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行为干预在腹部手术后疼痛护理中的应用

Abstract

Painmanagementafterabdominalsurgeryremainsacrucialaspectofpost-operativecare.Behavioralinterventionshavebeenusedtomanagepainduringandaftersurgery.Theseinterventionsincludehypnosis,relaxation,cognitive-behavioraltherapy,andmusictherapy,amongothers.Thispaperprovidesanoverviewoftheuseofbehavioralinterventionsinpainmanagementafterabdominalsurgery.Italsohighlightsthebenefitsoftheseinterventionsandtheirlimitations.

Introduction

Abdominalsurgeryisoneofthemostcommonlyperformedsurgicalproceduresworldwide.However,post-operativepainisacommonproblemafterabdominalsurgeryandcanleadtoaprolongedhospitalstay,decreasedmobility,delayedrecovery,anddecreasedpatientsatisfaction.Painmanagementafterabdominalsurgerythusremainsacriticalaspectofpost-operativecare.Severalpharmacologicalandnon-pharmacologicalinterventionscanbeusedtomanagepainafterabdominalsurgery.Behavioralinterventionslikehypnosis,relaxation,cognitive-behavioraltherapy,andmusictherapyaresomeofthenon-pharmacologicalinterventionsthatcanbeusedtomanagepainafterabdominalsurgery.Thispaperprovidesanoverviewoftheuseofbehavioralinterventionsinpainmanagementafterabdominalsurgery.

Hypnosis

Hypnosisisabehavioralinterventionthatinvolvesastateofalteredconsciousnesscharacterizedbyincreasedsuggestibility,deeprelaxation,andheightenedfocus.Hypnosisaimstoreducepainbyinducingastateofrelaxationandfacilitatingthepatient'sabilitytocontroltheirpainresponse.AstudyconductedbyLangetal.(2014)investigatedtheeffectsofhypnosisonpost-operativepainmanagementinpatientswhounderwentlaparoscopiccholecystectomy.Thestudyfoundthatpatientswhoreceivedhypnosishadsignificantlylowerpainintensityscoresandloweranalgesicusethanpatientswhodidnotreceivehypnosis.Hypnosishasalsobeenshowntoreduceanxietyandimprovepatientsatisfactionaftersurgery(Jensenetal.,2011).

Relaxation

Relaxationtechniqueslikeprogressivemusclerelaxation,guidedimagery,anddeepbreathingcanreducestress,decreasepainperception,andpromoterelaxation.Progressivemusclerelaxationinvolvestensingandrelaxingspecificmusclegroupstopromoterelaxation.Guidedimageryinvolvespicturingpositiveandcalmingimagestopromoterelaxation.Deepbreathinginvolvestakingslowanddeepbreathstopromoterelaxationandreducepain.AstudyconductedbyGuptaetal.(2014)investigatedtheeffectsofprogressivemusclerelaxationonpost-operativepaininpatientswhounderwentabdominalsurgery.Thestudyfoundthatpatientswhoreceivedprogressivemusclerelaxationhadsignificantlylowerpainintensityscoresandloweranalgesicusethanpatientswhodidnotreceiveanyrelaxationtechnique.

Cognitive-behavioraltherapy

Cognitive-behavioraltherapy(CBT)isaformofpsychotherapythathelpspatientsrecognizeandchangenegativethoughtpatternsthatcontributetopainperception.CBTtechniqueslikedistraction,problem-solving,andpositiveself-talkcanbeusedtomanagepainaftersurgery.Distractioninvolvesfocusingonsomethingotherthanpain,likeengaginginanenjoyableactivity.Problem-solvinginvolvesidentifyingproblemsrelatedtopainandfindingwaystosolvethem.Positiveself-talkinvolvesreplacingnegativethoughtswithpositiveones.AstudyconductedbyAnetal.(2015)investigatedtheeffectsofCBTonpost-operativepaininpatientswhounderwentlaparoscopiccolorectalsurgery.ThestudyfoundthatpatientswhoreceivedCBThadsignificantlylowerpainintensityscoresandloweranalgesicusethanpatientswhodidnotreceiveCBT.CBThasalsobeenshowntoimprovephysicalfunctioningandqualityoflifeaftersurgery(McCrackenetal.,2011).

Musictherapy

Musictherapyinvolveslisteningtomusicorplayingmusictopromoterelaxation,reducestress,andmanagepain.Musictherapycanbeusedduringpre-operative,intra-operative,andpost-operativeperiods.AstudyconductedbyNilssonetal.(2011)investigatedtheeffectsofmusictherapyonpost-operativepaininpatientswhounderwentabdominalsurgery.Thestudyfoundthatpatientswhoreceivedmusictherapyhadsignificantlylowerpainintensityscoresandloweranalgesicusethanpatientswhodidnotreceivemusictherapy.Musictherapyhasalsobeenshowntoreduceanxietyandimprovepatientsatisfactionaftersurgery(Holeetal.,2015).

Limitationsofbehavioralinterventions

Behavioralinterventionslikehypnosis,relaxation,cognitive-behavioraltherapy,andmusictherapycanbeeffectiveinmanagingpainafterabdominalsurgery.However,theseinterventionsmaynotworkforeveryone.Patientswhohaveunderlyingpsychologicalorpsychiatricdisordersmaynotbenefitfromtheseinterventions.Furthermore,behavioralinterventionsmaynotbeeffectiveinmanagingseverepain.Finally,theseinterventionsmaynotbeaccessibleoraffordableforallpatients.

Conclusion

Painmanagementafterabdominalsurgeryremainsacriticalaspectofpost-operativecare.Behavioralinterventionslikehypnosis,relaxation,cognitive-behavioraltherapy,andmusictherapycanbeeffectiveinmanagingpainafterabdominalsurgery.Theseinterventionscanreducepainintensityscores,decreaseanalgesicuse,reduceanxiety,improvepatientsatisfaction,physicalfunctioning,andqualityoflife.However,behavioralinterventionsm

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