【摘要】：目的：觀察心理干預(yù)對(duì)全身麻醉蘇醒期患者導(dǎo)尿相關(guān)膀胱刺激癥(CRBD)的防治效果,以及心理干預(yù)的合適時(shí)機(jī)。 方法：將240例全麻下骨科、普外科擇期手術(shù)患者,隨機(jī)分為四組,每組各60例,A組：術(shù)前一天麻醉訪視時(shí)行心理干預(yù)；B組：術(shù)前一天和麻醉誘導(dǎo)前行心理干預(yù)各一次；C組：麻醉誘導(dǎo)前心理干預(yù)一次；D組：觀察組。各組常規(guī)訪視談話簽字,均在全麻誘導(dǎo)后行導(dǎo)尿術(shù),所有患者麻醉誘導(dǎo)方式相同,進(jìn)行機(jī)械控制呼吸后采用全憑靜脈麻醉維持。記錄研究對(duì)象麻醉誘導(dǎo)前(To)和術(shù)后麻醉蘇醒拔管時(shí)(T1)及拔管后行躁動(dòng)評(píng)分時(shí)(T2)的平均動(dòng)脈壓(MAP)、心率(HR)；同時(shí)記錄患者的麻醉時(shí)間、蘇醒時(shí)間和拔管時(shí)間；拔管后待患者意識(shí)清醒(能準(zhǔn)確回答問題)后行躁動(dòng)評(píng)分、VAS評(píng)分、膀胱刺激程度分級(jí)。比較四組患者在全身麻醉蘇醒期因?qū)蚬芟嚓P(guān)的重度CRBD。 結(jié)果： 1、四組患者在性別、年齡、身高、體重、麻醉時(shí)間、蘇醒時(shí)間、拔管時(shí)間上差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)； 2、入室時(shí)(T0)MAP、心率四組均值無(wú)統(tǒng)計(jì)學(xué)意義,拔管時(shí)(T1)A、B、C三組低于D組(p0.05)有統(tǒng)計(jì)學(xué)意義,B組略低于A、C組,但無(wú)統(tǒng)計(jì)學(xué)意義,躁動(dòng)評(píng)分時(shí)(T2)和入室時(shí)(T0)MAP、心率四組均值(p0.05)無(wú)統(tǒng)計(jì)學(xué)意義。 3、A、B、C三組與D組相比全麻蘇醒后躁動(dòng)率有統(tǒng)計(jì)學(xué)意義,前三組躁動(dòng)率明顯低于D組；B組略低于A、C組,但無(wú)統(tǒng)計(jì)學(xué)意義；A、C組相比無(wú)統(tǒng)計(jì)學(xué)意義；四組VAS相比無(wú)統(tǒng)計(jì)學(xué)意義。 4、A、B、C三組于D組相比重度CRBD (p0.05)的發(fā)生率有統(tǒng)計(jì)學(xué)意義,B組低于A、C組但沒有統(tǒng)計(jì)學(xué)意義,A、C組相比無(wú)統(tǒng)計(jì)學(xué)意義。A、B、C三組與D組相比輕度的明顯增多,有統(tǒng)計(jì)學(xué)意義,B組較A、C組更明顯但沒有統(tǒng)計(jì)學(xué)意義。 結(jié)論： 1、術(shù)前心理干預(yù)后蘇醒期導(dǎo)尿相關(guān)的重度CRBD發(fā)生率顯著降低,而且心血管不良事件的發(fā)生率也有所減少,輕度CRBD顯著增多,明顯降低患者全麻蘇醒期導(dǎo)尿相關(guān)CRBD的不適。 2、實(shí)施心理干預(yù)的合適方法是術(shù)前一天實(shí)施一次,麻醉誘導(dǎo)前再加強(qiáng)一次。
[Abstract]:Objective: to observe the effect of psychological intervention on the prevention and treatment of (CRBD) in patients with urinary catheterization associated with bladder irritation during general anesthesia recovery and the appropriate time of psychological intervention. Methods: 240 patients undergoing orthopedic and general surgery under general anesthesia were randomly divided into four groups: group A: psychological intervention during anaesthesia visit one day before operation, group B: psychological intervention one day before operation and one intervention before anesthesia induction; Group C: psychological intervention once before anesthesia induction, group D: observation group. After induction of general anesthesia, all patients were given urethral catheterization. All patients had the same anaesthesia induction mode, and all patients were maintained by total intravenous anesthesia after mechanical control of breathing. The mean arterial pressure (MAP),) heart rate (HR);) of (To) before anesthesia induction and after anesthesia recovery and extubation (T1) and restlessness score (T2) after extubation were recorded. The anesthesia time, recovery time and extubation time were recorded at the same time. After the extubation, the patients were conscious (who could answer the questions accurately) and then they were graded with restlessness, VAS and bladder irritation. Comparison of four groups of patients with severe CRBD. associated with urethral catheter during general anesthesia recovery Results: 1. There was no significant difference in sex, age, height, weight, anaesthesia time, recovery time and extubation time between the four groups (P0.05); During extubation, there was statistical significance in group C (T1) compared with group D (p0.05), group B was lower than group A (P 0.05), but there was no significant difference between group B and group A (P 0.05). There was no significant difference in the mean value of MAP, heart rate among the four groups (p0. 05) at the time of restlessness score (T2) and (T0). 3 the restlessness rate of group C was significantly lower than that of group D after general anesthesia, and the restlessness rate of group B was lower than that of group D, and that of group B was slightly lower than that of group C. But there was no statistical significance, there was no statistical significance in group A and C, but there was no significant difference between group A and C. The incidence of severe CRBD in group C was significantly higher than that in group D, but there was no significant difference between group B and group A, but there was no significant difference between group C and group A. the incidence of severe CRBD in group C was significantly higher than that in group D, but there was no significant difference between group A and group C. the incidence of severe CRBD in group C was significantly higher than that in group D, but there was no significant difference between group A and group C. There was a slight increase, There was statistical significance, group B was more obvious than group A C, but had no statistical significance. Conclusion: 1. The incidence of severe CRBD associated with urethral catheterization was significantly decreased, the incidence of adverse cardiovascular events was also decreased, and the incidence of mild CRBD was significantly increased after psychological intervention. The discomfort of urethral catheterization associated with CRBD was significantly reduced during general anesthesia recovery. 2. The appropriate method of psychological intervention was once a day before anesthesia induction and once more before anesthesia induction.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

【共引文獻(xiàn)】

相關(guān)期刊論文 前1條

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相關(guān)碩士學(xué)位論文 前1條

1 胡玉翠;心理干預(yù)在老年麻醉中的應(yīng)用研究[D];山東大學(xué);2008年

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本文編號(hào)：2265545