四逆散改善妇科手术患者术前心理应激、促进快速康复的临床研究

Clinical Study of Sini Powder( 四逆散) Improving Preoperative PsychologicalStress and Promoting Rapid Rehabilitation of Gynecological Surgery Patients

目的评价四逆散改善妇科术前患者心理应激状态、促进患者快速康复的临床疗效。方法采用随机对照的研究方法,纳入妇科择期手术术前心理应激阳性、中医辨证为肝气郁结证的患者,术前给予四逆散治疗,观察肝气郁结证中医症状、心理应激状态、术中失血量、术后快速康复指标、应激相关神经内分泌激素的变化,评价四逆散改善妇科术前患者心理应激状态、促进患者快速康复的临床疗效。结果给予中药四逆散干预后,可明显改善术前患者心理应激,表现在HAD总分、焦虑(A)因子总分及单项条目评分的降低,同时可以明显改善烦躁、失眠、善太息、嗳气等中医证候,总有效率明显高于对照组。术前的症状改善可使患者缓解紧张情绪,术中脉搏、呼吸次数、收缩压等生命体征趋于平稳,手术中出血量明显减少;试验组术后CRH、ACTH、COR、DA等指标明显低于对照组,5-HT、IL-2等指标明显高于对照组,患者理化指标的改善间接地减少了术后疼痛时间、疼痛程度,缩短了排气时间、排便时间、进食时间、术后住院时间,减少了术后发热、尿潴留、呕吐等并发症的发生。结论四逆散能够改善患者术前焦虑情绪,调节激素及神经递质水平,为手术顺利进行创造条件,减少术后并发症的发生,有利于术后快速康复。

Objective To evaluate the clinical effect of Sini Powder(四逆散)on improving psychological stress state of preoperative gynecologic patients and promoting rapid rehabilitation of patients.Methods A randomized controlled study was conducted to enroll patients with positive psychological stress and syndrome differentiation of liver-Qi stagnation before elective gynecological surgery.Sini Powder was given before operation.The symptoms of traditional Chinese medicine,psychological stress state,intraoperative blood loss,rapid recovery index after operation and stress-related neuroendocrine were observed.The clinical effect of Sini Powder improving the psychological stress state of preoperative gynecologic patients and promoting the rapid recovery of patients was evaluated.Result After the intervention of Sini Powder,the psychological stress of patients before operation wassignificantly improved,manifested in the decrease of HAD total score,anxiety factor total score and single item score,and the improvement of TCM syndromes such as irritability,insomnia,good breath and belching.The total effective rate was significantly higher than that of the control group.The improvement of symptoms before operation can alleviate the tension of patients,and the vital signs such as pulse,breathing times and systolic blood pressure tended to be stable during the operation,and the amount of bleeding during the operation was significantly reduced.The indexes of CRH,ACTH,COR and DA in the experimental group were significantly lower than those in the control group,while 5-HT and IL-2 were significantly higher than those in the control group,and the improvement of physical and chemical indexes in the patients was significant.It reduced the pain time and degree after operation,shortened the exhaust time,defecation time,eating time,hospitalization time after operation,and reduced the occurrence of complications such as fever,urinary retention and vomiting after operation.Conclusion Sini Powder can improve preoperative anxiety,regulate levels of hormone and neurotransmitter,create conditions for operation,reduce complications and facilitate rapid recovery after operation.