心理干预及硬膜外自控镇痛对胸部手术后应激反应的影响

Influence of psychologic intervention and autocontrol analgesia outside the hard membrane on stress reaction after thoracic operation

目的:观察心理干预联合患者自控镇痛对胸部手术患者术后应激反应的影响。方法:选择择期开胸手术患者60例,随机分为Ⅰ组为对照组,术后根据需要间断肌注哌替啶;Ⅱ组为观察组,围手术期进行心理干预,术后行硬膜外自控镇痛。结果:Ⅰ组HR、SBP有不同程度的增高(P<0.05)而Ⅱ组则较稳定;Ⅰ组术后应激激素水平明显增高(P<0.01);Ⅱ组虽有增高趋势但差异无显著性(P>0.05);两组各时点组间比较差异有显著性(P<0.05);Ⅰ组术后RR浅快,SpO2 有不同程度的降低(P<0.05),与Ⅱ组比较差异有显著性(P<0.05);Ⅱ组患者镇痛效果明显优于Ⅰ组(P<0.05)。结论:心理干预联合硬膜外自控镇痛能提供完善的止痛效果,能更有效地控制术后应激反应,并有改善呼吸和稳定循环之功效。

Objective： To observe the influence of psychologic intervention combined with autocontrol analgesia on stress reaction after thoracic operation. Method ： 60 operation patients were divided into the control group, receiving intravenous infusion of pethidine after the operation when necessary and the observation group , receiving perioperafive psychologic intervention and autocontrol analgesia outside the hard membrane after the operation. Result： There were increases in HR, SBP （ P〈0. 05 ） in the control group, while the observation group were steady ; The hormone level increased obviously （ P 〈 0. 01 ） after the operation in the control group, while the observation group had the tendency to increase but without significant difference （P 〈0.05） ; The two groups had significant difference （P 〈0.05 ） ; RR was simple and fast after the operation in the control group and SpO2 reduced（ P〈0.05 ） ,with a significant difference （P〈0. 05） compared with the observation group; patients had a better analgesic effect in the observation group than the control group （ P〈0.05） . Conclusion： Psychologic intervention combined with autocontrol analgesia on stress reaction can offer perfect analgesic effect outside the hard membrane in psychology, control stress reaction after the operation, and improve breathing maintain circulation.