RU2369414C1 - Method for psycho-physiological preparation of parients for surgery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: psycho-physiological intervention on patient's body is performed with the help of pre-recorded phonogramme text being listened by patient during natural sleep, attending doctor's voice is pre-recorded on the phonogram. After achieving patient's steady hemodynamic parametres, surgery is imitated whereof patient is warned beforehand. To carry this imitation out, somnifacient is injected to patient, phonogramme with attending doctor's voice is activated and patient's state is controlled by means of hemodynamic parametres recording during time of their adjustment and stabilisation. They are compared with standard values, whereafter conclusion on patient's psycho-physiological readiness is made and operation is conducted immediately or postponed, operation being made to a recording of attending doctor's voice.

EFFECT: method allows reducing number of complications during and after operation by means of increasing efficiency of patient's adaptation to stress situations with more precise evaluation of patient's readiness for operation owing to decline of adrenalin level in blood of operated patient.

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Description

The invention relates to medicine and can be used for preoperative preparation of patients, as well as during exposure to the patient during surgery.

Known methods of preoperative preparation of patients with medications aimed at stabilizing the functions of the autonomic nervous system, which prevents complications from the cardiovascular system during anesthesia. For example, Mashkovsky V.N. Medicines M., 1999.

The disadvantage of these methods is the lack of effectiveness in some cases, for example, with lability of the nervous system.

There is a method of correcting a depressive state with the help of phased trainings of psychological self-influence (RF patent No. 2289435). The disadvantage of these methods is also the lack of effectiveness in cases of lability of the nervous system.

Known methods of psychotherapy based on auditory exposure, for example, RF patent No. 2254147, as well as a method of exposure using a phonogram with recording your own voice, allowing the patient to control his current emotional state, directly affecting the autonomic-nervous activity, RF patent No. 2177648.

A known method of psychotherapeutic effects on the human body, described in the application for invention No. 2001129650, comprising pre-recording a special text of self-hypnosis with subsequent exposure to the body during natural sleep at night listening to the recorded text.

The applicant's task is to reduce the number of complications during and after the operation by increasing the efficiency of the patient’s adaptation to stressful situations with a more accurate determination of the degree of readiness of the patient for surgery. The result is achieved by reducing the level of adrenaline in the blood of the operated patient.

The result is achieved due to the fact that in the known method of preoperative preparation of patients, including the psychophysiological effect on the patient’s body using the previously recorded phonogram text, which is listened to by the patient during natural sleep, the voice of the attending physician is recorded on the phonogram when the patient achieves stable hemodynamic parameters an imitation of an operation is performed, about which the patient is warned in advance, while the patient is injected with sleeping pills, include a phonogram with the voice of the treating patient Cha and control the condition of the patient by registering the hemodynamic parameters during the time of their alignment and stabilization, compare them with the normal values, whereupon conclude psychophysiological readiness of the patient and the operation is carried out immediately or postponing, wherein the operation also goes under the track with the voice of the attending physician.

Recording the voice of the attending physician on a phonogram, the voice of a person whom the patient trusts inspires confidence in him as a result of the operation.

Imitation of the operation is performed when the patient reaches stable hemodynamic parameters, which can be within normal limits or can be reduced if the patient worsens.

Simulation of an operation performed in an operating room, in full preparation for an operation, including intravenous preoperative therapy and cleansing of the gastrointestinal tract, allows you to really assess the condition of the patient, his readiness for surgery.

Hemodynamic parameters are recorded during sessions of listening to the phonogram and during the simulation of the operation, which allows you to adjust the patient's condition, postpone the operation, or perform it without delay.

The patient calms down by hearing the doctor’s familiar voice and assuming that the operation is simulated, perceives what is happening in a balanced state, which reduces the risk of complications during and after the operation.

A full-fledged psychophysiological preparation according to the proposed method relieves the patient’s preoperative stress and gives confidence in the professional reliability of doctors and positive success with surgical intervention, confidence in the reliability of the organs of his body, which reduces the amount of adrenaline in the blood of patients, and this, in turn, reduces the number anesthetic drugs and relaxants introduced during surgery, the amount of which determines the hemodynamics of the surgical and postoperative period.

80-75% of the administered anesthetic drugs and relaxants from the calculated volume is administered to adequately anesthetize and turn off the respiratory muscles and controlled breathing, and 20-25% goes to the fight against blood adrenaline, which is produced in connection with preoperative stress and fear for one's life.

Clinical examples. Testing of the method was carried out in the regional oncology clinic of Khabarovsk.

Example 1. Patient P., 49 years old, diagnosis: kidney cancer.

In parallel with the examination in the hospital, preparations were conducted with fivefold listening of phonograms during a night's sleep. The patient was told about the imitation of the operation after the hemodynamic parameters stabilized:

- blood pressure 140-160 / 100-120 mm RT. pillar;

- pulse 80-88 per minute

After preoperative drug preparation and cleansing of the gastrointestinal tract, the patient was taken to the operating room in order to simulate the operation. After 20 minutes, after simulated anesthesia, the hemodynamic parameters were stable, it was decided to stop the imitation and begin a planned operation to remove the kidney.

The duration of the operation is 2 hours 56 minutes. During surgery, hemodynamic parameters:

- HELL 115-110 / 75-75 mm RT. pillar.

- Pulse 60-66 per minute.

The amount of drugs and relaxants administered during surgery is 25% less than the usual volume for such an operation. The exit from anesthesia is mild. After extubation, breathing is free, independent, without the use of respiratory stimulants.

Example 2. Patient Z., 53 years old, commodity specialist, diagnosis: uterine cancer.

Psychological training was carried out for five days, parallel to the laboratory and instrumental examination. On the sixth day, the patient was taken to simulate surgery. During the simulation, after the words “start of operation”, blood pressure dropped to 90/40 and the heart rate increased to 100 per minute. It was concluded that the patient has a deficiency of fluid in the vascular bed. Within two days, the patient was given intravenous infusion therapy with artificial blood substitutes in order to stably fill the vascular bed. After which a planned operation was performed, in which hemodynamic parameters were stable.

The duration of the operation is 3 hours 15 minutes. During surgery, hemodynamic parameters:

- HELL 110-115 / 70 mm RT. pillar.

- Pulse 66-68 per minute.

The amount of drugs and relaxants administered during surgery is 23% less than the usual volume for such an operation. The exit from anesthesia is mild. After extubation, breathing is free, independent, without the use of respiratory stimulants

Example 3. Patient M., 59 years old, cook, diagnosis: cancer of the stomach.

Psychological training was carried out for seven days in parallel with laboratory and instrumental examination. After the hemodynamic parameters stabilized, on the eighth day, the patient was told about the imitation of the operation. Hemodynamic parameters after the start of the simulation in the 18th minute worsened, blood pressure decreased to 90/50 and the pulse increased to 92, drug correction did not give an effect. Analyzing the indicators of preoperative observation and taking into account the growing process of the disease with increased cardiovascular failure, it was decided within an hour under the influence of barbiturates and the simulator program to carry out massive infusion preoperative preparation with blood substitutes, including plasma and dextrans in the form of hemodesis and reopoliglyukin, and start the operation.

The operation was carried out 3 hours 15 minutes. During surgery, hemodynamic parameters were stable:

- AD120-115 / 70 mm RT. pillar.

- Pulse 68-72 per minute.

The amount of drugs and relaxants administered during surgery is 18% less than the usual volume for such an operation. The exit from anesthesia is mild. After extubation, breathing is free, independent, without the use of respiratory stimulants.

In the postoperative period, this group of patients showed no deterioration in well-being and complications associated with the introduction of a large number of drugs and relaxants during surgery.

Claims (1)

 A method of preoperative preparation of patients, including the psychophysiological effect on the patient’s body using the previously recorded phonogram, which is listened to by the patient before surgery during natural sleep, characterized in that during preparation for the operation after the patient has stable hemodynamic parameters, the operation is simulated, while the patient is injected with sleeping pills, include a phonogram with the voice of the attending physician and monitor the patient's condition by registering hemodynamic p exponent for their time alignment and stabilization, compared with their normal values, is carried out emergency medical correction if necessary, conclude psychophysiological readiness of the patient and postpone or elective surgery is performed under the track with the voice of the attending physician.