心理干预联合患者自控镇静术对手术期间疼痛的影响  

The effect of combined psychological intervention on patient-controlled sedation during surgery pain

作　　者：李俊[1] 张文生[1] 

机构地区：[1]泰山医学院附属医院麻醉科,山东泰安271000

出　　处：《中国当代医药》2010年第19期7-8,17,共3页China Modern Medicine

摘　　要：目的:研究围术期药物-心理综合镇痛法对疼痛、应激的影响。方法:60例ASAⅠ级择期颌面部手术患者,随机分为两组,Ⅰ组常规围术期准备;Ⅱ组心理干预和患者自控镇静(PCS)。监测患者术前,术中10、30、60min,术后24h的HR,MAP,SpO2,术中采用警觉/镇静(OAA/S)评分。于术前、术中1h、术后24h取外周静脉血,用放射免疫分析法测定血清中的SP、β-EP及皮质醇含量,术后24h应用视觉模拟评分(VAS)评定术后疼痛。结果:患者一般资料比较,差异无统计学意义(P>0.05)。心率,MAP术中30、60minⅠ组较Ⅱ组明显升高(P<0.05);SpO2在术中60minⅡ组较Ⅰ组降低(P<0.05);SP、皮质醇术中1h、术后24hⅠ组较Ⅱ组升高明显(P<0.01);β-EP术中1hⅠ组较Ⅱ组明显降低(P<0.05);OAA/S评分两组在术中呈现先低后高(P<0.05);Ⅱ组疼痛不适的程度明显低于Ⅰ组。结论:心理干预联合PCS明显减轻应激反应;增强患者对手术疼痛的耐受,进一步完善镇痛效果,促进术后康复。Objective：Study of perioperative medicine-psychological analgesia method integrated pain,stress effects. Methods：ASA Ⅰ 60 cases of elective maxillofacial surgery were randomly divided into two groups,Ⅰ Group were given general perioperative preparation;Ⅱ group were given psychological intervention and patient-controlled sedation（PCS） . Monitoring of preoperative,intraoperative 10,30,60 min,after 24 hours of HR,MAP,SpO2,intraoperative use of OAA/S sedation score. In the preoperative,intraoperative 1 hour,24 hours after peripheral venous blood taken,measured with radioimmunoassay in serum of SP,β-EP and cortisol levels 24 hours after application of VAS assessment of pain. Results：General information of patients,the difference was not significant（P0.05） . Heart rate,MAP surgery 30,60 min Ⅰgroup were significantly higher than group Ⅱ（P0.05）;SpO2 during surgery 60 min Ⅱ group than in group Ⅰ lower（P0.05）;SP,intraoperative cortisol 1 hour,after 24 hoursⅠ group significantly higher than that in group Ⅱ（P0.01）;β-EP surgery group than in the 1 hour Ⅰgroup was significantly lower than group Ⅱ（P0.05）;OAA/S score two in the surgery at first and after the high-low（P0.05）;Ⅱ group was significantly lower than the degree of pain and discomfort in group Ⅰ. Conclusion：PCS psychological intervention can significantly reduces joint stress;increases pain tolerance to surgical patients,to further improve the analgesic effect,and promote postoperative rehabilitation.

关 键 词：心理干预 患者自控镇静 镇痛 手术 

分 类 号：R61[医药卫生—外科学]