Conscious Experience and Psychological Consequences of Awake Craniotomy
Conscious Experience and Psychological Consequences of Awake Craniotomy
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DOI：
10.1016/j.wneu.2019.05.156
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发表时间：
2019-09-01
影响因子：
2
通讯作者：
Surbeck, Werner
中科院分区：
文献类型：
--
作者：
Hejrati, Nader;Spieler, Derek;Surbeck, Werner
背景技术背景：在清醒条件下进行颅脑手术可能会使患者暴露于相当大的心理strain.METHODS：本研究的目的是调查清醒开颅手术（AC）脑肿瘤后的心理后遗症的发生和过程中的一系列20例患者使用广泛的，有效的心理评估术前，术中，术后和标准化的后续3个月。此外，关联的术前心理状况（包括，但不限于，焦虑和恐惧）与围手术期疼痛的感知和干扰assessed.RESULTS：AC没有引起任何转移的焦虑，抑郁和应激症状的中位数水平已经存在的程序之前。此外，随着时间的推移，焦虑和抑郁都有中度至强烈的相关性（均P < 0.05）。压力症状也呈正相关的所有时间的测量。术后3天的压力与术后3个月的压力密切相关（P < 0.001），而术前和术后即刻压力之间的相关性显示出统计学趋势（P = 0.07）。术前恐惧与术中疼痛无关，但与术后第3天疼痛及其对日常活动的干扰有关（分别为P < 0.001和P < 0.01）。因此，在我们的系列中，心理健康并没有受到AC体验的负面影响。术中恐惧和疼痛与术前心理状况无关。然而，术前恐惧和焦虑与术后疼痛及其对日常活动的干扰呈正相关。
BACKGROUND: Experiencing cranial surgery under awake conditions may expose patients to considerable psychological strain.METHODS: This study aimed to investigate the occurrence and course of psychological sequelae following awake craniotomy (AC) for brain tumors in a series of 20 patients using a broad, validated psychological assessment preoperatively, intraoperatively, postoperatively and a standardized follow-up of 3 months. In addition, the association of the preoperative psychological condition (including, but not limited to, anxiety and fear) with peri-operative pain perception and interference was assessed.RESULTS: AC did not induce any shift in the median levels of anxiety, depression, and stress symptoms already present prior to the procedure. Furthermore, anxiety and depression were all moderately to strongly associated over time (all P < 0.05). Stress symptoms also correlated positively over all times of measurement. Stress 3 days after surgery was strongly associated with stress 3 months after surgery (P < 0.001), whereas the correlation between preoperative and immediate postoperative stress showed a statistical trend (P = 0.07). Preoperative fear was not related to intraoperative pain, but to pain and its interference with daily activity on the third postoperative day (P < 0.001 and P < 0.01, respectively).CONCLUSIONS: Postoperative psychological symptoms clearly correlated with their corresponding preoperative symptoms. Thus, mental health was not negatively affected by the AC experience in our series. Intraoperative fear and pain were not related to the preoperative psychological condition. However, preoperative fear and anxiety were positively related with pain and its interference with daily activity in the immediate postoperative period.