@article{oai:niigata-u.repo.nii.ac.jp:00025569,
 author = {田中, 裕 and 村松, 芳幸 and 染矢, 源治},
 issue = {1},
 journal = {新潟歯学会雑誌, 新潟歯学会雑誌},
 month = {Jun},
 note = {Backgrounds ; Patients who receive orthognathic surgery tend to be involved in unstable psychological situations because of their expected and/or ongoing anxiety for disturbed activity of daily life (e. g. respiration, mastication, and speech), resulting in the anxiety and depression state. It is possible that the psychological situations also affect the incidence of postoperative pain and other problems. Therefore, this study aimed at clinical evaluation of the changes in psychological situation and the factors which contribute to the incidence of physical complaints during the perioperative period in the patients who underwent orthognathic urgery. Methods ; Subjects were 104 healthy male and female patients (male 31, female 73 ; average age 19.8±4.2years old) who expected to receive orthognathic surgery of maxilla and mandible. Psychological status were evaluated by hospital anxiety and epression scale (HADs), State and trait inventory (STAI) and Somatosensory amplification scale (SSAS) at the date before and 10 days after the surgery. Egogram check list (ECL) was also investigated in these patients at the date before surgery and physical omplaints were asked by the questionnaire. Past-history of analgesics and other medicines use in each patient was investigated ccording to the patients' records. Results ; Significant decreases of the score are observed in HADs' anxiety score, STAI's state and trait score, and significant increases of the score are observed in SSAS (Wilcoxon signed rank sum test, p<0.05), but not in the HADs' depression score (Wilcoxon signed rank sum test, p>0.05). Moreover, these patients with higher anxiety score tend to have more physical complaints for a long time and to use many medicines after the surgery. Conclusions ; Patients who have higher anxiety score before orthognathic surgery tend to have higher anxiety score and show postoperatively higher incidence of physical complaints and have more chances for claims for medicines. These suggest that preoperative examination of anxiety scale is a critical key for psychological and physical management of patients postoperatively., 口腔外科手術患者の周術期心理状態と身体愁訴の関連性を明らかにすることを目的として、口腔外科手術患者のうち、特に全身麻酔下上下顎外科的顎矯正手術施行患者104例(男性31例、女性73例、平均年齢19.8±4.2歳)を対象として、(1)周術期の心理的因子を評価し、術前の心理的因子が術後の身体愁訴に及ぼす影響について検討を行った。また、各検討結果を元にして、(2)術前の心理的因子によって手術患者の術後身体愁訴の発生を予測することが可能かどうか、さらに(3)術後身体愁訴の発生が予測される手術患者への有効な主治医の対応法についてもあわせて検討を行った。調査方法として、心理テストは、Hospital Anxiety and Depression Scale(HADs), State and Trait Anxiety Inventory(STAI), Somatosensory amplification scale(SSAS)を用い、性格特性の検査にはEgogram check list(ECL)を用いた。また術後の身体愁訴の評価には、当科作成のアンケート調査と術後の薬剤使用状況を用いた。その結果、周術期の心理テストでは、手術患者は術前に比較的高い不安を有しており、術前後の比較では術前に対して術後は有意に不安得点が低下した。また抑うつの状態は術前後で有意な得点変化は認めず、身体感覚増幅尺度は術前に対して術後有意に増加した。術前の心理状態と術後の身体愁訴の関連性の検討では、術前に高い不安を有する患者は、術後の身体愁訴の発生も有意に高く、そのうち状態不安得点が術後の身体愁訴発生の指標となり得ることが明らかになった。また患者が術前に自覚する「不安が強い」という感情の強さも術後の身体愁訴の発生の指標となりえることが示唆された。術前の不安が強い患者では、術前の主治医による説明に対して理解度が低いことから、術前の患者の不安の十分な把握や術前の十分な説明など、積極的な術前からの不安軽減対策が良好な周術期管理上の一助となり得ることが示唆された。},
 pages = {23--37},
 title = {口腔外科手術患者の周術期心理状態と身体愁訴に関する心身医学的研究 : 外科的顎矯正手術患者を対象に},
 volume = {36},
 year = {2006}
}