心理干预联合患者自控镇静术对手术期间疼痛的影响(1)
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2010年7月5日
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[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、60 min,术后24 h的HR,MAP,SpO2,术中采用警觉/镇静(OAA/S)评分。于术前、术中1 h、术后24 h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24 h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、60 minⅠ组较Ⅱ组明显升高(P<0.05);SpO2在术中60 minⅡ组较Ⅰ组降低(P<0.05);SP、皮质醇术中1 h、术后24 h Ⅰ组较Ⅱ组升高明显(P<0.01);β-EP术中1 hⅠ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。
[关键词] 心理干预;患者自控镇静;镇痛;手术
[中图分类号] R61 [文献标识码]A [文章编号]1674-4721(2010)07(a)-007-03
The effect of combined psychological intervention on patient-controlled sedation during surgery pain
LI Jun,ZHANG Wensheng
(Anesthesiology Department, Affiliated Hospital of Taishan Medical College in Shandong Province,Tai′an 271000, China)
[Abstract] 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 (P>0.05). Heart rate,MAP surgery 30,60 min Ⅰgroup were significantly higher than group Ⅱ (P<0.05); SpO2 during surgery 60 min Ⅱ group than in group Ⅰ lower (P<0.05); SP, intraoperative cortisol 1 hour, after 24 hoursⅠ group significantly higher than that in group Ⅱ (P<0.01); β-EP surgery group than in the 1 hour Ⅰgroup was significantly lower than group Ⅱ (P<0.05); OAA/S score two in the surgery at first and after the high-low (P<0.05);Ⅱ group was significantly lower than the degree of pain and discomfort in group Ⅰ ......
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