围手术期椎管内麻醉患者实施心理干预的研究
［摘 要］ 目的：观察围手术期椎管内麻醉患者实施心理干预后的效果。方法：随机选择欲实施椎管内麻醉的手术患者95例，ASA病情评估Ⅰ级～Ⅱ级。将患者随机分为实验组和对照组，实验组46例，对照组49例。实验组的患者在其手术前、手术中和手术后进行心理干预，对照组仅实施常规围手术期护理。术后72 h完成焦虑自评量表(SAS)测评及自编效果评分表的评分。结果：实施心理干预后，实验组患者围手术期的情绪稳定，血压、脉搏正常，术后止痛效果满意，肠蠕动恢复及下床活动时间较对照组显著提前。结论：心理干预能减轻椎管内麻醉患者围手术期的应激反应，促进患者术后恢复。［关键词］ 心理干预；围手术期；椎管内麻醉
Discussion of Psychological Intervention on the Patients with Anesthesia in Vertebral Canal During the Period of Operation
Abstract：Objective Observe the effect of psychological intervention on the patients during the period of operation. Methods Choose 95 patients who intend to be anesthetized in vertebral canal at random and the evaluation of state of illness by means of ASA is Ⅰ～Ⅱ stage. The patients were divided into two groups at random; the experimental group consisted of 46 and the comparison group 49. The patients in experimental group were conducted with psychological intervention during the period of pre?operation, in?operation and post?operation, while the comparison group was only implemented the regular care of operation. The self?appraising?system (SAS) and self?editing?effect table were finished in 72hours after the operation. Results After the psychological intervention, the patients in experimental group presented the steady mood, normal blood pressure and pulse, satisfied acesodyne effect and the remarkable increase of intestine peristalsis and movementhours of off?bed compared with the comparison group. Conclusion The psychological intervention is conducive to alleviate the reaction of the patients with anesthesia in vertebral canal during the period of operation and facilitate their recovery.
Key words: Psychological intervention；The period during the operation; Anesthesia in vertebral canal
心理干预是指在心理理论的指导下，对个体和群体的心理健康问题和行为施加策略性影响，使之发生指向性预期目标的变化；围手术期是指患者在入院后手术前、手术中、手术后这段相连续的时间。为了测定心理干预对围手术期椎管内麻醉患者的影响程度，我们采取了以下的方法。
1 对象与方法
1.1 对象选择 从欲实施椎管内麻醉的患者中随机抽取95例，ASA病情评估I～II级(见表1)，男性50例，女性45例，年龄32岁～63岁，平均年龄47岁。其中阑尾切除术14例，前列腺摘除术12例，子宫次全切除术9例，胆总管结石摘除术11例，小肠切除术10例，大肠癌切除术10例，胆囊摘除术13例，胃大部切除术16例。手术前、手术中及手术后患者均为清醒状态，随机分为实验组和对照组，其中实验组46例，对照组49例，两组在性别、年龄、文化程度、职业分布、疾病种类间比较等均具有可比性，差异无显著性 。
表1 病情评估(ASA)分级分级 略
1.2 方法 两组椎管内麻醉患者手术前各项准备、手术中穿刺技术及护理、手术后处理均按常规操作进行，其中实验组在手术前、手术中及手术后72 h内采取下列干预措施。
1.2.1 对患者进行健康指导 给患者讲解手术的名称、目的、过程麻醉方法及有关手术中和手术后的不适和应对方法，使其了解椎管内麻醉、手术、各项检查等诊疗措施的必要性、重要性，消除患者对各项诊疗措施的恐惧和忧虑心理，并指导患者进行各项适应性训练。