Effect Evaluation of Preoperative Psychological Nursing Intervention on Sinusitis Patients Undergoing General Anesthesia by Multiplanner Reformation-Based CT.

The aim of this study was at exploring the clinical effect of CT images based on multiplanner reformation (MPR) combined with a preoperative psychological nursing intervention model in sinusitis patients undergoing general anesthesia. Sixty sinusitis patients who received MPR-based CT examination and general anesthesia were selected as the study subjects and randomly divided into the control group (n = 30) and the experimental group (n = 30). The control group used traditional preoperative education. The experimental group added the psychological nursing intervention based on traditional preoperative education. The blood pressure and heart rate before and after the operation, the self-rating anxiety scale (SAS) score before and after intervention, and satisfaction were comprehensively assessed. The results showed that CT based on MPR could observe the lesions and anatomical structures of the sinus wall and sinus in detail from multiple angles. The blood pressure (systolic blood pressure 135.12 ± 14.89 mmHg, diastolic blood pressure 87.05 ± 11.24 mmHg), heart rate (78.42 ± 12.19 beats/min), SAS score (45.85 ± 4.97 points), and nursing satisfaction (78.9%) of the experimental group were significantly better than those of the control group (145.83 ± 15.62 mmHg, 94.21 ± 10.86 mmHg, 86.44 ± 13.65 beats/min, 56.44 ± 5.12 points, 56.4%), and the differences were statistically significant (P < 0.05). In summary, the preoperative psychological care model has a positive role in reducing the tension and anxiety of patients before general anesthesia surgery and CT based on MPR is important for the clinical diagnosis and treatment of sinusitis. This study provides a theoretical reference for the clinical treatment of patients with sinusitis.

1. Introduction

The mucosal inflammation of the maxillary sinus, ethmoid sinus, frontal sinus, and sphenoid sinus is called sinusitis. This is a common nasal disease, namely, sinus mucosa nonspecific inflammation [1]. Sinusitis includes acute and chronic types. The main clinical manifestations of acute suppurative sinusitis include nasal obstruction, multiple purulent nasal discharge, and headache, while chronic suppurative sinusitis is characterized by multiple purulent nasal discharge, which can also be accompanied by varying degrees of nasal obstruction, headache, and olfactory dysfunction [2, 3]. After the patient was diagnosed with chronic sinusitis, the preferred treatment was drug treatment, including local treatment and systemic treatment. If the treatment effect is not good, a sinus CT scan is usually performed. If the imaging changes are determined, the operation will be performed to improve the condition [4].

Sinus CT is a commonly used examination modality for the diagnosis of sinus diseases in clinical practice. Clinically, the results of CT scans can be used to determine whether there is inflammation, whether there is compressive bone destruction caused by tumors, or whether there is nasal bone or maxillary fracture caused by trauma [5, 6]. According to the CT images presented by each sinus and sinus orifice, a comprehensive assessment can be carried out in clinical practice to determine the grade of sinusitis condition [7]. With the increasing update of spiral CT machine and computer image postprocessing technology, CT based on multiplanner reformation (MPR) can superimpose all axial images within the scanning range [8] and then reconstruct the images at coronal, sagittal, or any other angle of the tissue specified by the reticle. Arbitrary new tomographic images can be generated during reconstruction without the need for a second scan, and the density values of the original images can be well fed back into the output image [9, 10]. CT MPR can provide reliable information for clinical surgical treatment.

Traditional sinusitis surgery affects the patient's sense of smell to some extent, and the probability of complications such as nasal bleeding is also high [11]. With the development of medical science and technology, a minimally invasive approach to endoscopic sinusitis surgery has been gradually and widely used in clinical practice. It enables adequate removal of the lesion under the nasal endoscope, opening each sinus ostium to improve drainage and maximizing the preservation of normal tissue [12, 13]. It has good clinical efficacy and can reduce the probability of wound infection and scar retention, and the recovery rate is faster [14, 15]. General anesthesia is usually adopted during surgery, and patients do not feel pain under general anesthesia, which facilitates adequate opening of the sinus cavity, completes removal of the lesion [16], and reduces the possibility of postoperative recurrence. However, most patients experience worry and fear before surgery, which causes some difficulties for the surgical procedure and anesthetic management and can also easily cause a variety of complications [17, 18]. Therefore, it is necessary to carry out psychological nursing intervention for patients with sinusitis undergoing general anesthesia. Compared with traditional methods such as simple knowledge education, psychological nursing intervention can make patients have a sense of psychological security and have an optimistic attitude towards surgery and postoperative rehabilitation [19, 20], which is helpful for the smooth implementation of surgery.

The MPR-based CT examination was applied to 60 patients with sinusitis undergoing general anesthesia, and traditional preoperative education and preoperative psychological nursing intervention models were used for different groups. Through several clinical indicators, the preoperative psychological nursing model was comprehensively evaluated to provide a valuable reference for the clinical nursing and treatment of sinusitis.

2. Materials and Methods

2.1. Study Subjects

A total of 60 patients (39 males and 21 females) diagnosed with sinusitis by MPR CT imaging underwent endoscopic sinusitis surgery in the hospital from June 2018 to June 2021 and were randomly divided into the control group (n = 30) and experimental group (n = 30). The control group used traditional preoperative education, and the experimental group additionally performed psychological nursing intervention on this basis. In the study, the purpose, process, precautions, and legitimacy of the study were specifically explained to patients. In addition, the subjects agreed to sign informed consent with the consent of their family members. This study was approved by the ethics committee of the hospital. The obtained research data were confidential data, which were only for research purposes.

Inclusion criteria are as follows: patients aged ≥18 years, patients without serious organic disease or mental disease, patients in whom none of the lesions exceeded the middle turbinate base plate, and patients with clear cognition who could independently complete the questionnaire.

Exclusion criteria are as follows: patients who could not accept general anesthesia for various reasons, patients with poor compliance who did not cooperate with the experiment, and patients with incomplete clinical data.

2.2. MPR

During the scanning process, all the perceivable axial images in the range were superimposed. Through the tissue slope map reformation at any angle specified by the marking line, the operation was called MPR. Adhering to the principle of making the reconstruction process easier, the contour line of the image to be reconstructed was generally extracted during processing, and then the, data were obtained. The operation steps of MPR were roughly as follows.

The image was scanned to obtain the basic outline of the image to be reconstructed. At the early stage of scanning, these contour lines can be regarded as a series of discrete points. First, a three-dimensional dataset was constructed during extraction and the data and sequences in it were read. After filtering, a virtual three-dimensional data space can be obtained. Subsequently, some virtual baffles were built inside it and the baffles can be adjusted from various directions and angles to obtain virtual slices from multiple angles. Finally, the data information on these sections was extracted, including but not limited to contour, morphology, and tissue texture, to obtain the final mapped data in the sections. The basic operation process of MPR is given in Figure 1.

Figure 1

Basic flow of MPR. (a) The reconstruction diagram of the algorithm and (b) the multiplane display of the algorithm.

The contour discrete point set obtained from these data was saved, and these curves were fitted to synthesize the specified curve function. When they were finally shown, they were the processed reconstructed curve surfaces. Extracting the contour of the reconstructed object was the most important part of the whole MPR process. Moreover, the smoothness of the curve was closely related to the integrity of the reconstructed image structure. Therefore, the finer the contour that was drawn in the reconstruction, the higher the quality of the reconstructed image was and the structure of the tissue and the pathological structure can be clearly displayed.

2.3. CT Image Examination and Image MPR

A 16-slice spiral CT scanner was adopted. The patient lays on the examination bed, and spiral CT scan was carried out, with tube voltage 120 Kv, current 200 mA, layer thickness 1 mm, and screw pitch 0.8. The scanning range is the upper margin of the frontal sinus to upper alveolar. The collected data were uploaded to the workstation for MPR of the image. The reconstruction layer thickness was 1 mm, the interval was 0.4 mm, the window width was 2500 Hu, and the window level was 240 Hu. The reconstructed images were browsed by MPR at the three-dimensional interface, and the lesion sites of patients were observed in multiple directions to ensure the accuracy of diagnosis. All reconstructed images were uploaded to the system for storage.

2.4. Preoperative Intervention Methods

The control group was given traditional preoperative education. The main contents included instructing the patients to eat reasonably, providing preoperative education on basic knowledge for the patients and their families, such as the purpose of surgery and surgical efficacy, and instructing the patients to cooperate with the preoperative common sense, such as sleep requirements, avoiding cold and fever, smoking, and alcohol.

The experimental group added psychological nursing intervention methods on this basis. The main contents included a detailed understanding of the patient's preparation and psychological status before surgery, explanation of the knowledge about general anesthesia, such as anesthesia methods, effects, and intraoperative feelings, so that the patient can roughly understand the concept of general anesthesia and reduce tension and fear; for patients with a history of smoking and alcohol, the harm of smoking and alcohol to the condition should be informed in detail, as well as the benefits after smoking cessation and alcohol withdrawal (such as reducing the risk of general anesthesia operation and the probability of anesthetic complications); a shallow and understandable way should be used to describe the approximate treatment plan and surgical operation process to the patient, so that the patient can maintain a positive and optimistic attitude towards surgery; paying attention to the emotional changes of patients, when patients had depression and fear, it should gently carry out effective psychological counselling for them and guide patients to better cooperate with clinical treatment.

2.5. General Anesthesia for Sinusitis

Instruments and equipment are as follows: nasal endoscopy, camera, television video system, bite forceps, opening forceps, and drills. All patients were given nasal spray before the operation, oral granules relieving stuffy nose, and an intravenous route for intravenous infusion of cefuroxime sodium injection was established. Patients' routine preoperative preparation is as follows: patients lay on bed, and the hands and legs were fixed. Anesthesia: 0.5 mg atropine was intramuscularly injected one hour before the operation, and 1.5 mg/kg propofol combined with 0.03 g/kg sufentanil was inhaled by tracheal intubation. During the operation, a 5 mg/(kg·h) micropump drip was continuously given and the patient's respiration, heart rate, blood pressure, and saturation were continuously monitored during the operation. The drape was used, disinfection was performed, the television monitoring system was turned on to face the patient's head, the nasal suction cutter and vacuum suction system were connected, and the operation was carried out. During the operation, the patient's vital signs were observed, and after the operation, the patient returned to the ward after waking up.

2.6. Evaluation Criteria

Systolic blood pressure, diastolic blood pressure, and heart rate were measured before and after the operation, and detailed data were recorded after measurement

A self-rating anxiety scale (SAS) was used to assess the anxiety of patients. The SAS uses a 4-level score that mainly assesses the frequency of symptoms defined by the items, and its criteria are “1” no or little time, “2” a small part of the time, “3” a considerable amount of time, and “4” most or all of the time. After the evaluation, the scores of 20 items are summed to obtain the total score, which is the main statistical indicator of SAS. The higher the total score, the worse the symptoms. Scores of 50–59 were classified as mild anxiety, 60–69 were classified as moderate anxiety, and above 69 were classified as severe anxiety

A questionnaire was distributed to all patients on the day of discharge, and the survey content was the patient's satisfaction with the operation. After the investigation, the information was recorded in detail

2.7. Statistical Analysis

All data in this study were statistically analysed using SPSS 24.0 software, and measurement data were expressed as the mean ± standard deviation (). Data before and after surgery within the group were compared using the t-test, and an independent samples t-test was used for comparisons between the two groups. P < 0.05 was considered statistically significant.

3. Results

3.1. Comparison of General Clinical Data

The general clinical data of patients in the control group and the experimental group are shown in Table 1. There was no significant difference in age, sex proportion, height, weight, chronic/acute type, or course of disease between the two groups, and they were comparable (P > 0.05).

Table 1

Comparison of general clinical data between the two groups of patients.

	Control group	Experimental group	P value
Age (years old)	45.24 ± 3.58	46.76 ± 3.29	0.745
Male (people)	19	20	0.739
Height (cm)	165.48 ± 9.24	166.85 ± 8.19	0.714
Weight (kg)	67.42 ± 6.41	65.28 ± 5.92	0.802
Chronic/acute (case)	21/9	19/11	0.821
Course of disease (month)	7.92 ± 3.81	8.03 ± 4.76	0.709

3.2. CT MPR Image of Sinusitis

3.2.1. Typical Case

A 35-year-old male patient in the control group was hospitalized with the complaint of “intermittent nasal obstruction with headache for more than 7 months, yellowish-green purulent nasal discharge for more than 4 months.” A 42-year-old male patient in the experimental group was admitted with the complainant of “recurrent sinusitis for 1 year.” The patients were given CT examination based on MPR (Figure 2).

Figure 2

CT MPR of sinusitis. (a) Nasal mucosa thickening, sinus cavity with a little effusion, a small amount of peripheral distribution of soft tissue calcification, sinus wall hardening, and the diagnosis of fungal sinusitis. (b, c) Sinus cavity solid expansion, with different forms of high-density shadow, bone deformation erosion, and diagnosis of allergic fungal sinusitis.

3.3. Comparison of Blood Pressure between the Two Groups before and after Operation

Before surgery, there was no significant difference in systolic blood pressure or diastolic blood pressure between the control group and the experimental group (P > 0.05). After the operation, systolic blood pressure was 145.83 ± 15.62 mmHg and diastolic blood pressure was 94.21 ± 10.86 mmHg in the control group; systolic blood pressure was 135.12 ± 14.89 mmHg and diastolic blood pressure was 87.05 ± 11.24 mmHg in the experimental group. The blood pressure indexes of the experimental group were obviously better than those of the control group, and the difference was statistically significant (P < 0.05) (Figures 3 and 4).

Figure 3

Comparison of preoperative blood pressure between the two groups.

Figure 4

Comparison of postoperative blood pressure between the two groups. ∗P < 0.05 compared with the control group.

3.4. Comparison of Preoperative and Postoperative Heart Rates

Before the operation, there was no significant difference in systolic and diastolic blood pressure between the control group and the experimental group (P > 0.05). After surgery, the heart rate of the control group was 86.44 ± 13.65 times/min and that of the experimental group was 78.42 ± 12.19 times/min. The heart rate of the experimental group was significantly better than that of the control group, and the difference was statistically significant (P < 0.05) (Figure 5).

Figure 5

Comparison of the heart rate between the two groups before and after the operation. ∗P < 0.05 compared with the control group.

3.5. Comparison of SAS Scores between the Two Groups before and after Intervention

Before intervention, there was no significant difference in SAS scores between the control group and the experimental group (P > 0.05). After intervention, the SAS score of the control group was 56.44 ± 5.12 and that of the experimental group was 45.85 ± 4.97. The SAS score of the experimental group was superior to that of the control group, and the difference was statistically meaningful (P < 0.05) (Figure 6).

Figure 6

Comparison of SAS scores between the two groups before and after intervention. ∗P < 0.05 compared with the control group.

3.6. Comparison of Postoperative Nursing Satisfaction between the Two Groups

Through the questionnaire on the day of discharge, the nursing satisfaction rate was 56.4% in the control group and 78.9% in the experimental group. The nursing satisfaction rate in the experimental group was clearly higher than that in the control group, and the difference was statistically significant (P < 0.05) (Figure 7).

Figure 7

Comparison of postoperative nursing satisfaction between the two groups. ∗P < 0.05 compared with the control group.

4. Discussion

Sinusitis is a nonspecific inflammation of the sinus mucosa and is a common and frequent disease in rhinology. It is generally divided into two categories, acute and chronic, which have many causes and are complex [21, 22]. The main symptom of sinusitis is nonventilation. Therefore, it is necessary to use a membrane contraction agent for nasal anti-inflammatory treatment. If ventilation is not maintained after a period of conservative treatment, surgery is required to treat it. Currently, minimally invasive endoscopic techniques are commonly used to treat sinusitis in clinical practice, and under endoscopic illumination, doctors can completely remove the lesion, maximize the preservation of the normal mucosa and structure of the nasal cavity and paranasal sinuses, and maintain a better state of ventilation and drainage. Due to the complexity of the surgical procedure, each sinus should be finely treated, the operation time should be long, and nasal surgery bleeding should be handled during this period, which cannot be completed under local anesthesia. Therefore, general anesthesia is mostly applied. However, due to the condition, most patients will experience negative emotions such as tension and anxiety before surgery, which will have a certain impact on the surgical process and postoperative rehabilitation [23]. In this study, we used the intervention method of preoperative psychological nursing for some patients undergoing sinusitis surgery under general anesthesia and compared and analysed the various indicators of these patients in the context of MPR CT examination.

In preoperative psychological intervention, tension and anxiety of patients are the most prevalent problems. He et al. [24] mentioned in the article that if the patient is too fearful and nervous before surgery, then, the pain during surgery as well as during postoperative recovery will be more obvious, which is detrimental to the efficacy of surgery. According to the results of this study, it is not difficult to find that after receiving preoperative psychological care, the overall situation of patients in the experimental group was better than that in the control group. The specific manifestations were that the blood pressure index of the patients in the experimental group (systolic blood pressure 135.12 ± 14.89 mmHg, diastolic blood pressure 87.05 ± 11.24 mmHg) tended to the normal level more than that in the control group (systolic blood pressure 145.83 ± 15.62 mmHg, diastolic blood pressure 94.21 ± 10.86 mmHg); the heart rate level in the experimental group (78.42 ± 12.19 beats/min) was better than that in the control group (86.44 ± 13.65 beats/min), indicating that preoperative psychological nursing played a role in the stability of the general vital characteristics of the patients. The SAS score of the experimental group (45.85 ± 4.97 points) was lower than that of the control group (56.44 ± 5.12 points), which was under the standard of “mild anxiety.” The preoperative psychological intervention model was of great help in reducing the tension and anxiety of the patients, could effectively alleviate the fear of the patients for the operation, and promoted the successful completion of the operation to a certain extent. The satisfaction rate of nursing in the experimental group (78.9%) was also significantly higher than that in the control group (56.4%), and the differences were statistically significant (P < 0.05). This is consistent with the study conclusion of Liu et al. [25] that the nursing model, such as preoperative psychological intervention, does have a positive effect on reducing the negative situation of patients. As an emerging nursing modality, it has reflected excellent clinical results and is worthy of promotion and use.

MPR CT is a two-dimensional image processing method at any angle of human tissues and organs obtained by postprocessing the original transaxial images, which can show the morphological changes of various systems and organs of the body, especially in judging the anatomical structure and the nature, invasion range, and adjacent relationship of the lesions of the treated organs. In this study, CT based on MPR was selected as the imaging examination of patients undergoing general anesthesia for sinusitis and the results suggested that MPR CT could carefully observe the sinus wall of the sinus cavity and the lesions and anatomical structures of the sinus cavity from multiple angles. The innovation is that MPR was first used to optimize the CT image, and then, it was applied to patients with sinusitis. Combined with the preoperative psychological nursing intervention mode, it provides a reference scheme for the clinical diagnosis and treatment of sinusitis. As Liu et al. [26] pointed out, compared with conventional CT scanning, MPR CT can better display some deep tissue structure relationships, which is helpful for the diagnosis of the disease and further plays a role in clinical treatment.

5. Conclusion

Traditional preoperative education and psychological nursing intervention were performed on 60 patients with sinusitis undergoing general anesthesia. The results showed that the preoperative psychological nursing intervention could effectively reduce the tension and anxiety of patients before general anesthesia, which had a good effect on the operation process and postoperative rehabilitation. MPR CT can show the structure and lesions of the sinus from multiple perspectives, which has important value in the imaging examination of sinusitis. The deficiency is that the sample size is small and the results are one sided. In the future, the sample size will be increased for further research in this direction. In conclusion, MPR-based CT and preoperative psychological nursing intervention have a positive effect on sinusitis patients undergoing general anesthesia, which provides a reference for the clinical treatment and postoperative recovery of patients with sinusitis.