颈部淋巴结结核患者术前焦虑现状及其影响因素

doi:10.19982/j.issn.1000-6621.20260179

摘要/Abstract

摘要：

目的: 调查颈部淋巴结结核患者术前焦虑现状,识别独立影响因素,为制定针对性护理干预措施、缓解患者焦虑、促进术后康复提供科学依据。 方法: 采用便利抽样法,选取2023年10月至2024年9月于上海市公共卫生临床中心胸外科拟行择期手术的颈部淋巴结结核患者94例为研究对象。通过一般资料调查问卷、焦虑自评量表(self-rating anxiety scale,SAS)、社会支持评定量表(social support rating scale,SSRS)收集数据,采用SPSS 26.0软件进行统计分析。 结果: 94例患者术前焦虑标准分为(59.06±17.89)分,明显高于国内普通人群常模(33.80±5.90)分(t=12.345,P<0.001);其中,无焦虑28例(29.8%)、轻度焦虑14例(14.9%)、中度焦虑21例(22.3%)、重度焦虑31例(33.0%),55.3%(52/94)的患者存在中度及以上焦虑。社会支持总分为(42.87±13.29)分,其中,低水平支持19例(20.2%)、中等水平支持58例(61.7%)、高水平支持17例(18.1%)。Pearson相关性分析显示,术前焦虑与社会支持呈显著负相关(r=-0.499,P<0.001)。多元线性回归分析显示,女性(β=6.515,95%CI:0.925~12.105)、大专及以上学历(β=12.007,95%CI:6.232~17.782)、结核病相关手术次数≥2次(β=12.462,95%CI:5.690~19.235)、了解自身病情(β=-11.471,95%CI:-17.286~-5.657)、社会支持得分低(β=-0.228,95%CI:-0.527~-0.033)均与术前焦虑相关。 结论: 颈部淋巴结结核患者术前焦虑发生率高且程度突出,临床需重点关注女性、高受教育程度、病情认知不足、多次结核病相关手术经历及社会支持匮乏的患者,通过性别差异化心理疏导、精准健康宣教、社会支持强化等个性化干预措施,改善其焦虑状态,为手术顺利实施及术后康复奠定基础。

关键词: 结核,淋巴结, 颈, 焦虑, 社会支持, 危险因素, 围手术期护理

Abstract:

Objective: To investigate the current status of preoperative anxiety among patients with cervical lymph node tuberculosis, identify independent influencing factors, and provide a scientific basis for targeted nursing interventions to alleviate anxiety and promote postoperative recovery. Methods: A convenience sample of 94 patients with cervical lymph node tuberculosis scheduled for elective surgery at Shanghai Public Health Clinical Center from October 2023 to September 2024 was enrolled. Data were collected using a demographic questionnaire, the Self-Rating Anxiety Scale (SAS), and the Social Support Rating Scale (SSRS). Statistical analysis was performed using SPSS 26.0. Results: The mean preoperative anxiety standard score of the 94 patients was 59.06±17.89, significantly higher than the Chinese national norm (33.80±5.90, t=12.345, P<0.001). Among them, 28 (29.8%) had no anxiety, 14 (14.9%) had mild anxiety, 21 (22.3%) had moderate anxiety, and 31 (33.0%) had severe anxiety; 55.3% (52/94) exhibited moderate or higher anxiety. The total social support score was 42.87±13.29. Pearson correlation analysis showed a significant negative correlation between preoperative anxiety and social support (r=-0.499, P<0.001). Multivariate linear regression identified female sex (β=6.515,95%CI:0.925-12.105), college degree or above (β=12.007,95%CI:6.232-17.782), history of ≥2 tuberculosis-related surgeries (β=12.462,95%CI:5.690-19.235), lack of disease awareness (β=-11.471,95%CI:-17.286--5.657), and low social support score (β=-0.228,95%CI:-0.527--0.033) related to preoperative anxiety. Conclusion: Preoperative anxiety is highly prevalent and severe in patients with cervical lymph node tuberculosis. High-risk groups include female patients, those with higher education, multiple previous tuberculosis-related surgeries, insufficient disease awareness, and low social support. Personalized nursing interventions are recommended to alleviate anxiety before surgery.

Key words: Tuberculosis,lymph node, Neck, Anxiety, Social support, Risk factors, Perioperative nursing

中图分类号:

黄丽萍, 顾雯菊, 包赔煜, 沈佳怡, 宋言峥, 张林. 颈部淋巴结结核患者术前焦虑现状及其影响因素[J]. 中国防痨杂志, 2026, 48(9): 1324-1330. doi: 10.19982/j.issn.1000-6621.20260179

Huang Liping, Gu Wenju, Bao Peiyu, Shen Jiayi, Song Yanzheng, Zhang Lin. The current status and influencing factors of preoperative anxiety in patients with cervical lymph node tuberculosis[J]. Chinese Journal of Antituberculosis, 2026, 48(9): 1324-1330. doi: 10.19982/j.issn.1000-6621.20260179

图/表 3

表1

表2

表3

参考文献 30

[1]	高璐珏, 黄子慧, 王新方, 等. 淋巴结结核1082例临床分析[J]. 中国感染与化疗杂志, 2021, 21(5):505-511. doi:10.16718/j.1009-7708.2021.05.001.
[2]	中国人民解放军总医院第八医学中心结核病医学部,《中国防痨杂志》编辑委员会,中国医疗保健国际交流促进会结核病防治分会. 浅表淋巴结结核的诊断与治疗专家共识[J]. 中国防痨杂志, 2023, 45(6):531-542. doi:10.19982/j.issn.1000-6621.20230120.
[3]	徐志鸿, 吴国谦. 颈淋巴结结核临床分析[J]. 中国耳鼻咽喉头颈外科, 2012, 19(9):475-477.
[4]	王直, 刘锦程, 李军孝, 等. 173例颈部淋巴结结核外科治疗效果的相关因素分析[J]. 中国防痨杂志, 2016, 38(7):559-563. doi:10.3969/j.issn.1000-6621.2016.07.009.
[5]	肖淑芬, 陶振峰, 李晓明, 等. 颈部淋巴结结核的手术治疗[J]. 临床耳鼻咽喉科杂志, 2006, 20(3):140-141. doi:10.3969/j.issn.1001-1781.2006.03.017.
[6]	王直, 李军孝, 霍雪娥, 等. 颈部淋巴结结核外科治疗并发症的危险因素分析[J]. 临床肺科杂志, 2016, 21(7):1275-1278. doi:10.3969/j.issn.1009-6663.2016.07.033.
[7]	Madsen B K, Zetner D, Moller A M, et al. Melatonin for preoperative and postoperative anxiety in adults[J]. Cochrane Database Syst Rev, 2020, 12(12):CD009861. doi:10.1002/14651858.CD009861.pub3.
[8]	Maranets I, Kain Z N. Preoperative anxiety and intraoperative anesthetic requirements[J]. Anesth Analg, 1999, 89(6):1346-1351. doi:10.1097/00000539-199912000-00003.
[9]	Fortier M A, Kain Z N. Treating perioperative anxiety and pain in children: a tailored and innovative approach[J]. Paediatr Anaesth, 2015, 25(1):27-35. doi:10.1111/pan.12546. pmid: 25266082
[10]	姚琳, 顾斌斌, 张建平. 抗结核药物所致药物不良反应的临床表现及其处置的研究进展[J]. 抗感染药学, 2023, 20(12):1229-1234. doi:10.13493/j.issn.1672-7878.2023.12-001.
[11]	黄楹, 江琦, 蒙粮广, 等. 结核病患者受歧视及产生病耻感的现状及研究进展[J]. 中国防痨杂志, 2019, 41(4):452-456. doi:10.19982/j.issn.1000-6621.20181279.
[12]	Kassahun W T, Mehdorn M, Wagner T C, et al. The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery[J]. Sci Rep, 2022, 12(1):6312. doi:10.1038/s41598-022-10302-z.
[13]	Starkweather A R, Witek-Janusek L, Nockels R P, et al. Immune function, pain, and psychological stress in patients undergoing spinal surgery[J]. Spine (Phila Pa 1976), 2006, 31(18): E641-E647. doi:10.1097/01.brs.0000231795.85409.87.
[14]	Bozza F, Vigili M G, Ruscito P, et al. Surgical management of parapharyngeal space tumours: results of 10-year follow-up[J]. Acta Otorhinolaryngol Ital, 2009, 29(1):10-15. pmid: 19609376
[15]	王玲. 围术期心理护理在减轻肺结核手术患者负性情绪中的应用价值分析[J]. 实用临床护理学电子杂志, 2020, 5(18):81. doi:10.3969/j.issn.2096-2479.2020.18.073.
[16]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380. doi:10.3761/j.issn.0254-1769.2010.04.037.
[17]	Zung W W K. A rating instrument for anxiety disorders[J]. Psychosomatics, 1971, 12(6):371-379. doi:10.1016/S0033-3182(71)71479-0. pmid: 5172928
[18]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994(2):98-100.
[19]	张明园, 何燕玲. 精神科评定量表手册[M]. 2版. 长沙: 湖南科学技术出版社, 2016: 189-192.
[20]	Yu J, Zhang Y, Yu T, et al. Preoperative Anxiety in Chinese Adult Patients Undergoing Elective Surgeries: A Multicenter Cross-Sectional Study[J]. World J Surg, 2022, 46(12):2927-2938. doi:10.1007/s00268-022-06720-9.
[21]	Yuki K, Matsunami E, Tazawa K, et al. Pediatric Perioperative Stress Responses and Anesthesia[J]. Transl Perioper Pain Med, 2017, 2(1):1-12. pmid: 28217718
[22]	Kamata K, Maruyama T, Komatsu R, et al. Intraoperative panic attack in patients undergoing awake craniotomy: a retrospective analysis of risk factors[J]. J Anesth, 2021, 35(6):854-861. doi:10.1007/s00540-021-02990-0. pmid: 34402974
[23]	马桂月, 沈志莹, 乔莉, 等. 认知行为疗法对高血压焦虑抑郁患者干预效果研究进展[J]. 中华高血压杂志, 2021, 29(4):328-332. doi:10.16439/j.issn.1673-7245.2021.04.005.
[24]	刘勇, 王哲芸. Stanford A型主动脉夹层患者围手术期负性情绪情况及其影响因素[J]. 临床与病理杂志, 2022, 42(6):1410-1415. doi:10.3978/j.issn.2095-6959.2022.06.016.
[25]	Eberhart L, Aust H, Schuster M, et al. Preoperative anxiety in adults-a cross-sectional study on specific fears and risk factors[J]. BMC Psychiatry, 2020, 20(1):140. doi:10.1186/s12888-020-02552-w. pmid: 32228525
[26]	居馨星, 冯竞, 杨洁, 等. 肺癌患者疾病感知对术前焦虑的影响:信息需求与患者信任的多重中介作用[J]. 军事护理, 2024, 41(11):74-78. doi:10.3969/j.issn.2097-1826.2024.11.018.
[27]	薛佩, 付占威, 赵轩, 等. 利用虚拟现实技术改善病人术前焦虑临床研究[J]. 中国实用外科杂志, 2020, 40(12):1425-1428. doi:10.19538/j.cjps.issn1005-2208.2020.12.21.
[28]	贾莎莎, 郭红, 杨秀玲, 等. 西安地区主动脉夹层术后社会支持与焦虑、抑郁状况和躯体功能相关性[J]. 中国社会医学杂志, 2024, 41(5):585-589. doi:10.3969/j.issn.1673-5625.2024.05.018.
[29]	黄慧玲, 尤冰, 白思慧. 肺结核患者病耻感与焦虑的交叉滞后分析与护理策略探讨[J]. 牡丹江医科大学学报, 2026, 47(1):110-114. doi:10.3969/j.issn.2097-5902.2026.01.023.
[30]	余朝凤, 肖敏恒, 胡昕. 影响肺结核患者心理健康的相关因素及其护理策略分析[J]. 心理月刊, 2025, 20(2):69-71. doi:10.19738/j.cnki.psy.2025.02.019.

变量	例数[构成比(%)]	焦虑标准评分(分,$\overline{\mathit{x}}$±s)	统计检验值	P值
性别			t=2.915	0.005
男性	34(36.2)	52.3±16.8
女性	60(63.8)	63.0±17.5
年龄(岁)			t=-0.405	0.524
<50	83(88.3)	58.5±18.2
≥50	11(11.7)	63.4±14.1
受教育程度			t=-2.290	0.024
中专/高中及以下	41(43.6)	53.2±17.1
大专及以上	53(56.4)	63.6±17.3
婚姻状况			t=-1.843	0.069
未婚	37(39.4)	55.4±18.6
已婚/离异/丧偶	57(60.6)	61.4±17.1
职业			F=2.397	0.090
在职	73(77.7)	60.12±16.95
无业	15(16.0)	51.87±18.34
离退休	6(6.3)	66.83±21.77
居住地			t=1.286	0.560
城镇	81(86.2)	58.1±17.5
农村	13(13.8)	64.5±18.9
家庭月收入(元)			t=-0.400	0.690
<5000	32(34.0)	58.2±18.5
≥5000	62(66.0)	59.5±17.3
医疗费用支付方式			t=1.080	0.283
全自费或其他^a	28(29.8)	56.4±18.2
城镇职工医保/城乡居民医保	66(70.2)	60.6±17.1
结核病相关手术次数			t=-6.919	<0.001
1	68(72.3)	55.1±16.8
≥2	26(27.7)	69.4±17.2
术前住院时间(d)			t=0.655	0.514
<5	47(50.0)	60.2±18.1
≥5	47(50.0)	57.9±17.5
了解自身疾病			t=2.752	0.007
是	38(40.4)	52.8±16.5
否	56(59.6)	63.3±17.8
并发基础疾病			t=-3.161	0.002
是	33(35.1)	65.2±18.5
否	61(64.9)	55.7±16.8

变量名称	赋值方式	变量名称	赋值方式
性别(X₁)	男性=0,女性=1	了解自身病情(X₄)	是=1,否=0
受教育程度(X₂)	中专/高中及以下=0,大专及以上=1	并发基础疾病(X₅)	是=1,否=0
手术次数(X₃)	1次=0,≥2次=1	社会支持得分(X₆)	原始数值录入

变量	回归系数 (β值)	s${}_{\overline{\mathit{x}}}$值	标准化回归系数(β值)	t值	P值	β的95%CI值	容差	VIF值
女性	6.515	2.812	0.176	2.317	0.023	0.925~12.105	0.929	1.077
大专及以上	12.007	2.905	0.335	4.133	<0.001	6.232~17.782	0.817	1.224
手术次数≥2次	12.462	3.407	0.340	3.657	<0.001	5.690~19.235	0.618	1.618
了解自身病情	-11.471	2.925	-0.316	-3.921	<0.001	-17.286~-5.657	0.823	1.215
并发基础疾病	2.639	3.008	0.071	0.877	0.382	-3.340~8.618	0.823	1.216
社会支持得分	-0.228	0.124	-0.208	-2.257	0.026	-0.527~-0.033	0.629	1.590
常数项	59.089	6.989	-	8.454	<0.001	45.198~72.981	-	-