心理干预对全麻手术患者围手术期应激反应影响.docVIP

心理干预对全麻手术患者围手术期应激反应影响 　　【摘要】 目的观察心理干预对全麻手术患者围手术期应激反应的影响。方法 100例拟行全麻手术的患者随机分两组:A组为对照组,常规护理;B组为心理干预组,围手术期进行综合心理干预治疗。入院时(T1)、手术前(T2)、术中(T3)、术后48～72 h(T4)分别从外周静脉抽取血标本, 采用放免法测定空腹血糖及血浆皮质醇。结果 两组患者围手术期血浆皮质醇B组在T2, T3明显低于A组(P0.05);而血糖B组在T2 ,T3,T4明显低于A组(P0.05)。结论 围手术期实行心理干预,能有效地减轻患者术后的应激反应。 　　【关键词】 心理干预;血浆皮质醇;血糖;全身麻醉 　　 　　Effect of psychological intervention on stress responses in patient after general anaesthesia 　　WANG Dong,ZHANG Yong-gang.The Central Hospital of Zhumadian,Zhumadian 463000,Henan Province,China 　　【Abstract】 Objective To study the effect of psychological intervention on stress responses in patient after general anaesthesia.Methods One hundred patients scheduled for general surgery were randomly allocated to one of the two groups: A、B. Each group was fifty cases. In group Apatients received regular nursing. In group B patients received psychological intervention before operation. Venous blood samples were obtained before psychological intervention (1 d before operation)(T1), Before induction of anesthesia (T2) , during operation (T3),and 48-72 hours after operation (T4) for determination of plasma glucose and cortisoil. Results Plasma glucose in group B were significantly lower than those in group A at T2 and T3(P0.05);and cortisoil were lower in group B than those in group A at T2 and T3(P0.05),too.Conclusion Psychological intervention can effectively relieve stress responses during cardiac surgical procedures. 　　【Key words】 Psychological intervention;Plasma cortisol;Blood glucose;General anesthesia 　　 　　手术给患者带来的心理反应可影响手术效果,影响术后康复。多数患者由于恐惧手术而产生焦虑、紧张情绪,并随手术时间的接近呈正相关。因此,手术患者术前的心理状态评估及其干预已成为快速康复的重要基础。本调查通过手术患者围手术期血浆皮质醇及血糖的变化来验证我院手术患者个性化心理干预的效果。 　　1 对象与方法 　　2005年9月至2007年3月,选取河南驻马店市中心人民医院骨科及普外科志愿接受调查,无伴随精神疾病,年龄 16周岁,神志清楚,能有效沟通的手术患者100例,随机分成两组。A组为对照组常规护理,B组为心理干预组围手术期进行综合心理干预治疗两组均接受病房护士的常规心理护理、基础及专科护理等,在此基础上B还接受麻醉医师给予的个性化心理干预。具体方法如下: 　　1.1 本心理干预采取“一对一”的个体干预形式所有的干预均由麻醉医师实施,麻醉医师专门经过人文关怀理论和心理学知识培训。全程严格遵照“评估-确定问题-制定计划-干预-效果评估”的程序实施心理干预。确定干预对象后,于术前1周予以心理干预1次/