A Study On The Effect Of Psychological Intervention On Postoperative Pain And Stress Reaction In Laparotomy Patients

Objective:To investigate the postoperative pain and its influential factors in patients who received elective general anesthesia laparotomy. To determine the level of postoperative pain, anxiety, cortisol,β-endorphin in order to explore the effect of psychological interventions on postoperative pain and stress reaction in laparotomy patients. To investigate the effect of psychological interventions on the postoperative recovery in laparotomy patients by follow-up study.Methods:This study was an experimental survey.96 patients who received elective general anesthesia laparotomy were randomly divided into experimental group and control group,48 cases in each group. The experimental group received pain control education,Patient Control Anangesia(PCA) and relaxation, the control received pain control education and Patient Control Anangesia(PCA). All the patients were evaluated with the demographic data scale, State Trait Anxiety Inventory(STAI) and Visual Analogue Scale(VAS). The cortisol and (3-endorphin was detected by Enzyme Linked Immunosorbent Assay (ELISA). Student's t-test, Chi-square analysis, One-way ANOVA, Student-Newman-Keuls(SNK-q), Pearson correlation analysis, multiple linear stepwise regression analysis and repetitive measure ANOVA were used in the data analysis.Results:The designed cases was 96, excluding 6 cases, the final effective cases was 90 and 45 cases in each group.1.The VAS score at 6h,24h,48h,72h after laparotomy was 5.51±0.95,4.88±0.98,3.87±1.14, 2.44±1.31,respectively. ANOVA and SNK-q showed that the difference was statistically significant(P<0.05).2. The result of multiple linear stepwise regression analysis showed that the factors which influenced the VAS score at 6h after laparotomy were the preoperative state-anxiety (b'±0.331), the duration of operation(b'=0.222), the degree of caregivers' care(b'=-0.185);the factors which influenced the VAS score at 24h after laparotomy were the duration of operation(b'=0.407), the preoperative state-anxiety(b'=0.262); the factors which influenced the VAS score at 48h after laparotomy were the preoperative state-anxiety (b'=0.307), the expectations of postoperative pain(b'=-0.213); the factors which influenced the VAS score at 72h after laparotomy were the expectations of postoperative pain(b'=-0.294), the educational level (b'=0.226). 3.Repeated measures ANOVA showed that the main effects of intervention on postoperative pain, anxiety, cortisol,β-endorphin were significant(P<0.05), in other word, the postoperative pain, anxiety, cortisol,β-endorphin were different between various interventions. There were significant interactions (P<0.05) between time and intervention exceptβ-endorphin (β=0.297). Interaction diagram indicated that the postoperative pain, anxiety, cortisol,β-endorphin were lower in experimental group than that of control group.4. Student's t-test showed that the time of sitting up in bed, bedside activities, getting up of bed and exercises, liquid diet, semiliquid diet, exhaust was earlier in the experimental group than that in the control group(P<0.05).Conclusions:1. The postoperative pain was gradually relieved after operation in laparotomy patients. The most serious pian was at 6h among different time points of 6,24,48,72h after operation.2.The preoperative anxiety, the educational level, the degrees of caregivers'care, the expectations of postoperative pain and the duration of operation significantly affected the postoperative pain of the laparotomy patients. 3.The psychological intervention could decrease the postoperative pain in laparotomy patients.4. The psychological intervention could relieve the stress reaction in laparotomy patients.5.The psychological intervention could promote postoperative recovery in laparotomy patients.