【作者】 张静；

【导师】 方波；

【作者基本信息】 中国医科大学 ， 麻醉学（专业学位）， 2020， 硕士

【摘要】 目的:探究术前短期正念冥想心理干预对妇科肿瘤手术患者术前镇静程度和术后焦虑的影响,在此基础上探究术前短期正念冥想心理干预在临床运用中的可行性。方法:选择我院择期行妇科肿瘤手术患者60例,年龄18-60岁,ASA分级I-II级,随机分为试验组(n=30)和对照组(n=30)。麻醉医师于术前1天对两组患者进行术前访视,使用状态-特质焦虑问卷(STAI)评估患者基线状态焦虑状况,使用简明精神状态量表(MMSE)评估患者基线状态认知功能。对照组患者仅进行常规术前访视和术前宣教,试验组患者除常规的术前访视外,于术前1天晚七点在病房接受一次15分钟的正念冥想训练,并在干预后填写即时满意度调查表。手术当日患者入室后,连接脑电双频指数(BIS)、ECG、SpO2等监测设备,完成静脉穿刺置管输液后让患者戴上耳机,对照组患者静卧15分钟,试验组患者在专业音频指导下进行15分钟的正念冥想训练,结束后进行麻醉。记录干预前后血压心率值,及干预过程中的BIS值。采用疼痛数字评分(NRS),在麻醉苏醒后、术后6h、术后24h、术后48h对患者进行疼痛评分。术后48h使用STAI和MMSE评估两组患者术后焦虑状况和认知功能,对试验组患者进行术后满意度调查。结果:进入手术室后,干预前两组患者收缩压和心率无明显差异(P>0.05),干预后,试验组患者的收缩压和心率明显低于对照组(P<0.05);试验组干预过程中BIS值明显低于对照组(P<0.05);术前1天两组患者状态焦虑问卷(SAI)分值无明显差异(p>0.05),术后48h,试验组SAI分值明显低于对照组(P<0.05);两组患者术前1天和术后48h的特质焦虑问卷(TAI)分值均无差异(P>0.05);两组患者术前1天和术后48hMMSE评分均无差异(P>0.05),且术后MMSE评分未下降;两组患者术后NRS评分无差异(P>0.05),NRS评分较高的时间点出现在麻醉苏醒后至术后6h;两组患者总体住院时间和术后住院时间无差异(P>0.05);试验组患者即时满意度和术后满意度都高。结论:综上,对妇科肿瘤手术患者进行术前短期正念冥想心理干预可有效地稳定麻醉前血压和心率,提高患者麻醉前的镇静水平,有效缓解术后状态焦虑,患者满意度高,可接受度高。此心理干预方法应用于妇科肿瘤手术患者,具有一定临床意义,且操作简便,是一种具有价值的心理干预工具,可应用于临床。更多还原

【Abstract】 Objective:To explore the effects of preoperative short-term mindfulness psychological intervention on preoperative sedation and postoperative anxiety of patients undergoing gynecological tumor surgery.Methods: A total of 60 patients aged 18-60 and classified as ASA I-II who underwent elective surgery for gynecological tumors in our hospital were randomly divided into an experimental group(n=30)and a control group(n=30).One day before the operation,the anesthesiologist made a preoperative visit to the two groups of patients.The State-Trait Anxiety Inventory(STAI)was used to evaluate the patients’ state anxiety at baseline,and the Mini-Mental State Examination(MMSE)was used to evaluate the patients’ cognitive function at baseline.Patients in the control group received only routine preoperative visits,while patients in the experimental group received a 15-minute mindfulness meditation training in the ward at 7 p.m.one day before the operation,in addition to routine preoperative visits,and filled in the immediate satisfaction questionnaire after the intervention.On the day of the operation,after being connected with standard monitoring and the Bispectral index(BIS)and venipuncture,patients in the control group laid still for 15 minutes,and patients in the experimental group underwent 15 minutes of mindfulness meditation training under professional audio guidance.The blood pressure(BP)and heart rate(HR)before and after the intervention and the BIS value during the intervention were recorded.Numerical Rating Scale(NRS)was used to evaluate the pain degree at four time point: recovery from anesthesia,6h,24 h and 48 h after surgery.Two days after the operation,STAI and MMSE were used to evaluate the postoperative anxiety and cognitive function,and the postoperative satisfaction of the patients in the experimental group was investigated.Results: There was no significant difference in systolic blood pressure and heart rate between the two groups before intervention after entering the operating room(p>0.05).After intervention,systolic blood pressure and heart rate in the experimental group were significantly lower than those in the control group(p<0.05).The BIS value in the experimental group was significantly lower than that in the control group(P<0.05).There was no significant difference in SAI score between the two groups on the first day before the operation(p>0.05),and 48 h after the operation,the SAI score in the test group was significantly lower than that in the control group(p<0.05).There was no difference in TAI scores between the two groups at 1 day before surgery and48 h after surgery(p>0.05).There was no difference in MMSE score between the two groups at 1 day before surgery and 48 h after surgery(p>0.05),and MMSE score did not decrease after surgery.There was no difference in the degree of postoperative pain between the two groups(p>0.05),and the most intense postoperative pain occurred between anesthesia recovery and 6h after surgery.There was no difference in total hospital stay and postoperative hospital stay between the two groups(p>0.05).Both immediate satisfaction and postoperative satisfaction were high in the experimental group.Conclusion: Preoperative short-term mindfulness psychological intervention can effectively stabilize patients’ BP and HR before anesthesia,improve the sedation level of patients before anesthesia,and relieve postoperative state anxiety.The satisfaction and acceptability of patients were high.The application of preoperative short-term mindfulness psychological intervention to gynecological tumor surgery patients has certain clinical significance,and can be easily operated.It is a valuable psychological intervention tool which can be applied to clinical work.更多还原