耳鼻咽喉头颈外科手术患者术前焦虑水平对围手术期应激反应及术后恢复的影响OA

Objective To explore the influence of preoperative anxiety level on perioperative stress response and postoperative recovery in patients undergoing otorhinolaryngology head and neck surgery.Methods A total of 156 patients undergoing otorhinolaryngology head and neck surgery admitted to the First Affiliated Hospital of Air Force Medical University from June 2023 to June 2025 were selected as research subjects.According to the self-rating anxiety scale scores,patients were categorized into a no or mild anxiety group(≤59 points,71 cases),a moderate anxiety group(60-69 points,46 cases),and a severe anxiety group(>69 points,39 cases).Perioperative stress hormone levels[cortisol(Cor),norepinephrine(NE),angiotensin Ⅱ(AngⅡ),insulin],vital signs[heart rate(HR),systolic blood pressure(SBP)],and postoperative recovery outcomes(postoperative complications,time to ambulation,length of hospital stay,number of postoperative analgesic administrations)were compared among the groups.Results One day before surgery,levels of Cor,NE,AngⅡ,and insulin in the severe anxiety group were higher than those in the no or mild anxiety group and the moderate anxiety group(P<0.05).On the day of surgery,Cor,NE,AngⅡ,and insulin levels in the moderate anxiety group were lower than those in the no or mild anxiety group and the severe anxiety group(P<0.05),and levels in the no or mild anxiety group were lower than those in the severe anxiety group(P<0.05).One day after surgery,insulin level in the no or mild anxiety group was lower than that in the severe anxiety group(P<0.05),and levels of Cor,NE,AngⅡ,and insulin in the moderate anxiety group were lower than those in the no or mild anxiety group and the severe anxiety group(P<0.05).Upon entering the operating room,HR in the severe anxiety group was higher than that in the no or mild anxiety group and the moderate anxiety group(P<0.05).At 0.5 hours after surgery began,HR and SBP in the moderate anxiety group were lower than those in the no or mild anxiety group and the severe anxiety group(P<0.05).At 1 hour after surgery,HR in the moderate anxiety group was lower than that in the no or mild anxiety group and the severe anxiety group(P<0.05),and HR in the no or mild anxiety group was lower than that in the severe anxiety group(P<0.05).Time to ambulation and length of hospital stay in the moderate anxiety group were shorter than those in the no or mild anxiety group and the severe anxiety group;length of hospital stay in the no or mild anxiety group was shorter than that in the severe anxiety group;and the proportion of patients requiring postoperative analgesics less than twice was higher in the moderate anxiety group than in the severe anxiety group(P<0.05).Conclusion Patients with no,mild,or moderate preoperative anxiety exhibited a milder stress response than severe anxiety patients one day before surgery.However,after surgery,patients with moderate anxiety showed the mildest stress response,followed by those with no or mild anxiety,while severe anxiety patients had the most pronounced response.Patients with moderate preoperative anxiety had the shortest time to ambulation and hospital stay,and required the fewest postoperative analgesic administrations.