音乐香薰疗法和触摸疗法相结合对假体隆乳术患者围手术期应激反应的影响 隆乳假体植入

　　[摘要]目的：探讨触摸疗法和音乐香薰疗法相结合对假体隆乳术患者围手术期应激反应的影响。方法：选取90例静脉麻醉下行假体隆胸术的患者，按随机数字表分为3组，每组30例，于术前一天上午、下午及临睡前半小时分别给予三次不同的护理干预：对照组（A组），静卧于病床20 min；触摸疗法组（B组），触摸治疗20 min；触摸疗法＋音乐香薰疗法组（C组），触摸治疗＋音乐香薰疗法20 min。干预前（术前1h）和干预后（术后6h）分别测定患者状态焦虑值（SAI）；入院时、术前1h、术中（切皮时）、术后4h测定患者平均动脉血压（MAP）、心率（HR）和血糖（Glu）；术后6h测定患者疼痛程度（VAS）的变化。结果：三组患者入院时SAI值均显著高于常模，组间无差异（P＞0.05）；干预后A组略上升，B组和C组明显下降，低于常模，C组低于B组（P＜0.05）。入院时、术前1h 组间MAP和HR无差异（P＞0.05）；术中三组MAP、HR均升高，B、C组间差异明显（P＜0.05）；术后4h三组均降低，C组低于B组，B组低于A组（P＜0.05）。患者入院时、术前1h 组间Glu无差异（P＞0.05）；术中略升高；术后4h 下降，C组最低（P＜0.05）。术后6h C组VAS值小于B组，B组小于A组，但无统计学差异（P＞0.05）。结论：术前触摸疗法和音乐香薰疗法相结合的护理措施可以有效减轻假体隆乳术患者的围手术期应激反应。
　　[关键词]触摸疗法；音乐疗法；香薰疗法；隆乳术；应激反应
　　[中图分类号]R655.8 [文献标识码]A[文章编号]1008-6455（2011）04-0549-04
　　
　　Effects of therapeutic touch associated with musicotherapy and aromatherapy on perioperative stress reaction of patients undergoing breast implants surgery
　　LU Yan
　　（Department of Plastic Surgery,The Second Affiliated Hospital of Harbin Medical University,Harbin 150086,Heilongjiang,China）
　　
　　Abstract:ObjectiveTo investigate the effects of therapeutic touch associated with musicotherapy and aromatherapy on perioperative stress reaction of patients undergoing breast implants surgery.Methods90 women undergoing breast implants surgery with intravenous anesthesia were randomly into three groups (n=30):control group (group A),therapeutic touch group (group B) and therapeutic touch associated with musicotherapy and aromatherapy group (group C).Treatments were applied for 20 min in preoperative day three times, with (group A) lying in bed with eyes closed only; (group B) therapeutic touch; (group C) therapeutic touch associated with musicotherapy and aromatherapy. The values of SAI from patients were determined at 1h before operation and 6h after operation; MAP,HR and Glu were detected at admission to hospital,1h before operation, during operation and 4h after operation; the values of VAS were recorded at 6h after operation.ResultsThe values of SAI among three groups were all higher than the average of normal humans, however, there were no obvious differences among three groups (P＞0.05).After the treatment, the values in group A increased and group B and C decreased, with group C lower than group B (P＜0.05). There were no obvious differences in MAP and HR among three groups at admission to hospital and 1h before operation (P＞0.05).However,MAP and HR increased during operation and decreased at 4h after operation,with group C lower than group B and group B lower than group A (P＜0.05). No obvious differences in the content of Glu in peripheral blood were observed among three groups at admission to hospital and 1h before operation (P＞0.05); however,the content of Glu increased during operation and decreased at 4h after operation,with group C the lowest (P＜0.05). There were no obvious differences in the values of VAS among three groups at 6h after operation (P＞0.05), although the values in group C were lower than group B, and group B were lower than that of group A.ConclusionTherapeutic touch associated with musicotherapy and aromatherapy could effectively relieve the stress reaction of the patients undergoing breast implants surgery.
　　Key words:touch therapeutics;musicotherapy;aromatherpy;augmentation mammoplasty;stress reation
　　
　　假体隆乳术是目前最为流行的一种隆胸方式，是恢复女性形体美安全而有效的方法[1]。然而，手术作为一种极具威胁性的应激源，常常导致患者强烈的心理应激反应（如焦虑）和生理应激反应（如血压、 心率等的改变），影响手术的顺利进行和疾病的预后。因此，有必要寻求一种有效的护理方式降低患者围手术期应激反应。基于女性对触觉、声音、气味的敏感程度高于男性[2]这种独特的生理心理特点，本研究拟应用触摸疗法和音乐香薰疗法相结合的护理干预模式，利用触觉、听觉和嗅觉的三重刺激对患者进行术前干预，探讨其对假体隆乳术患者围术期应激反应的影响。
　　
　　1资料和方法
　　1.1 临床资料：选择我院2009年1月至12月静脉麻醉下进行假体隆乳手术的患者。入组标准：年龄25～40岁，术前无心肺功能异常，无高血压病史，无内分泌系统疾病，无神经精神疾患，能正确理解SAI和VAS评分系统。入组患者90例，随机分为对照组（A组）、触摸疗法组（B组）和触摸疗法＋音乐香薰疗法组（C组），每组各30例，经患者知情同意后实施不同的护理干预及指标测定。三组患者年龄、职业、文化程度等构成无统计学差异（P＞0.05）。
　　1.2 方法：所有患者均接受常规的术前健康教育，记录MAP、HR和Glu等生理指标。病人于术前一天9:00～9:20，15:00～15:20和21:00～21:20平躺于治疗室的病床上，研究者对其进行不同的护理干预，环境安静，无干扰。A组：闭目静卧于病床上20min；B组：触摸治疗法20min；C组：触摸治疗法与音乐香薰疗法同时进行20min。所有护理干预均由受过培训的护士完成。干预后评定患者的焦虑程度；术前1h、术中和术后4h测定患者MAP、HR和Glu；术后6h测定SAI、VAS值的变化。
　　1.2.1 触摸治疗法：患者穿贴身单衣躺在治疗床上，控制室温，注意保暖。研究者立于病人右侧，按摩位于头部的百会穴和后颈部的风池穴各5min，按序进行，力度以稍微产生痛感即可。而后用右手大拇指按摩患者双脚心的涌泉穴共10min，力度以患者没有产生不适为准。
　　1.2.2 触摸治疗法+音乐香薰疗法：音乐选定为莫扎特《蓝色多瑙河》，器乐作品《二泉映月》和《空山鸟语》，依患者意愿自行选择。选取薰衣草和罗马洋甘菊两款单方精油，按1:2的比例配成复方精油[3]。治疗时，在插电式熏香灯内放入5ml冷开水和5ml复方精油，嘱病人平静呼吸，并按患者适合音量播放选定音乐，同时研究者按前述方法进行触摸式治疗，全程持续20min。
　　1.3 观察指标：MAP和HR（多功能监护仪，荷兰飞利浦公司）；Glu（血糖仪，美国雅培公司）；状态焦虑值（SAI，采用Likert 1分～4分计分法，分数越高，焦虑程度越重，国内常模为39.91分±8.66分[4]）；疼痛评分（VAS，0分～10分标记，分数越高，疼痛越重）。
　　1.4 统计方法：采用SPSS 13.O统计学软件进行分析。计量资料以均数±标准差（x±s）表示，组内比较采用重复测量资料的方差分析，组间比较采用单因素方差分析。P 　　本研究结果表明，单纯静卧20min往往不能降低患者应激水平。对于假体隆胸术患者来说，对术后效果的过分关注常常使其术前焦虑水平显著增高，影响休息，进而使围术期生理指标数值波动范围较大,甚至导致严重的术后精神障碍[13]。而与触摸疗法相比，音乐香薰疗法与触摸疗法相结合更能有效的维持患者生理环境的稳定，有利于手术的顺利进行。
　　综上所述，对假体隆乳手术患者实施触摸疗法与音乐香薰疗法相结合的护理手法，能够有效降低患者围手术期的心理应激反应和生理应激反应，降低术后疼痛，有利于术后恢复，是一项有效、可行的术前干预措施。
　　
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　　[收稿日期]2010-10-26 [修回日期]2011-02-23
　　编辑/张惠娟