术前心理疏导联合快速康复外科理念干预对经尿道膀胱肿瘤电切术患者麻醉恢复期的影响  

Effect of preoperative psychological counseling combined with enhanced recovery after surgery intervention in anesthesia recovery period after transurethral resection of bladder tumor

作　　者：宋丽霞 支慧[1] 吴苏 陈少如 SONG Lixia;ZHI Hui;WU Su;CHEN Shaoru(Henan Provincial People's Hospital,Department of Anesthesiology and Perioperative Medicine,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450000

出　　处：《中国健康心理学杂志》2024年第12期1865-1870,共6页China Journal of Health Psychology

基　　金：2021和2022年度河南省医学科技攻关计划省部共建项目(编号:SBGJ202103024)。

摘　　要：目的:分析术前心理疏导联合快速康复外科理念(ERAS)干预对经尿道膀胱肿瘤电切术(TURBT)患者麻醉恢复期的影响。方法:选取2022年1月-2024年1月某院收治的95例TURBT患者,随机分至观察组、对照组分别48例、47例,对照组采用常规干预,观察组在对照组基础上予以术前心理疏导联合ERAS干预,对比两组手术及麻醉恢复情况、膀胱痉挛程度,分析其干预前后Kolcaba的舒适状况量表(GCQ)、疼痛视觉模拟评分(VAS)、负性情绪[Zung氏焦虑自评量表(SAS)、Zung氏抑郁自评量表(SDS)]评分、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)]、麻醉不良反应发生率。结果:观察组苏醒时间、拔除尿管时间、术后排气时间、住院时间短于对照组(t=-14.516,-25.203,-14.936,-14.716;P<0.01);观察组麻醉恢复室中膀胱痉挛发生率与严重程度低于对照组(χ^(2)=4.270,4.870;P<0.05),痉挛发作频率、痉挛持续时间少于对照组(t=-17.550,-30.602;P<0.01);干预后6 h、12 h、24 h观察组GCQ评分高于对照组(t=2.164,2.478,4.100;P<0.05),而VAS评分低于对照组(t=-12.112,-12.799,-2.156;P<0.05);干预后观察组SAS评分、SDS评分低于对照组(t=-6.505,-2.363;P<0.05);麻醉后观察组Cor、NE、AngⅡ水平低于对照组(t=-10.465,-5.464,-2.510;P<0.01);观察组麻醉不良反应发生率低于对照组(χ^(2)=4.116,P<0.05)。结论:术前心理疏导联合ERAS干预可有效促进TURBT后麻醉恢复,减少麻醉不良反应,减轻麻醉恢复室中膀胱痉挛,缓解患者负性情绪。Objective:To analyze the effect of preoperative psychological counseling combined with enhanced recovery after surgery(ERAS)intervention in anesthesia recovery period after transurethral resection of bladder tumor(TURBT).Methods:From January 2022 to January 2024,95 patients who underwent TURBT in the hospital were selected as the study subjects.The subjects were divided into observation group(48 cases)and control group(47 cases)randomly.The control group received routine intervention,and the observation group received preoperative psychological counseling combined with ERAS intervention on this basis.The situation of surgery and anesthesia recovery and the degree of bladder spasm were compared between the groups.Kolcaba's General Comfort Questionnaire(GCQ)scores,Visual Analogue Scale(VAS)scores for pain and scores for negative emotions[Zung's Self-Rating Anxiety Scale(SAS)and Zung's Self-Rating Depression Scale(SDS)]before and after intervention,stress response[cortisol(Cor),norepinephrine(NE)and angiotensin II(Ang II)],and the incidence rates of adverse anesthesia reactions were analyzed.Results:Awakening time,catheter removal time,postoperative exhaust timeand hospital stay of the observation group were shorter than those ofthe control group(t=-14.516,-25.03,-14.936,-14.716;P<0.01).In the anesthesia recovery room,the incidence and severity of bladder spasms in the observation group were lower than those in the control group(χ^(2)=4.270,4.870;P<0.05).The frequency and duration of spasmwere lower and shorter than those in the control group(t=-17.550,-30.602;P<0.01).After 6 h,12 h and 24 hof intervention,the observation group had higher GCQ scores(t=2.164,2.478,4.100;P<0.05),and lower VAS scores(t=-12.112,-12.799,-2.156;P<0.05).After intervention,theobservation group had lower SAS scores and SDS scores than thatthe control group(t=-6.505,-2.363;P<0.05).After anesthesia,the levels of Cor,NE and Ang II in the observation group were lower than those in the control group(t=-10.465,-5.464,-2.510;P<0.01).The incidence

关 键 词：心理疏导 快速康复外科理念 经尿道膀胱肿瘤电切术 麻醉恢复期 

分 类 号：R395.5[哲学宗教—心理学] R749.92[医药卫生—医学心理学]