肿瘤手术患者术前访视法的改良:人文关怀化的效果

Improvement of preoperative interview in patients undergoing resection of tumor:the efficacy of humanistic care

目的:评价人文关怀化术前访视法用于肿瘤手术患者的效果。方法:择期腹腔镜胃肠肿瘤切除术患者200例,年龄35~64岁,BMI 18~28 kg/m^(2),ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=100):常规术前访视组(C组)和人文关怀化术前访视组(H组)。于访视前(T_(0))采用焦虑自评量表(SAS)评估焦虑状况并记录HR和MAP,随后进行术前访视:C组采用常规术前访视法,H组采用人文关怀化术前访视法;于访视后24 h(T_(1))再次评估焦虑状况并记录HR和MAP;分别于T_(0)和T_(1)时采集静脉血样,采用ELISA法检测血清去甲肾上腺素(NE)和皮质醇(Cor)浓度。结果:与C组比较,H组T_(1)时MAP、HR和SAS评分降低,焦虑发生率及程度降低,血清NE和Cor浓度降低,MAP、HR和Cor浓度异常发生率降低(P<0.05)。结论:人文关怀化术前访视法用于肿瘤手术患者,可缓解访视后焦虑情绪,减轻过度应激反应。

Objective To evaluate the efficacy of preoperative interview with humanistic care in patients undergoing resection of tumor.Methods Two hundred patients,aged 35-64 yr,with body mass index of 18-28 kg/m^(2),of American Society Anesthesiologists physical statusⅠorⅡ,undergoing elective laparoscopic gastrointestinal tumor resection,were divided into 2 groups(n=100 each)by a random number table method:conventional preoperative interview group(group C)and preoperative interview with humanistic care group(group H).Pre-interview anxiety was assessed using the Self-Rating Anxiety Scale(SAS)at 1 day before the interview(T_(0)),and pre-interview heart rate(HR)and mean arterial pressure(MAP)were recorded,followed by a preoperative interview.Conventional preoperative interview was given in group C,and preoperative interview with humanistic care was given in group H.Anxiety was assessed again after interview(T_(1))and HR and MAP were recorded at 24 h.Venous blood samples were collected for determination of plasma norepinephrine(NE)and cortisol(Cor)concentrations by enzyme-linked immunosorbent assay at T_(0) and T_(1).Results Compared with group C,the MAP,HR and SAS scores were significantly decreased at T_(1),the incidence and degree of anxiety and plasma NE and Cor concentrations were decreased at T_(1),and the incidence of abnormalities of MAP,HR and plasma Cor concentrations were decreased in group H(P<0.05).Conclusion Preoperative interview with humanistic care can alleviate the post-interview anxiety and reduce the over-stress response in patients undergoing resection of tumor.