心理干预及自控镇痛对上腹部手术后应激反应的影响

Effect of psychological intervention combined with patient-controlled analgesia on stress responses in patients after upper abdominal surgery.

目的观察心理干预联合病人自控镇痛技术对上腹部手术后患者血浆促肾上腺皮质激素 (ACTH)、血管紧张素Ⅱ (AⅡ )和皮质醇 (F)的影响。方法将 4 5例拟行上腹部手术的患者根据不同镇痛方式随机分三组 :A组为对照组 ,术后根据需要间断肌注哌替啶镇痛 ;B组围术期进行综合心理干预治疗 ,术后行哌替啶肌注镇痛 ;C组围术期进行心理干预 ,术后行硬膜外自控镇痛 (PCEA)。采用放免法测定术前、术毕、术后 2 4h、术后 4 8h、术后 5d血浆ACTH、AⅡ、F浓度 ,监测BP、HR及进行VAS评分。结果B组及C组术后 2 4h、4 8h血浆ACTH、AⅡ、F浓度显著低于A组 (P <0 .0 5 ) ,且C组降低幅度更大 (P <0 .0 1)。B组及C组术后BP、HR及VAS评分显著低于同期A组(P <0 .0 5 ) ,且C组数值更低 (P <0 .0 1)。结论围术期实行心理干预 ,能有效地减轻病人的应激反应 ,心理干预联合PCEA能提供完善的止痛效果 ,维持血流动力学稳定 ,有效地调控围术期的应激反应水平。

Objective To investigate the effect of psychological intervention combined with patient-controlled analgesia on stress responses in patients after upper abdominal Surgery. Methods Forty five patients scheduled for upper abdominal surgery were randomly allocated to one of the three groups: A?B and C. Each group was fifteen cases. In group A, patients received a bolus of pethidine 50 mg im, when they complained that pain was intolerable. In group B patients received the per operative psychological intervention combined with the method of postoperative pain management like group A. In group C patients received the per operative psychological intervention combined with the postoperative patient controlled epidural analgesia (PCEA). Venous blood samples were obtained before operation(T 1), at the end of operation (T 2)?24h(T 3)?48h(T 4)and 5 d after operation (T 5) for determination of plasma adrenocorticotropic hormone (ACTH)?angiotensin Ⅱ(AⅡ) and kendall's compound F(F). Pain was assessed using visual analog scale (VAS).Results Plasma ACTH?AⅡ?F in group B and C were signifcantly lower than those in group A after operation ( P <0.05 for group B; P <0.01 for group C).BP?HR and VAS scores were higher in group A than those in group B and C after operation . Conclusions Psychological intervention can effectively relieve stress responses in patients after upper abdominal surgery. Psychological intervention Combined with PCEA Can fully provide analgetic effect and effectively control stress responses.