加速康复外科理念联合心理干预经内镜逆行胰胆管造影术治疗的患者心理状态及术后并发症的影响

Effect of accelerated rehabilitation surgery combined with psychological intervention on psychological state and postoperative complications of patients treated by endoscopic retrograde cholangiopancreatography

目的:探讨加速康复外科理念(ERAS)联合心理干预经内镜逆行胰胆管造影术(ERCP)治疗的患者心理状态及术后并发症的影响。方法:选取2020年1-12月间收治的272例行ERCP治疗的患者作为研究对象,将患者分为对照组(2020年1-6月,n=136)和观察组(2020年7-12月,n=136)。对照组予以常规心理干预,观察组予以ERAS联合心理干预。比较两组术后恢复情况,干预前、干预后,对比两组患者的心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、应激反应[创伤后成长评定量表(PTGI)]、正念心理特质[负性认知偏向量表(APNIS)]情况。结果:观察组术后24hVAS、通气通便时间、术后卧床时间、住院时间均短于对照组,差异具有统计学意义(t=-6.523,-12.070,-5.582,-16.514;P<0.05);观察组术后并发症发生率低于对照组,差异具有统计学意义(χ^(2)=4.180,P<0.05);观察组SAS、SDS得分低于对照组,差异具有统计学意义(t=-15.044,-19.965;P<0.05);观察组PTGI量表中人际关系、新可能性、个人力量、精神变化、欣赏生活均高于对照组,差异具有统计学意义(t=3.406,4.629,3.637,3.434,7.803;P<0.05);观察组APNIS中正性得分高于对照组,差异具有统计学意义(t=18.630,P<0.001),观察组APNIS中负性得分低于对照组,差异具有统计学意义(t=-15.045,P<0.001)。结论:ERAS理念联合心理干预应用于经ERCP治疗的患者效果良好,能改善患者心理状态、术后恢复情况、应激反应和正念心理特质,也有利于降低术后并发症。

Objective:To explore the influence of the concept of accelerated rehabilitation surgery(ERAS)combined with psychological intervention on the psychological state and postoperative complications of patients treated by endoscopic retrograde cholangiopancreatography(ERCP).Methods:A total of 272 patients treated with ERCP from January 2020 to December 2020 were selected as research objects,and were divided into control group(January 2020 to June 2020,n=136)and observation group(July 2020 to December 2020,n=136).The control group was given routine psychological intervention,while the observation group was given ERAS combined with psychological intervention.The recovery after operation was compared between two groups.Before and after intervention,the psychological state[Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)],stress response[Post-traumatic Growth Rating Scale(PTGI)]and mindfulness psychological characteristics[Negative Cognitive Bias Scale(APNIS)]were compared between two groups.Results:VAS,ventilation and defecation time,postoperative bed rest time and hospitalization time in the observation group were shorter than those in the control group(t=-6.523,-12.070,-5.582,-16.514;P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(χ^(2)~2=4.180,P<0.05).The scores of SAS and SDS in the observation group were lower than those in the control group,and the difference was statistically significant(t=-15.044,-19.965;P<0.05).Interpersonal relationship,new possibility,personal strength,mental change and appreciation of life in the observation group were higher than those in the control group,and the differences were statistically significant(t=3.406,4.629,3.637,3.434,7.803;P<0.05).The positive scores of APNIS in the observation group were higher than those in the control group(t=18.630,P<0.001),while the negative scores in the observation group were lower than those in the control group(t=-15.045,P<0.001).Conclusion:The combination of ERAS concept and psychological intervention has a good effect on ERCP patients,which can improve their psychological state,postoperative recovery,stress response and mindfulness psychological characteristics,and also help to reduce postoperative complications.