心理干预复合咪达唑仑对腹腔镜胆囊切除患者术前心理应激反应的影响

目的探讨心理干预复合咪达唑仑对腹腔镜胆囊切除患者术前心理应激反应的影响。方法择期行腹腔镜胆囊切除术患者90例，ASAⅠ或Ⅱ级，完全随机等分为3组：对照组术前进行常规访视，不用药；咪达唑仑组术前进行常规访视，术前30min肌内注射咪达唑仑0．05mg／kg；心理干预复合咪达唑仑组（PIM组）按照心理干预方法进行术前访视，术前30min肌内注射咪达唑仑0．05mg／kg。术前1d8：00及入室后即刻测定3组患者的血清促肾上腺皮质激素（ACTH）、皮质醇、血管紧张素Ⅱ（ATⅡ）与IL-6水平，记录MAP、HR和SpO2值，并行自行状态焦虑量表评分（S—AI）、焦虑视觉模拟评分（AVAT）评分。结果对照组和咪达唑仑组人室后即刻的MAP、HR值明显高于术前基础值对照组：MAP：（98．2±7．9）VS（85．5±7．3），HR：（93．5±10．2）vs（80．6±7．4）；咪达唑仑组：MAP：（91．5±8．2）VS（84．8±6．2），HR：（85．0±11．2）VS（79．2±8．2），P〈0．05或P〈0．01]。对照组入室后即刻的s—AT和AVAT值较术前基础值明显增高S—AI：（67．9±6．4）vs（61．3±4．2），AVAT：（69．5±6．7）VS（60．6±3．4），均P〈0．05]，PIM组较术前基础值则有显著性降低S—AI：（53．1±4．8）vs（62．8±4．0），AVAT：（50．8±5．2）VS（61．4±3．2），P〈0．05]。对照组入室后即刻的血清ACTH、皮质醇、ATⅡ和IL-6值较术前基础值均有显著增高ACTH：（29．5±6．2）VS（18．4±2．9），皮质醇：（198．5±15．0）VS（106．4±10．5），ATⅡ：（66．2±11．0）VS（50．0±8．5），IL-6：（189．3±18．5）vs（102．4±13．2），P〈0．05或P〈0．01]，咪达唑仑组的皮质醇、IL-6值也有明显增高皮质醇：（152．4±12．2）vs（108．2±11．7），IL-6：（161．0±15．3）VS（106．5±12．0），P〈0．05]，PIM组则无明显变化。结论心理干预复合咪达唑仑能明显减轻腹腔镜胆囊切除术患者术前的心理负担和焦虑程度，不失为一种调控手术患者术前急性不良心理应激反应的简便易行而又切实有效的方法。

Combined psychological intervention and midazolum for preoperative psychological stress reaction of pa-tients undergoing laparoscopic cholecystectomy

Objective To investigate the efficacy of combined psychological intervention and midazolum for preoperative psychological stress of patients undergoing laparoscopic cholecystectomy. Methods Ninty ASA Ⅰ or Ⅱ patients aged 28-62 year old undergoing elective laparoscopic cholecystectomy were enrolled in this study. All partic-ipants were randomly allocated into three groups: Control group (C): preoperative routine visiting, no premedica-tion; Midazolum group (M): preoperative routine visiting and preoperative intramascular injection of midazolum 0. 05 mg/kg; Psychological intervention and midazolum group (PIM): preoperative intramascular injection of mid-azolum 0.05 mg/kg based on psychological intervention. The visiting day and the time points of the operating room, MAP, HR and SpO2 were recored. S-AI and AVAT scores were performed in Cortisol, ACTH, AT-Ⅱ and IL-6 con-centrations were measreal. Results MAP and HR in C and M groups were significantly higher at the time point in the operating room than the baseline values before operation (P<0.05 or P<0.01). The scores of S-AI and AVAT in C group were significantly increased at the time points in the operating room than the baseline values before opera-tion (P<0.05), but the scores of S-AI and AVAT in PIM group were significantly decreased (P<0.05). The cor-tisol, ACTH, AT-Ⅱ and IL-6 concentrations in C group were obviously increased at the time points of entering the operating room than the baseline values before operation (P<0.05 or P<0.01) The cortisol and IL-6 in M group were also significantly increased (P<0.05), but those in PIM group had no significant difference (P>0.05). Conclusion Combined psychological intervention and midazolum com reduce preoperative psychological stress and the degree of anxiety undergoing laparoscopic cholecystectomy. It is a simple and effective method to relieve patients' preoperative actue psychological distress.