心理干预对胃镜检查期间肥胖患者清醒镇静中焦虑情绪的影响

Effect of psychological intervention for gastroscopy on anxiety in obese patients during conscious sedation

目的:探究心理干预对肥胖患者胃镜检查期间清醒镇静中焦虑情绪的影响。方法:纳入84例拟行胃镜检查的住院肥胖患者,采用随机数字表法分为心理干预组(T组)和常规监护组(C组),每组42例。C组患者在检查期间采用常规健康宣教,T组患者除采用常规健康宣教外,在胃镜检查前3 d开始予以综合心理干预,一直持续到检查结束。两组患者无痛胃镜检查中均使用瑞芬太尼清醒镇静。记录患者一般资料,检查前3 d(T_(1))、检查前30 min(T_(2))及检查后30 min(T_(3))的状态特质焦虑量表(State-Trait Anxiety Inventory, STAI)评分[包括状态焦虑量表(State-Anxiety Inventory, S-AI)评分、特质焦虑量表(State-Trait Inventory, T-AI)评分、第1次和最后1次相比的状态焦虑改变量(ΔS-AI)和特质焦虑改变量(ΔT-AI)],进镜前1 min(检查前)、胃镜进入胃大部即刻(检查中)、检查后5 min(检查后)的MAP及心率;记录检查时间,内镜医师满意人数及患者舒适人数,瑞芬太尼诱导剂量及追加剂量,胃镜检查结果,检查期间低血压、心动过缓、低氧血症发生情况,术后15 min恶心呕吐及头晕发生情况。 结果:两组患者一般资料及瑞芬太尼诱导量、胃镜检查结果差异无统计学意义( P>0.05)。两组患者T_(1)时S-AI、T-AI评分差异无统计学意义( P>0.05),但T_(2)、T_(3)时T组患者S-AI及T-AI评分明显低于C组( P<0.05);与T_(1)时比较,T组患者T_(2)、T_(3)时S-AI、T-AI评分明显降低( P<0.05),C组患者T_(3)时S-AI、T-AI评分明显降低( P<0.05)。与ΔT-AI比较,T组患者ΔS-AI明显较高( P<0.05),C组患者差异无统计学意义( P>0.05)。检查前和检查后两组患者MAP、心率差异无统计学意义( P>0.05);检查中T组患者MAP、心率均低于C组( P<0.05)。与C组比较,T组患者检查时间缩短( P<0.05),内镜医师满意人数和患者舒适人数增高( P<0.05),瑞芬太尼追加剂量降低( P<0.05);检查期间两组低血压、心动过缓、低氧血症发生率差异无统计学意义( P>0.05);术后T组患者恶心呕吐和头晕发生率低于C组( P<0.05)。 结论:对于行胃镜检查的肥胖患者,心理干预能够改善其在清醒镇静中的焦虑情绪,降低应激反应,并减少药物使用剂量。

Objective To explore the effect of psychological intervention for gastroscopy on anxiety in obese patients during conscious sedation.Methods A total of 84 obese inpatients who were scheduled for gastroscopy were included.According to the random number table method,they were divided into two groups(n=42):a psychological intervention group(group T)and a routine mon‑itoring group(group C).Patients in group C received routine health education during the examination.In addition to the routine manage‑ment,group T underwent comprehensive psychological intervention three days before gastroscopy,which continued until the end of the examination.During gastroscopy,both groups used remifentanil for conscious sedation.Then,their general information were recorded.Their State‑Trait Anxiety Inventory(STAI)scores were evaluated three days before the examination(T_(1)),30 min before the examination(T_(2)),and 30 min after the examination(T_(3)),including scores of State-Anxiety Inventory(S‑AI),scores of Trait-Anxiety Inventory(T‑AI),the variation of State-Anxiety Inventory(ΔS‑AI)and Trait-Anxiety Inventory(ΔT‑AI)for the last time compared to the first time.The mean arterial pressure(MAP)and heart rate were recorded 1 min before tube insertion(before examination),immediately after the gas‑troscope entered into most of the stomach(during the examination),and 5 min after the examination(after the examination).The dura‑tion of gastroscopy,the number of endoscopists with satisfaction and the number of patients with comfort,the induction dose and supplementary dose of remifentanil,the results of gastroscopy,the incidences of hypotension,bradycardia and hypoxemia during the examina‑tion,and the incidences of nausea,vomiting and dizziness 15 min after the operation were recorded.Results There was no statisti‑cal difference in general information,the induction dose of remifentanil and gastroscopy results between the two groups(P>0.05).There was no statistical difference in S‑AI and T‑AI scores between the two groups at T_(1)(P>0.05),but S‑AI and T‑AI scores in group T were significantly lower than those in group C at T_(2) and T_(3)(P<0.05).Compared with those at T1,S‑AI and T‑AI scores in group T at T_(2) and T_(3) remarkably decreased(P<0.05),and S‑AI and T‑AI scores in group C at T_(3) significantly decreased(P<0.05).Compared withΔT‑AI,ΔS‑AI in group T was significantly elevated(P<0.05),while there was no statistical difference in group C(P>0.05).There was no statis‑tical difference in MAP and heart rate between the two groups before and after examination(P>0.05).During the examination,group T showed lower MAP and heart rate than group C(P<0.05).Compared with group C,group T presented shortened duration of examination(P<0.05),and increases in the number of endoscopists with satisfaction and the number of patients with comfort(P<0.05),with a de‑creased supplementary dose of remifentanil(P<0.05).There was no statistical difference in the incidences of hypotension,bradycardia and hypoxemia between the two groups(P>0.05).The incidences of nausea,vomiting and dizziness in group T were lower than those in group C(P<0.05).Conclusions For obese patients who underwent gastroscopy,psychological interventions can improve their anxi‑ety,reduce stress response,and reduce the consumption of drugs during conscious sedation.