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Der perioperative Anpassungsstatus des Patienten

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Stress und Stressbewältigung bei Operationen

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Zusammenfassung

Das Ausmaß der Stressbelastung eines Patienten wird über die Beurteilung seines Anpassungsstatus bestimmt. Präoperativ interessieren negative Affekte wie Angst und die Güte zentraler Körperfunktionen. Intraoperativ werden Kriterien wie Herzfrequenz, Blutdruck sowie Parameter des Anästhesieverlaufs herangezogen. Die postoperative Phase befasst sich mit dem Zustand unmittelbar nach dem Eingriff, der Erholung nach Rückkehr des Patienten auf die Station und der Anpassung nach Entlassung aus der Klinik. Untersuchungen weisen darauf hin, dass eine erhöhte Stressbelastung Einfluss auf den Verlauf der Anästhesie haben kann sowie Reaktionen im Aufwachraum oder auf der Intensivstation beeinflusst. Ferner wurden fremd- oder selbsteingeschätzte Körperfunktionen, Schmerzbelastung, Wundheilung, kognitive Dysfunktionen und die Verweildauer in der Klinik untersucht. Bei der längerfristigen Anpassung zeigten sich Zusammenhänge von Stress mit der psychophysische Erholung, der Wiederanpassung an den Alltag, der allgemeinen sowie auf die durchgeführte Operation bezogenen Lebensqualität und dem Mortalitätsrisiko.

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Notes

  1. 1.

    Die Minimale Alveoläre Konzentration beschreibt die anästhetische Potenz von Medikamenten zur Inhalationsnarkose.

  2. 2.

    Außerdem wurde auch die dispositionelle und aktuelle Stressbewältigung auf den Dimensionen Vigilanz und kognitive Vermeidung (Abschn. 4.4.3) erfasst. Über die Ergebnisse zu diesen Variablen wird in Kapitel 4 berichtet (Kap. 4).

  3. 3.

    Im Jahre 2012 hatte sich die Zahl der Patienten, die mehr als ein Jahr auf ein Spenderherz warteten, auf ca. 60 % erhöht (Rahmel, 2013).

  4. 4.

    Über Zusammenhänge mit präoperativ erhobenen Variablen der Stressbewältigung wird in Abschnitt 4.5 (Abschn. 4.5) berichtet.

  5. 5.

    Bei diesem Test wird die Hand oder der Unterarm, gewöhnlich für eine Minute, in ein Gefäß mit Eiswasser getaucht. Dabei werden Veränderungen verschiedener kardiovaskulärer Reaktionen (Blutdruck, Herzrate) registriert. Die Stärke dieser Reaktionen gilt als Indikator für das Reagieren auf Stressbelastungen, wobei hohe Werte eine vermehrte Stressanfälligkeit indizieren.

  6. 6.

    ASA = American Society of Anesthesiologists

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Krohne, H.W. (2017). Der perioperative Anpassungsstatus des Patienten. In: Stress und Stressbewältigung bei Operationen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53000-9_3

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