心理指导减少腹部手术患者术后镇痛中吗啡的用量

Preoperative-psychological Education Reduces Morphine Doses for Postoperative Analgesia in Patients with Abdominal Operation

目的探讨心理指导对腹部手术病人术后镇痛中吗啡用量的节俭作用。方法 60例ASAⅠ或Ⅱ级择期腹部手术的成人患者,随机均分为心理指导组和对照组。心理指导组于手术前2天和1天麻醉访视时给予患者心理安慰,充分解释患者提出的问题及控制患者的焦虑。对照组只要求配合手术和麻醉。两组均为依托咪酯、万可松、舒芬太尼诱导,术中维持用七氟醚、丙泊酚、舒芬太尼或芬太尼,术毕均行病人静脉自控镇痛(PCIA),镇痛药为1mg/ml吗啡,静脉滴注0.5ml/h,PCA量0.5ml,锁定时间10min。记录术后6、12、24、48h患者视觉模拟评分(VAS)、舒适评级(BCS)、Ramesay镇静评分;记录术后12和24h内PCIA总按压次数、有效按压次数和吗啡总量;记录PCIA的不良反应。结果两组术后VAS评分差异无统计学意义,但心理指导组BCS评级高于对照组,Ramesay镇静评分低于对照组(P<0.05);术后12和24h内PCIA总次数、有效次数和吗啡总需求量心理指导组低于对照组(P<0.05)。结论心理指导可以减少术后镇痛中吗啡的用量,且方法简单易行,无不良反应。

Objective To explore possible regimen that could help reduce morphine dos - es for postoperative analgesia in patients with abdominal operation. Methods Sixty ASA I or lI adult patients who received selective, abdominal operation were indnded. These patients were r - andomly divided into two groups： control and preoperative - psychological education gro - up. The preoperative - psy- chological education was given each time by an anesthesiologist one day prior to the operation while the anesthesiologist providing anesthe- sia advice. The preoperative - psychological education included psychological comfort, explanations of questions and worries from the pa- tients. Patients in control group were simply told to be cooperated with during anesthesia and operation. The anesthesia scheme in both gro - ups was identical to each other. Anesthesia was induced by iv. etomidate, vecuronium bromide and sufentanil, maintained with sevoflu- rane, propofol and sufentanil or fentanil. All patients received postoperative analgesia produced by iv. PCIA including morphine （ ling/ml） with background injection of 0.5ml/h, PCA 0.5ml for 10min. Patients were evaluated by visual analogue scale （VAS） , bruggrmann comfort scale （BCS） , and Ramesay anesthesia score at 6,12,24 and 48 hours after operation. The total and effective nu -mbers of PCIA as well as total doses of morphine at 12 and 24 hours after operation were recorded, and adveres reactions were also recorded. Results No between -group difference in postoperative VAS was found. However, in psychological education group, compared to con -trol group, BCS was higher and Ramsay anesthesia score was lower（P 〈 0.05）. The total and effective numbers of PCIA, as well as total doses of morphine at 12 and 24 hours after operation was lower in psychological education group than the control group （P 〈 0. 05 ）. Conclusion Preoperative -psychological education may reduce the amount of morphine in the postoperative analgesia. It is simple, practicable and without any side effects.