心理干预对重症肌无力患者围术期的影响

摘要

目的 探讨心理干预对重症肌无力患者围术期血流动力学及术后镇痛效果、不良反应发生率的影响.方法 60例择期行胸腺扩大切除术的重症肌无力患者(OssermannⅠ～Ⅱb型)随机分为心理干预组(n=30)和对照组(n=30).两组患者均接受常规护理,术后均使用PCEA镇痛,心理干预组患者在此基础上实施围术期心理干预.监测并记录两组患者在麻醉前(T1)、插管时(T2)、拔管时(T3)及术后60 min(T4)的心率(HR)、平均动脉压(MAP)及两组患者术后镇痛总体满意度评分、不良发应的发生率.结果 两组患者在T2、T3、T4与T1比较,HR和MAP均升高;两组患者在T1、T4时,组间比较差异有统计学意义(P＜0.05);两组患者术后镇痛总体满意度评分比较,心理干预组患者优于对照组患者(P＜0.05);两组患者术后不良反应发生率比较,心理干预组患者术后躁动的发生率明显低于对照组患者(P＜0.05).结论 心理干预能够保证围术期血流动力学的稳定,提高术后镇痛的效果,降低术后躁动的发生率.%Objective To discuss the effect of psychological intervention on hemodynamic and postoperative analgesia, the incidence of adverse reaction in patients with myasthenia gravis undergoing thymectomy. Methods 60 patients with myasthenia gravis (Ossermann I ～ II b) undergoing thymectomy were randomly divided into two groups:psychological intervention group (n=30) and control group (n=30). The two group patients were accepted the same conventional care and postoperative patient-controlled epidural analgesia. Monitoring and recording the changes of two group patients HR, MAP before induction of anesthesia(T1), intubation (T2), extubation (T3) and 60 rain afterThe MAP and HR in two group patients in T2, T3, T4 compared with T1 rose obviously, but there existed significant difference between two groups in T1 and T4 (P＜0.05). Compared with group B, the score of general satisfaction of postoperative analgesia and the incidence of postoperative restless were obviously lower in group A (P＜0.05). Conclusion Psychological intervention can ensure the stability of hemodynamic, improve the effect of postoperative analgesia and reduce the incidence of postoperative restless.