| As a surgical operation, laparoscopic cholecystectomy, has the features of smallwound and rapid recovery, but as most of the patients undergoing general anesthesiaoperation are the first time to receive general anesthesia, they would have variousdegrees of anxiety and fear, which would cause a strong psychological stressresponses, and affect the operation effect and postoperative recovery, and lead topsychological reactance for diagnosis and treatment, and then produce adversereactions in the body which would affect the smooth operation and effect, increasingoperation complication probability.Objective: To explore the validity of psychological intervention on relieving stressreaction, reducing anxious, improving the degree of comfort for the patients undergeneral anesthesia with laparoscopic cholecystectomy, and on this basis, to exploreinfluence of gender and educational levels on the effect of psychological intervention.Methods1.Source of cases and case-mix: Collected200cases undergoing laparoscopiccholecystectomy in Jilin province of hepatobiliary disease hospital from August.2011to July.2012with ASA I-II, non-emergency, no mental and nervous system diseases,no diabetes or other endocrine disease history, no taking anxiolytics or antidepressantswithin two weeks, no liver function changing, and divided randomly to interventiongroup(n=100) and control group(n=100).The control group were only gotten routinely preoperative visiting, that is,anesthesia doctors introduce to patient about the methods of anesthesia andpostoperative analgesia, the risk of anesthesia operation, the implementation plan and safety measures, and then signed the anesthesia informed consent paper. The time ofduration is about5to10minutes.The anesthetist would communicated with the patient of intervention group onthe day of admission, to gain the patients’ trust and acquaint his personality andhobbies. In addition to routine preoperative visit, the anesthetist would carry outpsychological intervention, that is, psychological support, health education andrelaxation training, on intervention group for20min when1day before surgery,anesthesia and postoperative3hours.All cases would under same anesthesia methods, that is, intramuscular injection0.3mg scopolamine and2mg midazolam at preoperative30minutes, slow infusion of0.2mg fentanyl,0.1mg/kg vecuronium bromide,2mg/kg propofol. After trachealintubation, carrying out anesthesia machine with mechanical ventilation, the tidalvolume controlled at8ml/kg, the respiration rate controlled at14/min, the ETCO2pressure regulated at35-45mmHg, the respiratory quotient controlled at1:2.Anesthesia maintenance: injection pump intravenous remifentanil at0.05~0.15μg/(kg·min), propofol at15~75μg/(kg·min), intravenous injection vecuroniumbromide at0.05mg/kg every30minutes. Intraoperative control of heart rate and bloodpressure in the base value of around80%, intravenous ketorolac three butyl alcoholammonia30mg and tropisetron5mg at20minutes before the end of the operation.Stopping venous pump at the end of operation, linking up the venous analgesic pumpsimultaneously. When patients in anesthesia recovery period, to inject muscle relaxantantagonist, neostigmine and atropine. Pulling out the tracheal catheter after the patientwaking up. Maintenance the normal body temperature of patients during preoperative.2.Detection of indexes: Recording vital signs, that is, systolic blood pressure, heartrate, and recording scores of self-rating anxiety scale when the time is one day beforeoperation and one day after operation, and degree of preoperative comfort, and stateanxiety scale when the time is to be hospitalized and one day after operation.3.Statistical analysis Respectively compared with systolic blood pressure, heart rate, self-rating anxiety scale, postoperative comfort, postoperative state anxietyinventory between intervention group and control group, different gender anddifferent educational levels in intervention group, and there would be statisticallysignificant when the value of P is less than0.05.Result:1.Systolic Blood PressureThere was significant different about systolic blood pressure when the time werebeing sent into the operation room and pulled out endotracheal tube tracheal betweenintervention group and control group (131.57±15.66mmHg,136.76±10.43mmHg);144.69±14.12mmHg148.71±13.35mmHg), and the different had statistics meaning(P<0.05); and the different had not statistics meaning when the time were hospitalizedand intraoperative30minutes between two groups(P>0.05).There was significant different about systolic blood pressure when the time werebeing sent into the operation room and pulled out endotracheal tube tracheal betw-eenmale and female patients of intervention group (134.76±10.69mmHg,129.81±11.66mmHg;146.58±16.51mmHg,139.18±17.09mmHg), and the differenthad statistics meaning(P<0.05); and the different had not statistics meaning when thetime were hospitalized and intraoperative30minutes between male and femalepatients of intervention group(P>0.05).There was significant different about systolic blood pressure when the time werebeing sent into the operation room and pulled out endotracheal tube tracheal betweenjunior middle school or below and junior high school patients of intervention group(129.62±12.54mmHg,134.97±13.23mmHg;141.23±14.16mmHg,146.94±13.67mmHg), and the different had statistics meaning(P<0.05); and the different hadnot statistics meaning when the time were hospitalized and intraoperative30minutesbetween junior middle school or below and junior high school patients ofintervention group(P>0.05). 2.Heart RateThere was significant different about heart rate when the time were being sentinto the operation room and pulled out endotracheal tube tracheal betweenintervention group and control group (87.48±10.70times/min,91.42±8.46times/min;92.53±15.75times/min,96.77±14.40times/min), and the different had statisticsmeaning (P<0.05); and the different had not statistics meaning when the time werehospitalized and intraoperative30minutes between two groups(P>0.05).There was significant different about heart rate when the time were being sentinto the operation room and pulled out endotracheal tube tracheal between male andfemale patients of intervention group (89.58±10.36times/min,85.13±11.28times/min;95.32±14.39times/min,90.17±14.08times/min), and the different had statisticsmeaning(P<0.05); and the different had not statistics meaning when the time werehospitalized and intraoperative30minutes between male and female patients ofintervention group(P>0.05).There was significant different about heart rate when the time were being sentinto the operation room and pulled out endotracheal tube tracheal between juniormiddle school or below and junior high school patients of intervention group(84.23±12.49times/min,89.41±11.75times/min;89.31±14.63times/min,95.76±13.01times/min), and the different had statistics meaning(P<0.05); and the different hadnot statistics meaning when the time were hospitalized and intraoperative30minutesbetween junior middle school or below and junior high school patients of interventiongroup(P>0.05).3. Self-Rating AnxietyThere was significant different about the scores of self-rating anxiety when thetime were one day before operation and one day after operation between interventiongroup and control group (40.55±8.24,43.61±7.23;35.70±7.85,38.49±6.81), and thedifferent had statistics meaning(P<0.05).There was significant different about the scores of self-rating anxiety when the time was one day before operation between male and female patients of interventiongroup (42.08±7.64,38.82±8.34), and the different had statistics meaning(P<0.05); andthe different had not statistics meaning when the time was one day after operationbetween male and female patients of intervention group(P>0.05).There was significant different about the scores of self-rating anxiety when thetime was one day before operation between junior middle school or below and juniorhigh school patients of intervention group (39.24±7.49,42.58±8.46), and the differenthad statistics meaning(P<0.05); and the different had not statistics meaning when thetime was one day after operation between junior middle school or below and juniorhigh school patients of intervention group(P>0.05).4.Postoperative ComfortThere was significant different about the scores of postoperative comfortbetween intervention group and control group (6.01±1.31,6.53±1.22), and thedifferent had statistics meaning(P<0.05).There were not significant different about the scores of postoperative comfortbetween different gender or different educational level patients of intervention group,and the different had not statistics meaning(P>0.05).5.Postoperative State Anxiety InventoryThere was significant different about the scores of postoperative state anxietyinventory between intervention group and control group (45.16±10.25,49.12±9.84),and the different had statistics meaning(P<0.05).There were not significant different about the scores of postoperative stateanxiety inventory between different gender or different educational level patients ofintervention group, and the different had not statistics meaning(P>0.05).Conclusion: The effects of psychological intervention on the patients undergoinggeneral anesthesia with laparoscopic cholecystectomy was satisfied:1. Psychological intervention can effectively alleviate of patients’ operationanxiety; 2. Psychological intervention can reduce preoperative patients’ systolic bloodpressure and heart rate fluctuations caused by the stress response;3.Psychological intervention can significantly improve patient’s postoperativecomfort, and promote postoperative recovery;4.The effect of psychological intervention would be more obvious for female orlow educated patients. |
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