Manyande A, Berg S, Gettins D, Stanford S C, Mazhero S, Marks D F, Salmon P
Department of Psychology, University College London, UK.
Psychosom Med. 1995 Mar-Apr;57(2):177-82. doi: 10.1097/00006842-199503000-00010.
Existing evidence suggests that preoperative psychological preparation that is designed to reduce anxiety may sensitize cortisol and adrenaline responses to surgery. In a controlled trial of abdominal surgery patients, we therefore tested the effects of a preoperative preparation that used guided imagery, not to reduce anxiety, but to increase patients' feelings of being able to cope with surgical stress; 26 imagery patients were compared with 25 controls who received, instead, background information about the hospital. State-anxiety was similar in each group, but imagery patients experienced less postoperative pain than did the controls, were less distressed by it, felt that they coped with it better, and requested less analgesia. Hormone levels measured in peripheral venous blood did not differ on the afternoon of admission, before preparation. Cortisol levels were, however, lower in imagery patients than in controls immediately before and after surgery. Noradrenaline levels were greater on these occasions in imagery patients than controls. The results are interpreted in relation to two theories. One states that preoperative "worry" reduces surgical stress. The other concerns the influence of active and passive coping on endocrine responses to stress.
现有证据表明，旨在减轻焦虑的术前心理准备可能会使皮质醇和肾上腺素对手术的反应更加敏感。因此，在一项针对腹部手术患者的对照试验中，我们测试了一种术前准备的效果，这种准备使用引导式意象法，不是为了减轻焦虑，而是为了增强患者应对手术压力的能力；将26名接受意象法的患者与25名接受医院背景信息的对照组患者进行了比较。每组患者的状态焦虑水平相似，但接受意象法的患者术后疼痛比对照组轻，对疼痛的困扰也较小，感觉自己应对得更好，且要求的镇痛药物更少。在入院当天下午准备前，外周静脉血中测量的激素水平并无差异。然而，在手术前即刻和手术后，接受意象法的患者的皮质醇水平低于对照组。在这些时刻，接受意象法的患者的去甲肾上腺素水平高于对照组。我们根据两种理论对结果进行了解释。一种理论认为术前“担忧”会减轻手术压力。另一种理论关注主动应对和被动应对对应激内分泌反应的影响。
