目的 观察不同心理干预方法对心脏手术患者围手术期血桨促肾上腺皮质激素(ACTH)和皮质醇(F)的影响,以寻求科学的围术期心理干预方案.方法 将120例拟行体外循环心脏手术的患者随机分三组:A组为对照组,病房常规护理；B组围术期访谈式心理干预；C组访谈辅以多媒体进行围术期心理干预.采用放免法测定心理干预前(手术前一天)(T1)、麻醉诱导前(T2)、术后第3天(T3)血浆ACTH、F浓度,监测BP、HR及进行焦虑自评量表(SAS)评估.结果 A、B、C三组SAP、DAP、HR在T2高于T1(P＜0.05),B组及C组在T2时SAP、DAP、HR均低于对照组A组(P＜0.05),且C组降幅更大,HR、BP更趋于平稳；A、B、C三组ACTH、F在T2、T3高于T1(P＜0.05或0.01).但B组及C组在T2、T3时低于对照组A组(P＜0.05或0.01),且C组数值更低(P＜0.01),ACTH、F释放更少.结论 围手术期访谈式的心理干预,一定程度上减轻了患者的应激反应；访谈辅以多媒体教材进行围术期心理干预,可增强围术期相关知识的教育效果,能进一步改善患者的不良情绪,更有效地减轻应激反应.%Objective To investigate the effect of different psychological intervention methods on stress reaction for patients with cardiac surgical during peri-operation period. Method 120 patients scheduled for heart surgery were randomly divided into group A, group B and group C, each group was 40 cases. In group A, patients received ward routine care. In group B, patients received peri-operative interview-style psychological intervention, in group C. Patients received peri-operative interviews and multimedia psychological intervention. Venous blood samples were obtained before psychological intervention the day before operation (T1), before induction of anesthesia (T2) and 3 days after operation (T3),for determining the plasma adrenocorticotropic hormone (ACTH) and cortisol (F). Blood pressure, heart rate and the self-rating anxiety scale (SAS) assessment were monitored in the three groups. Result Three groups' data of SAP, DAP, HR at T2 were higher than those at T1 (P<0. 05). The data of SAP, DAP, HR in group B and C were significantly lower than those in group A at T2 and T3(P<0. 05). Three groups data of ACTH and F at T2 ,T3 were higher than those at T1(P<0. 05). The data of ACTH and F in group B and C were significantly lower than those in group A at T2 and T3 (P<0. 05). Conclusion To some extent, peri-operative interviews and multimedia psychological intervention can reduce the patient's stress response, enhance effects of education about knowledge of peri-operative, further improve the patient's negative emotions more effectively, and reduce the stress reaction.
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