摘要
目的 探讨异体手移植过程中的心理问题及其对策。方法 筛选病人时采用交谈方式进行心理测试,观察病人是否有心理障碍以及处理各种压力的能力。在移植手术前,对病人进行心理辅导使病人作好充分心理准备。移植手术后病人心理康复采用镇痛等针对性治疗、心理暗示疗法、调动支持系统和改善环境等治疗方法。结果 筛选病人时发现12位病人中有1位因心理障碍不适宜作手术。病人术后1周内烦躁、焦虑、忍耐力极差、对移植手稍有恐惧,1周以后对移植手初步认可,1月后心理上已基本接受,术后4、5月时移植手痛温觉已恢复至指尖、手指伸屈已得到较好恢复,病人在心理上完全接受该手。结论 在患者的术前选择和术后康复过程均存在不同的心理问题,需要心理医生参与整个治疗过程,应予重视。
Objective To study the psychological problems and their treatments during the process of human hand allograft. Methods One psychologist participated in the whole process of human hand allograft. 12 patients, with unilateral or bilateral upper extremity amputation, were interviewed to find the suitability for surgery depending on the patient's ability to cope with such stress as waiting for donor, the surgical procedure itself and adaptation to life with a new hand and compliance with the medical regimen. They were trained to resolve a distressing emotional state before surgery. After the surgery suggestion psychotherapy, analgesia, family supporting, and environmental improving were used to treat the psychological disorders. Results One out of twelve candidates in this series was found to be unsuitable for surgery because of psychiatric illness. The other 11 showed wishes of cooperation and understanding of the advantages and disadvantages, and were willing to prepare for adaptation to the life with a new hand. The patients showed anxiety of different levels while waiting for donor. Two male candidates with traumatic right wrist amputation of 2 years were selected by tissue typing with donors. After the surgery the 2 patients were anxious, depressed, agitated, and horrified at seeing the long-expected grafted hand. The psychological disorders were complicated by operation trauma, anesthesia reaction, pain, noise from the air laminar flow conditioner and immunosupressants. After operation the patients were encouraged to touch the new hand and gradually accepted the new hand 1 week later. 1 month postoperation with recovery of active movement of the hand the patients accepted the hand on the whole. With the recovery of the hand sensation 4 to 5 months postoperation, the patients held the hand as his own. Besides these, the 2 patients felt that life quality of had improved since transplant with respect to health, energy level, activity level, family relationships, and social relationships and overall quality of life. Conclusion Different psychological problems exist before and after hand transplantation. Psychologists are needed to participate in the whole process of human hand allograft.
