慢性疼痛患者情绪、生活质量及其干预效果研究

发布时间：2018-05-08 02:40

本文选题：性疼痛 + 焦虑　；参考：《中国人民解放军医学院》2013年硕士论文

【摘要】：第一部分慢性疼痛患者焦虑、抑郁和睡眠质量的研究目的：了解慢性疼痛患者焦虑、抑郁水平及睡眠质量状况，探讨其相关因素。方法：随机抽取2012年8月至12月于我院疼痛科门诊就诊的慢性疼痛患者308例，评估工具采用简式McGill疼痛问卷（SF-MPQ）、综合医院焦虑抑郁量表（HAD）和匹茨堡睡眠质量指数（PSQI）。所有数据录入EXCEL，采用SPSS17.0软件进行统计分析。结果：回收有效问卷301例（有效率97.93%）。其中共检出伴有焦虑症状患者106例（占35.22%），检出伴有抑郁症状患者83例（占27.57%），同时伴有焦虑抑郁症状患者57例（占18.94%），检出睡眠质量差患者137例（占45.51%）；单因素分析发现：患者焦虑、抑郁水平与性别、年龄、文化程度、职业、婚姻状况和疼痛持续时间无关（p＞0.05），而与疼痛强度（p＜0.01）、疼痛部位的数目（p＜0.05）、感觉项计数（p＜0.01）和情感项计数（p＜0.01）有关；多因素回归分析发现：慢性疼痛患者焦虑、抑郁水平与其疼痛强度（p＜0.05）和情感项计数相关有关(p＜0.001)；患者睡眠质量(PSQI)主要与疼痛强度（p＜0.01）及是否伴有焦虑有关（p＜0.001）。结论：慢性疼痛患者焦虑、抑郁患病率较高，睡眠质量较差，，与疼痛特征有关。第二部分对慢性疼痛患者注意偏向的事件相关电位研究目的:探讨慢性疼痛患者对痛觉相关信息是否存在注意偏向及其机制。方法:采用E-prime2.0程序编写情绪Stroop范式，记录并比较慢性疼痛患者16例（实验组）及健康志愿者16例（对照组）对3类词汇（包括中性、痛觉、威胁）颜色命名的反应时及正确率，同时记录其32通道的ERP。结果:慢性疼痛患者对痛觉相关词汇、威胁性词汇的颜色命名反应时均长于中性词汇；健康对照组威胁相关词汇反应时长于中性词汇。威胁性词汇在两组被试各脑区诱发P200幅值显著高于中性词汇；慢性疼痛患者疼痛相关词汇诱发P300幅值显著高于中性词汇。结论:慢性疼痛患者存在对痛觉相关信息的注意偏向，其产生机制可能与情绪控制加工有关；两组对威胁性信息均存在注意偏向可能与情绪的自动加工有关。第三部分慢性疼痛患者生活质量及其相关因素研究目的：了解慢性疼痛患者的生活质量状况，并探讨其影响因素。方法：随机抽取就诊于我院疼痛科门诊301例患者为研究对象，研究工具采用生活质量指数问卷（QL-Index）测量慢性疼痛患者生活质量状况。统计分析采用t检验、单因素方差分析、Pearson相关分析、多元线性逐步回归分析等方法探讨慢性疼痛患者生活质量与疼痛、焦虑、抑郁及其睡眠质量的关系。结果：①不伴焦虑的慢性疼痛患者生活质量显著高于伴焦虑者(p＜0.001)；不伴抑郁的慢性疼痛患者生活质量显著高于伴抑郁者(p＜0.001)；无失眠者的生活质量显著高于失眠者(p＜0.001)；②重度疼痛患者生活质量指数总分显著低于轻度、中度组(p＜0.001)；感觉项数目不同患者生活质量有显著差异(p＜0.01)；情感项数目不同患者生活质量有显著差异(p＜0.001)；③慢性疼痛患者生活质量总分与SF-MPQ总分、感觉项总分、情感项总分、VAS评分、PPI、感觉项计数、情感项计数、焦虑评分、抑郁评分和PSQI评分均呈显著负相关(r=-0.195-0.433,p＜0.01)；④多元线性逐步回归分析模型可解释慢性疼痛患者生活质量指数改变的49.1%，自变量情感项总分、抑郁、VAS评分对患者生活质量改变有影响，尤其以情感项总分对患者生活质量的影响最为显著。结论：焦虑、抑郁、失眠、疼痛特征（疼痛程度、感觉项计数、情感项计数）对慢性疼痛患者的生活质量有影响，尤其以情感项总分、抑郁及VAS评分对患者生活质量的影响最为显著。第四部分：结构式放松训练对慢性疼痛患者焦虑、抑郁和睡眠质量的干预研究目的：探讨放松训练对缓解慢性疼痛患者焦虑、抑郁水平及改善睡眠质量的作用；方法：选取我院疼痛科住院慢性疼痛患者70例，随机分为干预组和对照组（各35例），干预组33例和对照组30例完成实验观察。对照组患者接受疼痛科常规治疗和护理，干预组患者在常规治疗和护理的同时接受放松训练。结果：两组患者干预1周后焦虑、抑郁和睡眠质量评分均有所下降,并且干预组的焦虑、抑郁和睡眠质量评分低于对照组。经重复测量方差分析结果显示,不同测量时间的焦虑、抑郁和睡眠质量评分差异均有统计学意义(P0.01)。干预组经干预2周、4周后焦虑、抑郁和睡眠质量评分随时间变化呈下降趋势（p＜0.01），对照组经干预2周、4周后焦虑、抑郁和睡眠质量评分无明显改变（p＞0.05）。结论：放松训练对缓解慢性疼痛患者焦虑抑郁水平，改善其睡眠质量有效。
[Abstract]:Part one research on anxiety, depression and sleep quality of patients with chronic pain
Objective: to understand the anxiety, depression and quality of sleep in patients with chronic pain, and to explore the related factors. Methods: 308 patients with chronic pain were randomly selected from August 2012 to December in the clinic of pain department of our hospital. The assessment tools used the simplified McGill pain questionnaire (SF-MPQ), the comprehensive hospital anxiety and Depression Scale (HAD) and Pittsburgh sleep. Mass index (PSQI). All data were recorded in EXCEL, and SPSS17.0 software was used for statistical analysis. Results: 301 cases of effective questionnaires were recovered (97.93%). Among them, 106 cases (35.22%) accompanied with anxiety symptoms were detected, 83 cases (27.57%) with depressive symptoms were detected, and 57 patients (18.94%) with anxiety and depressive symptoms were detected, and sleep was detected. There were 137 patients with poor quality of sleep (45.51%), and single factor analysis found that anxiety, depression level was not related to sex, age, education, occupation, marital status and duration of pain (P > 0.05), but with the intensity of pain (P < 0.01), the number of pain sites (P < 0.05), sensory count (P < 0.01) and emotional count (P < 0.01). Multiple regression analysis showed that the anxiety, depression level of the patients with chronic pain was related to the intensity of pain (P < 0.05) and the count of emotional items (P < 0.001); the quality of sleep (PSQI) was mainly related to the intensity of pain (P < 0.01) and anxiety (P < 0.001). Conclusion: the anxiety of chronic pain patients, the high incidence of depression, and sleep quality The poor quantity is related to the characteristics of pain.
The second part is an event related potential study on attentional bias in patients with chronic pain.
Objective: To investigate whether there is attention bias and mechanism of pain related information in patients with chronic pain. Methods: the E-prime2.0 program was used to write the emotional Stroop paradigm, and to record and compare 16 cases of chronic pain (experimental group) and 16 healthy volunteers (control group), the reaction and positive of the 3 categories of words (including neutral, pain, threat) color naming. At the same time, the ERP. results of the 32 channels were recorded. The color naming reaction of the patients with chronic pain was longer than that in the neutral vocabulary while the color naming reaction of the threatened vocabulary was longer than that of the neutral vocabulary. The healthy control group threatened the related lexical response longer than the neutral vocabulary. The P200 amplitude in each brain area of the subjects was significantly higher than the neutral vocabulary; the chronic pain was chronic pain. The amplitude of P300 evoked by pain related words in pain patients was significantly higher than that in neutral words.
Conclusion: Patients with chronic pain have attention bias to pain related information, and their mechanism may be related to emotional control processing; the two groups of threatening information may be related to the automatic processing of emotion.
The third part is the quality of life and its related factors in patients with chronic pain.
Objective: to understand the quality of life of patients with chronic pain and to explore its influencing factors. Methods: 301 patients in the clinic of pain department of our hospital were selected randomly. The quality of life of patients with chronic pain was measured by means of quality of life questionnaire (QL-Index). The statistical analysis was made by t test and single factor variance. The relationship between quality of life and pain, anxiety, depression and sleep quality in patients with chronic pain was analyzed by Pearson correlation analysis and multiple linear stepwise regression analysis. Results: (1) the quality of life of patients with chronic pain without anxiety was significantly higher than those with anxiety (P < 0.001); the quality of life of patients with chronic pain without depression was significantly higher. In patients with depression (P < 0.001), the quality of life of those without insomnia was significantly higher than those of insomnia (P < 0.001). The total score of quality of life index of patients with severe pain was significantly lower than that of mild, moderate group (P < 0.001), and the quality of life of patients with different sensory items was significantly different (P < 0.01), and the quality of life of patients with different emotional terms was significantly different. (P < 0.001); (3) the total score of life quality and total score of SF-MPQ, total score of sensory items, total score of emotion, VAS score, PPI, feeling item count, emotional item count, anxiety score, depression score and PSQI score were all significantly negative correlation (r=-0.195-0.433, P < 0.01); (4) multivariate linear stepwise regression analysis model could explain chronic pain. The changes in the quality of life index were 49.1%, the total score of affective variables, depression and VAS score had an influence on the quality of life of the patients, especially the effect of the total score of emotion on the quality of life of the patients. Conclusion: anxiety, depression, insomnia, and pain characteristics (pain degree, feeling item count, emotional item count) on the life of patients with chronic pain Quality is influential, especially the total score of emotion. Depression and VAS score have the most significant effect on patients' quality of life.
The fourth part: intervention study of structural relaxation training on anxiety, depression and sleep quality of patients with chronic pain.
Objective: To explore the effect of relaxation training on anxiety, depression and improvement of sleep quality in patients with chronic pain. Methods: 70 patients with chronic pain in hospital pain department were randomly divided into intervention group and control group (35 cases each), 33 cases in the intervention group and 30 cases in the control group. The control group received the routine treatment of pain department. Results: the anxiety, depression and sleep quality score of the two groups were decreased after 1 weeks of intervention, and the anxiety, depression and sleep quality score of the intervention group were lower than those in the control group. The results of repeated measurements of variance analysis showed that the anxiety of different time of measurement was different. The differences in depression and sleep quality score were statistically significant (P0.01). After intervention for 2 weeks, the anxiety, depression and sleep quality score decreased with time (P < 0.01) after intervention (P < 0.01). The control group had 2 weeks of intervention and no significant changes in anxiety, depression and sleep quality score after 4 weeks (P > 0.05).
Conclusion: relaxation training is effective in relieving anxiety and depression level and improving sleep quality in patients with chronic pain.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.4

【参考文献】