术前抑郁状态对术后疼痛评分影响的研究

发布时间：2018-05-22 12:47

本文选题：腹部手术 + 抑郁　；参考：《山东大学》2015年硕士论文

【摘要】：目的：通过对腹部手术患者术前抑郁程度及术后疼痛程度的评估,分析手术患者术后疼痛程度与术前抑郁程度的变化趋势和相关关系。方法：腹部手术患者术前采用抑郁自评量表(Self-rating depression scale, SDS)进行抑郁评估,将患者分为抑郁组(60例)、对照组(20例)。两组术后采用经静脉自控镇痛(patient controlled intravenous analgesia, PCIA)。术后12、24、48小时分别对两组患者进行术后疼痛程度评估,评估方法为：视觉模拟量表评分(VAS)、简化MeGill疼痛问卷(SF-MPQ)、患者自控镇痛按压次数。评价患者术前抑郁程度和术后疼痛程度的变化趋势和相关性。结果：(1)抑郁组和对照组两组患者一般资料(如性别构成、年龄构成、文化程度、婚姻状况、职业及家庭收入等)比较,两组差别无统计学意义(P0.05)。(2)抑郁组和对照组两组患者术前SDS评分的比较,对照组SDS评分为46.0+6.6,而抑郁组SDS评分为66.0+7.3,抑郁组明显高于对照组(P0.01)；其中抑郁组中轻度患者24例,SDS评分59.0±6.3,中度患者23例,SDS评分62.0±7.3,重度患者13例,SDS评分73.0±7.7。(3)抑郁组和对照组两组患者术后12、24小时VAS分值的比较,抑郁组分别为8.2±2.4、6.7±1.9,较对照组7.3±2.1和5.3±1.5明显升高,差异具有统计学意义(P0.05)。而术后48小时,两组的VAS值(3.7±1.3和2.3±1.0)差异无统计学意义(P0.05)。组内术后12、24和48小时间不同时间点比较显示,随着术后时间的延长疼痛程度逐渐降低。(4)抑郁组和对照组两组患者术后SF-MPQ分值的比较,抑郁组术后12、24小时SF-MPQ分值(10.44±3.7,8.9±2.9),较对照组7.3±2.2、6.9±1.5显著升高,差异具有统计学意义(P0.01)；而术后48小时,两组的SF-MPQ分值差异无统计学意义(P0.05)。组内比较提示,术后随着时间的延长两组SF-MPQ分值逐渐降低。(5)抑郁组和对照组两组患者术后24小时内PCIA泵的按压次数的比较,抑郁组患者手术后24小时内PCIA泵的按压次数(15.4+3.4)明显高于对照组的按压次数(6.7+2.2),两组比较差异具有统计学意义(P0.01)。(6)患者术后疼痛评分与术前抑郁程度的相关性分析发现,手术后12小时、24小时,患者术前抑郁程度越高,术后疼痛程度越高,抑郁程度和疼痛程度呈正相关(VAS:r=0.826,0.746,P=0.014,0.023;SF-MPQ:r=0.878,0.759,P=0.012, 0.019)。结论：手术患者术前抑郁程度会影响其术后的疼痛程度,术后疼痛评分与术前抑郁程度呈正相关,即术前抑郁程度越高术后疼痛评分越高。
[Abstract]:Objective: to evaluate the degree of preoperative depression and postoperative pain in patients undergoing abdominal surgery, and to analyze the relationship between the degree of postoperative pain and the degree of preoperative depression. Methods: Self-rating depression scale, SDS) was used to evaluate depression in patients undergoing abdominal surgery. Patients were divided into depression group (n = 60) and control group (n = 20). Patient controlled intravenous analgesia, PCIA was used after operation in both groups. The degree of postoperative pain was evaluated by visual analogue scale (VAS), simplified MeGill pain questionnaire (SF-MPQ) and patient controlled analgesia (PCEA). To evaluate the trend and correlation of preoperative depression and postoperative pain. Results the general data (such as sex, age, education, marital status, occupation and family income) were compared between the depression group and the control group. There was no significant difference between the two groups (P0.05U. 2) the comparison of preoperative SDS score between the depression group and the control group, The SDS score of the control group was 46.06, while that of the depression group was 66.07.3, which was significantly higher in the depression group than that in the control group (P 0.01), in which 24 patients with mild depression had a SDS score of 59.0 卤6.3, 23 patients with moderate depression had a SDS score of 62.0 卤7.3, and 13 patients with severe depression had a SDS score of 73.0 卤7.7.3). Comparison of VAS scores between the control group and the control group at 24 hours after operation. Compared with the control group (7.3 卤2.1 and 5.3 卤1.5), the depression group was significantly higher than that of the control group (8.2 卤2.4 卤6.7 卤1.9). The difference was statistically significant (P 0.05). However, there was no significant difference in VAS between the two groups (3.7 卤1.3,2.3 卤1.0) at 48 hours postoperatively (P 0.05). The comparison of postoperative SF-MPQ scores between the depression group and the control group at different time points at 24 and 48 hours after operation showed that the pain degree decreased gradually with the prolongation of postoperative time, and the comparison between the depression group and the control group showed that there was no significant difference in postoperative SF-MPQ scores between the depression group and the control group. The SF-MPQ score of the depression group was 10.44 卤3.7 卤8.9 卤2.9 at 24 hours postoperatively, which was significantly higher than that of the control group (7.3 卤2.2 卤6.9 卤1.5), and the difference was statistically significant (P 0.01), but there was no significant difference in the SF-MPQ score between the two groups at 48 hours after operation (P 0.05). The comparison between the two groups showed that the scores of SF-MPQ in the two groups decreased gradually as the time went on. (5) the comparison of the times of PCIA pump pressing within 24 hours after operation between the depression group and the control group. The pressure times of PCIA pump in the depression group within 24 hours after operation were 15.4 3.4) significantly higher than that in the control group (6.7 2.2%). The difference between the two groups was statistically significant (P 0.01) and the correlation between the postoperative pain score and the degree of depression before operation was found. 12 hours after operation and 24 hours after operation, the degree of depression was higher before operation and the degree of postoperative pain was higher. There was a positive correlation between the degree of depression and the degree of pain. There was a positive correlation between the degree of depression and the degree of pain. Conclusion: the degree of preoperative depression will affect the degree of postoperative pain, and the postoperative pain score is positively correlated with the degree of preoperative depression, that is, the higher the degree of preoperative depression, the higher the postoperative pain score.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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