心理干预在老年麻醉中的应用研究

发布时间：2018-04-03 21:23

本文选题：心理学　切入点：应激　出处：《山东大学》2008年硕士论文

【摘要】： 目的:随着社会发展,我国人均寿命已近70岁,人口年龄随着医疗水平和公共卫生方面的改善,在很大程度上降低了早期死亡率,延长了平均寿命,社会人口年龄结构已为老龄化,随着年龄的增长,适应环境的能力下降,老化的静止状态或基本参数的变化不是主要的(比如静止状态下的心率或血清糖皮质醇激素水平),而对环境刺激(如运动或禁食)的反应能力的变化才是主要的。更何况对于面临手术麻醉的威胁,患者往往产生严重的焦虑反应,从而给病人带来极大地心理反应。焦虑的因素主要有:对于手术的效果如何存在担忧;对于手术有可能带来的疼痛产生恐惧;对于日后生活状况、生活质量如何存在忧虑;担心手术中有可能发生意外;对于医生的医术和经验存在挑剔心理。这些焦虑的因素是围麻醉期应激反应发生的主要因素。人的这种焦虑反应,往往伴有机体不同程度应激反应,其中交感—肾上腺髓质系统尤为活跃,引起血中儿茶酚胺释放增多,使心肌氧耗增加,在此基础上麻醉和手术刺激将进一步加剧心肌氧供需矛盾,可导致围术期心脑血管意外增加。精神紧张时可影响血液循环及神经传导,引起焦虑、抑郁、疼痛等负性情绪。因此围麻醉期对应激的控制至关重要。因此,老年人的麻醉手术问题已成为临床研究的重要课题。伴随着传统的生物—医学模式向生物—心理—社会医学模式转变,病人的心理因素越来越受到各科医师的重视。本研究旨在探讨心理干预对老年围麻醉期的应激反应的影响。方法:随机选取65—89岁男性120例,拟行择期手术,随机分为实验组和对照组。对照组不做任何干预,术前分别进行SDS(抑郁自评量表);试验组进行心理疏导,方法有:1、提供信息:术前向病人讲清手术的必要性及手术的安全性;2、认知疗法:向病人介绍麻醉方法、主要操作过程及操作中的注意事项;3、放松训练:指导病人进行放松训练、进行腹式呼吸,减少病人术前的紧张情绪,改善其睡眠。 4、麻醉后对患者实施触摸,通过心理、生理途径调节人体循环,使心率、血压维持在正常状态,达到良好的放松效果。然后分别记录术中的血流动力学变化、血糖变化、血浆糖皮质醇浓度、脑电变化,并对术后的恢复情况进行跟踪观察。结果:对照组病人切皮时MAP、SAP及DAP较术前基础值明显增高,而实验组病人切皮时血压、心率变化不明显,术中血流动力学变化较对照组明显稳定,对照组病人切皮后60分钟血糖值较基础值明显升高,而实验组变化不大;说明,通过对病人的心理干预,明显减轻手术病人术中的应激反应,可以使血糖水平降低。术中脑电变化表示麻醉后30分钟,实验组睡眠状态较对照组相对要多;说明通过心理干预可以使人体内的脑啡呔和脑电中的α波增加,降低交感神经的冲动,从而帮助人们镇定情绪。实验组病人术中镇静度评分低于对照组;术后疼痛评分,实验组分值明显低于对照组,说明有效的心理干预可以消除病人的焦虑,指导病人进行放松训练,减轻患者的痛苦,也减少了镇痛药的应用。另外,我们还分别于术前一天晨8时及手术当日晨8时分别测定了120例(实验组和对照组各60例)患者血中的皮质醇浓度,结果显示,对照组病人手术前一日皮质醇浓度明显高于实验组前一日皮质醇浓度,而实验组病人在手术当日血中的皮质醇浓度明显低于对照组。心理疏导可以改善情绪,亦可使皮质醇水平下降,从而降低应激激素的分泌水平。结论:通过心理干预可以明显降低老年人麻醉手术中的应激反应,并促进患者早日康复。
[Abstract]:Objective: with the development of society, China's life expectancy has nearly 70 years of age, the population age with the level of medical and public health improvements, largely reduce the early mortality, prolonged life expectancy, the age structure of population is aging, with the age growth, adapt to the decline in environmental capacity, aging rest or change is not the main basic parameters (such as resting heart rate or serum cortisol hormone levels), and to the environmental stimuli (such as exercise or fasting) change response ability is main. Not to mention the face anesthesia threat, patients often anxiety seriously, so as to bring great psychological reactions to the patient. The anxiety factors are: how worried about the effect of surgery; fear for surgery may have pain; for life after life How to have concerns about possible quality; surgical accident; for the doctor's skill and experience are critical. These factors of psychological anxiety is the main factor of stress during anesthesia. Such anxiety, often accompanied by different level of stress, the sympathetic adrenal medulla system is particularly active, causing catecholamine release the increase in blood, the myocardial oxygen consumption increased, on the basis of anesthesia and surgical stimulation will further exacerbate the contradiction between myocardial oxygen supply and demand, can lead to cardiovascular and cerebrovascular accident patients increased peri. Mental stress can affect the blood circulation and nerve conduction, causing anxiety, depression, pain and other negative emotions. It is vital to stress during anesthesia the control. Therefore, anesthesia and operation problems of the elderly has become an important topic in clinical research. With the traditional biomedical model to bio - heart In the transformation of medical social medicine mode, the psychological factors of patients have been paid more and more attention by various physicians. The purpose of this study is to explore the effect of psychological intervention on stress response in the elderly during anesthesia.
Methods: 65 - 89 year old male 120 patients, undergoing elective surgery, were randomly divided into experimental group and control group. The control group without any intervention, preoperative SDS (self rating Depression Scale); experimental group psychological counseling methods are: 1, to provide information security necessity to tell the patient before surgery surgery and surgery; 2, cognitive therapy: anesthesia method is introduced to the patient, the main operation process and matters needing attention in operation; 3, relaxation training: to guide patients to relax training, abdominal breathing, reduce the tension of patients before operation, improve their sleep.
4, after anesthesia for patients with touch, through psychological, physiological pathways that regulate the circulation of the human body, the heart rate and blood pressure remained in the normal state, to achieve a good relaxation effect. Then record the hemodynamic changes, intraoperative changes in blood glucose, plasma cortisol concentration, EEG changes were observed, and the postoperative recovery.
Results: the patients in the control group when cutting leather MAP, SAP and DAP compared with the preoperative value increased significantly, while the experimental group patients with skin incision in blood pressure, heart rate did not change significantly, intraoperative hemodynamic changes significantly compared with the control group, the control group patients 60 minutes after skin incision blood glucose increased significantly compared to the baseline values, and experiment group changed little; that through psychological intervention to patients, significantly reduce the stress reaction of patients in operation, can reduce the blood sugar level. Intraoperative EEG changes 30 minutes after anesthesia, sleep in experimental group than in the control group was relatively more; that through psychological intervention can make people in alpha endorphin tie and EEG increased, decreased sympathetic nerve impulses, which helps people to calm the mood.
The sedation score of patients in the experimental group was lower than that in the control group. The postoperative pain score in the experimental group was significantly lower than that in the control group, indicating that effective psychological intervention can eliminate the anxiety of patients, guide the patients to relax training, relieve the pain of patients, and reduce the use of analgesics.
In addition, we are also on the day before surgery, during the morning of 8 and 8 respectively at the day of operation were measured in 120 cases (experimental group and control group with 60 cases in each group) cortisol concentrations in blood of patients with the results showed that the control group of patients before surgery, cortisol concentration was significantly higher in the experimental group the day before the cortisol concentration. The cortisol concentrations in blood on the day of operation in the experimental group were significantly lower than the control group. Psychological counseling can improve mood, reduce cortisol level, thereby reducing the stress hormone level.
Conclusion: psychological intervention can obviously reduce the stress response in the anesthesia operation of the elderly and promote the early recovery of the patients.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R614;R395.5

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