围术期多学科疼痛管理结合心理干预在乳腺癌改良根治术中的应用  

Application of perioperative multidisciplinary pain management combined with psychological intervention in modified radical mastectomy

作　　者：舒华[1] 梁正[1] 黄大雪 李靖[1] 王丹 SHU Hua;LIANG Zheng;HUANG Da-xue;LI Jing;WANG Dan(Department of Anesthesiology,the Second People′s Hospital of Neijiang,Sichuan Province,Neijiang641000,China)

机构地区：[1]四川省内江市第二人民医院麻醉科,四川内江641000

出　　处：《中国当代医药》2021年第8期140-143,共4页China Modern Medicine

基　　金：四川省卫生和计划生育委员会科研课题(17PJ406)。

摘　　要：目的探讨围术期多学科疼痛管理结合心理干预在乳腺癌改良根治术中的应用及临床效果。方法选取内江市第二人民医院2017年6月~2018年12月收治的180例乳腺癌患者,依据随机数字表法分为A组、B组及C组,每组60例。所有患者均采用气管插管全身麻醉,A组采用术后静脉患者自控镇痛(PCIA),B组采用神经阻滞+术后PCIA,C组采用心理干预+神经阻滞+术后PCIA,术后镇痛时间为48 h。观察三组患者术前及术后第1、3天的疼痛视觉模拟(VAS)评分、术后PCIA按压次数及非甾体类镇痛药用量,术前及术后第1、3天采用Zung抑郁量表(SDS)及焦虑量表(SAS)评价三组患者的心理状态,观察术后的近期并发症发生情况及住院时间。结果三组患者术前的VAS评分比较,差异无统计学意义(P>0.05);C组术后第1、3天的VAS评分低于A组及B组,差异有统计学意义(P<0.05);C组术后的PCIA按压次数及非甾体类镇痛药用量均少于A组及B组,差异有统计学意义(P<0.05);三组术前的SDS及SAS评分比较,差异无统计学意义(P>0.05);C组术后第1、3天的SDS及SAS评分低于A组及B组,差异有统计学意义(P<0.05);C组术后并发症总发生率低于A组及B组,差异有统计学意义(P<0.05);B组、C组的住院时间短于A组,差异有统计学意义(P<0.05)。结论围术期多学科疼痛管理结合心理干预能够减轻乳腺癌改良根治术患者的心理及生理应激反应,缓解心理压力,改善患者术后的镇痛效果,促进患者的术后康复。Objective To investigate the application and clinical effect of perioperative multidisciplinary pain management combined with psychological intervention in modified radical mastectomy.Methods A total of 180 cases of breast cancer patients in the Second People′s Hospital of Neijiang from June 2017 to December 2018 were selected and divided into group A,group B and group C according to random number table method,60 cases in each group.All patients were given general anesthesia through tracheal in tubation.Group A was given postoperative patient controlled intravenous analgesia(PCIA),group B was given nerve block combined postoperative PCIA,and group C was given psychological intervention combined nerve block and postoperative PCIA.The postoperative analgesia time was 48 h.Visual analogue score(VAS),PCIA pressing times and dosage of postoperative nonsteroidal analgesic of the three groups were observed at the first and third day after operation,Zung depression(SDS)and anxiety scale(SAS)were used to evaluate the psychological status of the three groups before operation and at the first and third day after operation,and the recent complications and hospital stay were observed among the three groups.Results There was no significant difference in preoperative VAS score among the three groups(P>0.05).The VAS scores at the first and third days after operation in group C were lower than those in group A and group B,the differences were significant difference(P<0.05).Pressing time of PCIA and dosage of postoperative nonsteroidal analgesic in C group were less than those in group A and group B,the differences were significant difference(P<0.05).There were no significant differences in preoperative SDS and SDA scores among the three groups(P>0.05).The SDS and SDA scores at the first and third days after operation in group C were lower than those in group A and group B,the differences were significant difference(P<0.05).The total incidence of complications in group C was lower than that in group A and group B,the differences

关 键 词：多学科疼痛管理 乳腺癌 焦虑 抑郁 视觉模拟评分 

分 类 号：R614.2[医药卫生—麻醉学]