	n/%
年龄/岁
18~44	55/27.09
45~59	72/35.47
≥60	76/37.44
性别
男	116/57.14
女	87/42.86
职业
在职	124/61.08
退（离）休人员	63/31.03
无业人员	16/7.88
学历
小学及以下	42/20.69
初中	55/20.09
高中/中专	32/15.76
本科/大专及以上	74/36.45
婚姻情况
已婚	175/86.21
未婚	17/8.37
离异/丧偶	11/5.42
是否患高血压
是	58/28.57
否	145/71.43
是否患糖尿病
是	30/14.78
否	173/85.22
有无全麻手术经历
有	104/51.23
无	99/48.77
术前有无明显不适症状
有	142/69.95
无	61/30.05
病变类型
恶性肿瘤	123/60.59
良性肿瘤	46/22.66
囊肿	34/16.75
病变部位
颌骨	52/25.62
颊部	23/11.33
口底	21/10.34
腮腺	27/13.30
舌	31/15.27
其他	49/24.14
是否行游离皮瓣移植术
是	98/48.28
否	105/51.72
是否行淋巴清扫术
是	64/31.53
否	139/68.47

类别	AIC	BIC	aBIC	P值		Entropy	类别比例
类别	AIC	BIC	aBIC	LMR	BLRT	Entropy	类别比例
1	8 052.29	8 105.30	8 054.61			1.00
2	7 190.82	7 273.65	7 194.44	<0.001	<0.001	0.95	0.372/0.628
3	6 977.36	7 090.01	6 982.29	<0.001	<0.001	0.92	0.309/0.205/0.485
4	6 842.42	6 984.89	6 848.65	<0.001	<0.001	0.94	0.250/0.228/0.088/0.435

自变量	无恐惧		中度恐惧		重度恐惧
自变量	B值	OR（95%CI）	B值	OR（95%CI）	B值	OR（95%CI）
性别
男	参照
女	0.01	1.01（0.40~2.58）	0.79	2.19（1.06~4.52）*	1.00	2.72（1.22~6.06）*
是否患糖尿病
否	参照
是	0.73	2.08（0.64~6.73）	-0.33	0.72（0.21~2.45）	1.20	3.33（1.13~9.79）*
术前有无明显不适症状
无	参照
有	1.55	4.73（1.28~17.45）*	0.46	1.59（0.73~3.44）	-0.42	0.66（0.29~6.06）

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口腔颌面部肿瘤患者手术恐惧现状及影响因素分析

Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors

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