综合心理干预联合咪达唑仑对不孕症患者术前心理应激的影响

Effect of comprehensive psychological intervention combined with midazolam on preoperative stress response in sterile females

目的探讨综合心理干预联合咪达唑仑对不孕症患者术前心理应激反应的影响。方法60例不孕症患者随机分为3组,每组20例。Ⅰ组为对照组,进行常规的术前准备。Ⅱ组为心理干预组,在手术准备期间进行2～3次的心理干预。Ⅰ组和Ⅱ组术前均不使用镇静药。Ⅲ组为心理干预联合咪达唑仑组,在手术准备期间进行2～3次的心理干预,进入手术室前30 min肌内注射咪达唑仑0.05 mg/kg。所有患者在入院次日晨(入院时)和进入手术室后(入室时)各抽取静脉血4 mL,检测血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血管紧张素-Ⅱ(AT-Ⅱ)和血糖(PG)水平,记录相应时间点患者的心率(HR)、血压(BP)和脉搏血氧饱和度(SpO2),并进行Zung焦虑量表(SAS)、抑郁量表(SDS)评分。结果入院时3组间的HR、BP、SpO2和血清Cor、ACTH、AT-Ⅱ、PG水平以及SAS和SDS评分的差异均无统计学意义(P值均>0.05)。入室时,Ⅰ组以上指标均显著升高(P值分别<0.01、0.05);Ⅱ组除SAS、SDS评分显著降低外(P值均<0.05),其他指标的变化均不明显(P值均>0.05);Ⅲ组以上指标均显著降低(P值分别<0.05、0.01)。入室时,Ⅱ组和Ⅲ组以上指标均显著低于Ⅰ组(P值分别<0.05、0.01),Ⅲ组又显著低于Ⅱ组(P值分别<0.01、0.05)。结论综合心理干预能有效地改善不孕症患者术前的心理健康状况,降低患者术前心理应激反应的水平,咪达唑仑能强化心理干预的效果。

Objective To investigate the effect of comprehensive psychological intervention combined with midazolam on the preoperative stress response in sterile females. Methods Sixty sterile women were randomly divided into three groups, each with 20 cases. Group I （control group）., routine preoperative preparations, group II （psychological intervention group） = receiving 2-3 times psychological interventions during preparation of operation. Group I and group II received no preoperative sedative. Group III （psychological intervention combined with midazolam group） ： receiving 2-- 3 times psychological interventions during preparation of operation, and receiving muscular injection of midazolam （0.05 mg/kg） 30 min before entering operation room. Blood samples （4 mL） were taken in the next morning after admission and after entering the operation room. The serum concentrations of corticosteroid （Cor）, adrenocorticotropic hormone （ACTH）, angiotensin II （AT-II ）, plasma glucose （PG） and recorded with heart rate （HR）, blood pressure （BP）, oxygen saturation （SpO2）, Zung anxiety grade and depression grade （SAS, SDS） scores were all examined. Results There were no significant differences in HR, BP, serum concentrations of Cor, ACTH, AT-II , PG, and SAS, SDS scores between the three groups at the admission Call P〉0.05）. After entering operation room, the above data in group I were significantly increased （P〈0.01 or 0.05）; no other changes Call P〉0.05） except that significantly lower SAS, SDS scores were found in group II Call P〈0.05）; and all the data in group III were significantly decreased （P〈0.01 or 0.05）. Compared with group I , the item levels of group II and III were significantly decreased （P〈0.01 or 0.05）, and also those of the group III were significantly lower than those of group II （P〈 0.01 or 0.05）. Conclusion Comprehensive psychological intervention can effectively improve the psychological health of sterile patients, lover the preoperative stress response level; besides, midazolam can enhance the effect of psychological intervention. （Shanghai Med J, 2009, 32, 888-891）