1 Psychological care before and after surgery
1.1 preoperative psychological care
Before undergoing surgical treatment, patients are often in a very complicated psychological state, with anxiety and depression hidden in excitement, and doubt and fear hidden in trust. Therefore, medical staff must observe carefully and deal with symptoms.
1.1.1 "Introduce the surgical process, establish the concept of pain and countermeasures. In fact, every surgical patient is afraid of pain, only to show whether it is revealed or not. Therefore, for each patient undergoing surgery, we will outline the selected surgical method and its effect in a drawing line before the operation, focusing on the comparison with other surgical methods, especially the time and treatment of pain. Point out that the pain only occurs before and after anesthesia, and there is no pain during the operation; clearly inform the patient that the pain performance is divided into three degrees, and the feeling is closely related to the will and emotion, and it can be completely overcome, and even no pain . For patients whose fear of pain is very obvious, use the temperature chart as a quantitative tool to simulate the VAS pain measurement method and use a sterile silver needle to measure the pain on the arm and quantify it. It is pointed out that the degree of preoperative and postoperative pain is mostly at degree I (20-30 points) ) And below, only when it reaches degree II (30-50 points) or higher, analgesic treatment is required. At the same time, let the patients conduct pain desensitization training by themselves, record the score of each acupuncture pain, gradually increase the pain threshold, and establish the information of pain tolerance. You can also choose methods such as self-hypnosis, tranquilization induction, and progressive relaxation training to familiarize patients with and practice them for application. In this way, through a series of psychological dialogues and training, most of them can eliminate or significantly reduce the fear and anxiety of pain and enhance the confidence in treating diseases.
1.1.2 Exchange information and adjust emotional state. Before undergoing surgery, patients often consciously contact similar patients to obtain all kinds of information they need, especially the level of pain. This process has a huge impact on postoperative pain response and often has a strengthening effect. The information obtained in the unconscious is latent in the deep consciousness, and the response to postoperative pain also has a two-way adjustment effect. Therefore, medical staff should proactively provide various conditions before surgery, such as personal statement, historical recall method, investigation corroboration method, etc., to let patients know relevant information and establish benign stimulation. This kind of "preconceived" psychological influence should be used without losing the opportunity. Every time we meet, stare at the patient's eyes to feel the patient's trust and anxiety, smile and tell all kinds of information, and even make up stories and talk about the world, so that doctors and patients can enter harmony. Subtle atmosphere. In this way, deliberate psychological counseling can be diluted into invisible disorder and receive good after-effects.
1.2 Postoperative psychological care
After experiencing the stimulation of surgery, patients generally feel relieved, and turn from a state of horror anxiety to anticipation anxiety. At this time, I neither hope that there will be severe pain after the operation, but also eagerly wait for the pain to come; I believe that the doctor can handle the pain response, and I am worried that I can't stand the pain. Therefore, psychological care at this time not only has the basis for the success of preoperative care, but also faces the severe test of actual individual differences.
1.2.1 Analyze the type of pain and implement psychological induction. The occurrence and duration of postoperative pain are often related to the duration of anesthetics, the procedure and the condition. The type of pain reaction often differs from person to person: ① Burning pain is mostly caused by the traumatic reaction of the skin incision, and the duration will not be too long; ② Pain is mostly caused by injection of sclerosing agent or too much anal dressing. It can disappear after the first urination or after reducing the dressing; ③Throbbing pain is mostly caused by the traumatic reaction of the muscles around the anal wound or the hidden abscess that has not been properly treated, and special symptomatic treatment is often required; ④The persistent tingling is more common in the anus The wound ligation line is located on the skin or the anal canal below the dentate line; or after the suture operation; or seen in the wrong surgical treatment (such as accidental injection of external hemorrhoids as internal hemorrhoid sclerosing agent), etc., need to be treated differently. Based on this, if you are familiar with the types and treatment principles of pain, you can explain to the patient and make corresponding psychological induction. Practice has proved that the early implementation of hypnotherapy and induction of meditation or music analgesia can mostly control the postoperative pain within 1 degree, even eliminate the pain, and reduce the pain response. It also has a good inhibitory effect on muscle spasm pain and persistent pain.
2 Anal local care
On the basis of the implementation of psychological care, the local care of the anus is also very important, and through local inspection and treatment, not only part of the pain can be dealt with, but also a responsible and trusting benign psychological response can be established between doctors and patients, which can inhibit Pain is good and harmless.
2.1 Pay attention to the situation of the wound and treat it according to the symptoms. The pain comes from the anus, there must be a reason, and it must be dealt with according to the syndrome. The inflammatory reaction of burning pain can be relieved by anti-inflammatory treatment or antipyretic analgesics; if the pain is caused by dressings, remove too much dressing as soon as appropriate, and make sure that the dressing is thin when changing the dressing, and do not stick to the anus. In the tube; for throbbing pain caused by muscle spasm, relax training or use sedatives or muscle relaxants; stinging and throbbing pain caused by improper treatment should be corrected as soon as possible. Therefore, we say that "there is no visible pain to relieve pain, but the symptom and the root cause must be treated at the same time.
2.2 Take a bath in time to relieve pain and heal injuries. Sitz bath is a traditional treatment of Chinese medicine. In practice, it is found that sitz bath can not only treat wounds and cure diseases, but also relax the muscles and relieve pain. For inflammatory pain, cramps, etc., the effect of using traditional Chinese medicine to bathe is often better than taking analgesics. Excision of external hemorrhoids, anal fissure resection, anal fistula incision or thread hanging, and sitting bath after injection of internal hemorrhoids can achieve the dual effects of pain relief and wound healing. Using the "temperature-regulating decocting and fumigating bath machine" in conjunction with specialist Chinese medicine, the effect is even more ideal. Without this type of equipment and medicine, a simple hot water bath can also be effective.
3 Defecation care
Postoperative pain caused by defecation is another difficulty of postoperative pain, but it can be prevented by adjusting the hardness of the stool and the bath. Generally, you can take intestinal laxative drugs (such as Maren capsules) or temporarily use Kaisailu on the night before defecation; especially taking baths before and after defecation, most of which can avoid or significantly reduce the pain of defecation.
4 Diet care
To prevent pain, diet care should not be understated. Patients should be informed that it is not advisable to use black snakehead aquatic products, poultry and animals, and spicy foods that promote growth within five to seven days after surgery, so as not to aggravate inflammation or cause pain due to excessive inflammatory granulation growth. At the same time, a light and nutritious fibrous diet such as bran, fruits, vegetables, etc. helps normal bowel movements and relieves pain.
In short, postoperative pain is both a physiological response and a psychological response, and psychological response is very important, and the two interact. Therefore, the prevention and treatment of postoperative pain response should start with nursing care, correct the previous concept of focusing on drug treatment, and study the diagnosis and treatment of pain in an all-round way, in order to hope that anorectal surgery will enter a new era of painless or slight pain.