| Objective: To study the preoperative anxiety status and its influencing factors of lung cancer patients in thoracic surgery under the concept of accelerated rehabilitation surgery;to further explore the effect of music therapy on the control and reduction of perioperative anxiety status of lung cancer patients in thoracic surgery through clinical trials,and to explore its influence on restlessness,pain and vital signs after general anesthesia.Methods: 96 patients who undergoing pulmonary resection for primary lung cancer preoperative SAI questionnaires were enrolled in this study from April to August 2017 were included in this study.The preoperative anxiety status of patients was assessed by state anxiety scale(SAI),and the related risk factors leading to preoperative anxiety were analyzed.On this basis,we prospectively designed the effect of music therapy on perioperative anxiety of patients undergoing lung cancer surgery.A randomized controlled clinical trial was conducted in the Department of Thoracic Surgery,Affiliated Hospital of Qingdao University.Sixty patients were recruited and randomly divided into experimental group(n = 30)and control group(n = 30).The experimental group received standard nursing,60 minutes music therapy,15 minutes music therapy before operation,30 minutes music therapy during anesthesia recovery and 30 minutes music therapy on the first day after operation,while the control group only received standard nursing.Observation indicators included anxiety,pain,vital signs(blood pressure,heart rate,oxygen saturation and respiratory frequency),degree of anesthesia agitation,postoperative complications and evaluation of treatment satisfaction.SPSS(version 21.0)was used to analyze the data.Descriptive statistics was used to analyze the characteristics of the research objects and the survey results.In the multivariate analysis of anxiety risk factors in patients with lung cancer before operation,logistic regression was used to analyze the risk factors of anxiety level.Pay attention to the p-value of hosmer-lemeshowtest as the goodness-of-fit index of the model.Chi-square test was used to determine any significant differences in demographic data between the two groups.Independent t-test was used to detect any significant differences in baseline anxiety,blood pressure,heart rate,oxygen saturation and respiratory frequency.In this study,repeated measurement variance analysis(Renova)model and simple effect model were used to analyze anxiety,pain,blood pressure,heart rate,oxygen saturation and respiratory frequency at all time points,and to evaluate the difference.Take a = 0.05 as the test level.Results: In the current study of 96 patients with preoperative anxiety of lung cancer,the average SAI score was 37.76(10.64);54.17% of them had low anxiety,43.75% had moderate anxiety and 2.08% had high anxiety.The risk factors of low anxiety patients,moderate and high anxiety patients were analyzed and compared.The variables related to preoperative anxiety were gender(?2=4.51,P=0.034),operation history(?2=5.47, P=0.019),education level(?2=7.21,P=0.027),complications(?2=5.75,P=0.016),and there was no significant difference in age,religious belief,blood type,clinical stage of tumors,smoking history,preoperative hospitalization days,etc.(P > 0.05).In multivariate analysis,education level(P = 0.049)was a risk factor for preoperative anxiety;gender(P = 0.061),complications(P = 0.051)and surgical history(P = 0.0501)tended to be associated with anxiety,but there was no statistical significance.In the clinical trial of music therapy intervention,the results of repeated measurement variance showed that there were significant differences in anxiety(F=15.82,P<0.0001),pain(F=4.98,P=0.01),systolic blood pressure(F=3.25,P=0.044)and heart rate(F=3.99,P=0.024)between the music group and the control group.Further analysis of simple effect model showed that anxiety,pain,systolic blood pressure and heart rate were in the music group after operation.The mean state anxiety score of music group was significantly lower than that of control group(P < 0.05).The average difference of anxiety state and 95% confidence interval between music group and control group were-6.07(-9.34,-2.80),-7.07(-9.55,-4.58)and-9.00(-11.16,-6.84),respectively.The average difference of pain and 95% confidence intervals were-0.58(-1.06,-0.07),-1.03(-1.46,-0.60)and-1.20(-1.49,-0.91).The mean difference of systolic blood pressure and 95% confidence intervals were-6.17(-10.57,-1.76),-8.97(-13.01,-4.93)and-11.37(-14.58,-8.15),and the mean difference of heart rate and 95% confidence intervals were-2.57(-5.13,-0.001),-4.00(-6.91,-1.01)and-5.13(-7.52,-2.74),respectively.There were no significant differences in diastolic pressure and respiratory rate between music group and control group(P > 0.05);systolic pressure and heart rate of music group were significantly lower before and after anesthesia intubation and during extubation of trachea tube(P < 0.05).Riker's Sedation-Agitation(SAS)score during the recovery period was significantly lower than that in the control group(?2 = 7.92,P =0.048).Conclusion: This study found that anxiety is prevalent in patients with lung cancer during perioperative period.Gender,education level,operation history and complications may be risk factors for anxiety.In order to improve the safety and efficacy of perioperative operation,psychological assessment and necessary intervention measures should be taken for patients with lung cancer who have high-risk anxiety factors.Our further clinical trials confirm that music therapy can alleviate perioperative anxiety,reduce systolic blood pressure and heart rate,effectively reduce restlessness after general anesthesia,increase the stability of general anesthesia,alleviate pain to a certain extent,and effectively improve the prognosis of patients with lung cancer.In addition,the study found that most of the patients who participated in music therapy believed that music could alleviate anxiety. |
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