用SCL-90量表、OAA／S评价心理干预、靶控镇静对拇手指再造术的临床效果

Evaluation of the clinic effects of perioperative psychological intervention combined appropriate se- dation by target-controUed infusion of midazolam during operation via SCL-90 and OAA/S in pa- tients undergoing thumb or finger reconstruction

目的用症状自评量表（symptomchecklist90，SCL-90）、警觉／镇静评分（observersassessmentofalertness／sedationscale，OAA／S）评价拇手指再造术患者围术期进行心理干预、术中靶控镇静治疗对术后疼痛和一般心理状态的影响。方法选择拟在臂丛神经阻滞＋腰硬联合麻醉下行足趾移植再造拇、手指术患者80例，随机数字表法分成4组，每组20例。A组围术期心理干预＋术中咪唑安定靶控镇静治疗；B组常规处置；C组围术期心理干预；D组术中咪唑安定靶控镇静治疗。观察并记录生命体征、OAA／S评分、视觉模拟评分（VAS）及SCL-90评分。结果A、D组术中OAA／S评分较B、C组稳定（P〈0．05）；A组术后VAS评分和SCL．90心理状态评估明显优于B、C、D组（P〈0．05）。结论围术期心理干预、术中咪唑安定靶控镇静可减轻拇手指再造患者术后疼痛，减轻围术期强迫症状、抑郁及焦虑状态，改善饮食睡眠状况，提高术后康复质量。

Objective To evaluate the clinic effects of perioperafive psychological intervention combined appropriate sedation by target-controlled infusion of midazolam during operation via symptom check List 90 （SCL-90） and observers assessment of alertness/sedation scale （OAA/S） in patients under- going thumb or finger reconstruction. Methods Eighty patients undergoing thumb or finger reconstruction were randomly divided into group A, B, C, and D （ n = 20 cases per group）. All patients were received brachial plexus block and spinal-epidural combined anesthesia. Patients in group A were given perioperative psychological intervention combined appropriate sedation by target-controlled infusion of midazolam during operation ; patients in group B were received routine treatment; patients in group C were given perioperative psychological intervention; and patients in group D were sedated with midazolam during operation. The vital signs and the scores of OAA/S were observed during operation. The scores of visual analogue scale （VAS） and SCL-90 were recorded after operation. Results The OAA/S grade in groups A and D were stability than that in groups B and C （ P 〈 0. 05 ） ; the scores of VAS and the results of psychological status assess- ment by SCL-90 in group A were superior to groups B, C, and D （ P 〈 0. 05 ）. Conclusions Periopera- tive psychological intervention combined appropriate sedation in operation on thumb or finger reconstruction is a excellence anaesthesia processing method. It might have beneficial effects on postoperative recovery profile, and strengthen the tolerance to pain and improve the patient＇s psychological status during operative period.