积极心理干预联合胸骨旁阻滞对开胸切除胸骨后甲状腺肿患者全身麻醉苏醒期躁动和应激反应的影响  

Effect of positive psychological intervention combined with parasternal block on agitation and stress response during general anesthesia recovery in patients with retrosternal goitrogenesis after sternal median incision

作　　者：赵石磊 李林 曹惠鹃 

机构地区：[1]北部战区总医院麻醉科,沈阳110016

出　　处：《国际医药卫生导报》2020年第18期2794-2796,2804,共4页International Medicine and Health Guidance News

摘　　要：目的观察心理干预联合胸骨旁阻滞对胸骨正中切口术式切除胸骨后甲状腺肿患者全身麻醉苏醒期躁动及应激反应的影响。方法选取首次择期拟在全身麻醉下行胸骨正中切口摘除胸骨后甲状腺肿的患者90例,随机分为常规术前辅导组(A组,n=30)、术前积极心理干预组(B组,n=30)、术前积极心理干预联合胸骨旁阻滞组(C组,n=30)。记录3组诱导前(T1)、拔管前(T2)、拔管后1 min(T3)、拔管后5 min(T4)MAP和HR,躁动评分,Ramsay镇静评分,苏醒时间,拔出气管导管时间和不良事件发生情况。结果3组诱导前MAP、HR差异无统计学意义(均P>0.05)。相对T1,C组T2、T3、T4、时MAP、HR均出现降低,差异具有统计学意义(均P<0.05);A组T2时MAP、HR升高幅度明显(均P<0.05)。组间比较中,A组、B组T2时HR、MAP均高于C组,其中A组数据最为明显(均P<0.01)。C组苏醒期躁动情况和镇静理想程度均优于A组、B组(均P<0.05),但3组苏醒时间和拔管时间差异无统计学意义(均P>0.05)。3组患者均未发生明显相关并发症。结论所有组别的方案均可以安全地应用于开胸切除胸骨后甲状腺肿手术,其中积极心理干预联合胸骨旁阻滞在苏醒期质量和减少躁动方面具有一定优势。Objective To observe the effect of psychological intervention combined with parasternal block on the agitation and stress response during general anesthesia recovery in patients with retrosternal goitrogenesis after sternal median incision.Methods For the first time,90 patients with retrosternal goitrogenesis after sternal median incision under general anesthesia were randomly divided into group A,taking routine preoperative counseling,group B,taking preoperative active psychological intervention,and group C,taking preoperative positive psychological intervention and parasternal block,with 30 cases in each group.The MAP and HR before anesthesia induction(T1),before extubation(T2),1 min after extubation(T3),and 5 min after extubation(T4),agitation score,Ramsay sedation score,time to wake up,time to pull out the tracheal tube,and occurrence of adverse events were recorded.Results There were no statistical differences in HR and MAP between the three groups before anesthesia induction(all P>0.05).The MAP and HR in group C were lower at T2,T3,and T4 than at T1,with statistical differences(all P<0.05).The MAP and HR in group A increased significantly at T2(P<0.05).At T2,the HR and MAP were higher in group A and group B than in group C,and those in group A were the highest(all P<0.01).The agitation and sedation in group C were better than those in group A and group B(all P<0.05).There were no statistical differences in recovery time and extubation time between the three groups(all P>0.05).No significant complications occurred in all the three groups.Conclusion All the groups’protocols can be safely applied to open thoracotomy for retrosternal goitrogenesis.Positive psychological intervention combined with parasternal block has certain advantages in the quality of recovery and in reducing agitation。

关 键 词：积极心理干预 胸骨旁阻滞 胸骨后甲状腺肿 苏醒期躁动 

分 类 号：R473.6[医药卫生—护理学]