华西医学

华西医学

青年乳腺包块患者日间麦默通手术围手术期失眠相关因素分析

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目的 探讨青年乳腺包块患者日间麦默通(Mammotome,MMT)手术围手术期失眠相关危险因素。 方法 纳入 2016 年 6 月—12 月于四川大学华西医院入院诊断为乳腺包块、需要择期行乳腺包块 MMT 微创旋切活检手术的青年女性患者(n=166),并进行一般情况、围手术期失眠指数(Insomnia Severity Index,ISI)、医院焦虑抑郁量表、术后疼痛视觉模拟评分的问卷调查及收集,应用单因素回归分析对可能造成失眠的因素进行筛选,再用多因素 logistic 回归分析可能的危险因素。 结果 患者平均年龄(30.90±5.96)岁,围手术期 ISI 评分(8.83±4.97)分,其中 75 例(45.2%)无临床失眠,66 例(39.7%)轻度失眠,21 例(12.7%)中度失眠,4 例(2.4%)重度失眠。乳腺包块数量[以 1 个为参照,乳腺包块数量=4 个时:比值比(odds ratio,OR)=2.269,95% 置信区间(confidence interval,CI)(1.917,13.818),P=0.001;乳腺包块数量>4 个时,OR=9.359,95%CI(4.507,19.433),P<0.001]及乳腺包块最大直径[以 1~10 mm 为参照,乳腺包块最大直径为 26~30 mm 时:OR=6.989,95%CI(1.488,32.785),P=0.014;乳腺包块最大直径>30 mm 时:OR=17.290,95%CI(4.664,64.071),P<0.001]是影响患者围手术期睡眠困难程度的独立危险因素。 结论 对于乳腺包块数量> 3 个或乳腺包块直径> 25 mm 的青年乳腺包块患者,应重点进行术前全面的健康宣教及心理护理,缓解患者心理压力,并在术后给予一定的睡眠辅助治疗,进而促进失眠高危患者的术后快速康复。

Objective To explore the risk factors of perioperative insomnia in young patients with breast masses undergoing ambulatory Mammotome (MMT) minimally invasive surgery. Methods A total of 166 young female patients who were ≤40 years old, diagnosed with breast masses, undergoing ambulatory MMT between June and December 2016 in West China Hospital of Sichuan University were included in this study. Questionnaire survey and data about general condition, preoperative and postoperative Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale, and postoperative pain Visual Analogue Scale were collected in the enrolled population. Univariate analysis was used to screen the factors that might cause insomnia, and then multiple logistic regression analysis was performed to identify possible risk factors of insomnia. Results In the 166 young female patients, the mean age was (30.90±5.96) years, and the mean perioperative ISI score was 8.83±4.97. Slight insomnia was found in 39.7% (66/166) of the patients, moderate insomnia was found in 12.7% (21/166), and severe insomnia was found in 2.4% (4/166). The results of multiple logistic regression suggested that the number of breast masses [taking the number=1 as the reference, when the number=4, odds ratio (OR)=2.269, 95% confidence interval (CI) (1.917, 13.818), P=0.001; when the number>4,OR=9.359, 95%CI (4.507, 19.433), P<0.001] and the maximum diameter of breast masses [taking 1–10 mm as the reference, when the maximum diameter was 26–30 mm,OR=6.989, 95%CI (1.488, 32.785), P=0.014; when the maximum diameter >30 mm, OR=17.290, 95%CI (4.664, 64.071), P<0.001] were independent risk factors of the severity of perioperative insomnia in these young women. Conclusion It is recommended that psychological nursing and comprehensive admission education should be enhanced for young patients who have >3 breast masses or the diameter of the mass is >25 mm, aiming to improve the postoperative recovery of patients with high risk of insomnia.

关键词: 乳腺包块; 麦默通微创旋切手术; 失眠指数; 日间手术; 危险因素

Key words: Breast mass; Mammotome minimally invasive surgery; Insomnia Severity Index; Day surgery; Risk factors

引用本文: 蔡雨廷, 朱敏, 张素清, 龙小清, 马洪升, 戴燕. 青年乳腺包块患者日间麦默通手术围手术期失眠相关因素分析. 华西医学, 2017, 32(11): 1661-1666. doi: 10.7507/1002-0179.201709093 复制

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