知觉教养方式、气质对3～7岁OSAHS患儿术后疼痛强度的影响

发布时间：2018-08-27 12:29

【摘要】：研究目的: 描述阻塞性睡眠呼吸暂停低通气综合症(OSAHS)患儿知觉教养方式、气质、术后疼痛强度特征;分析儿童术后疼痛强度与上述其它三种因素的关系,筛选儿童术后疼痛强度的影响因素;探讨儿童术后疼痛强度的预测因素,建立预测方程。研究方法: 采用横断面研究设计,应用目的抽样方法,调查了广州市某儿童医疗机构的220例OSAHS患儿及其父母。采用儿童知觉教养方式问卷、中国3-7岁儿童气质量表、Wong-Baker面部表情疼痛量表分别调查OSAHS患儿知觉教养方式分布特征、气质特征(气质类型分布特征、气质维度得分水平)和术后疼痛强度水平。采用统计方法包括:描述性分析、Wilcoxon符号秩和检验、t检验、logistic回归。选用SPSS 13.0软件进行数据统计分析。研究结果: (1)OSAHS患儿知觉教养方式分布比例最高者为专制权威型(45.00%),最低者为忽视冷漠型(5.91%); (2)OSAHS患儿五种气质类型分布比例由高到低依次为:中间偏易型、平易型、中间偏烦型、麻烦型、发动缓慢型;心境(t=3.032,p=0.003)、注意分散(t=5.794,p0.001)、活动水平(t=2.410,p=0.017)、适应性(t=4.844,p0.001)、节律性(t=2.192,p=0.029)、趋避性(t=3.833,p0.001)、持久性(t=6.917,p0.001)七个气质维度得分均高于健康儿童水平;反应强度、反应阈两个维度得分在健康儿童范围内; (3)OSAHS患儿术后4h和6h不伴随吞咽动作,疼痛评分≥3分的人数比例分别为13.18%和11.36%;伴随吞咽动作的术后4h和6h疼痛评分≥3分的患儿人数比例分别为60.45%和68.18%; (4)父母职业等级、儿童年龄、上学状况、知觉教养方式、气质类型和气质维度中的心境、注意分散、活动水平、适应性、反应强度、趋避性对儿童术后疼痛强度的影响具有统计学意义(P0.05); (5)气质类型、气质维度中的心境、注意分散、活动水平、适应性存在于患儿术后疼痛强度的预测方程中(P0.05)。研究结论: (1)父母职业、学历、对子女性别满意度和患儿年龄、上学状况、知觉教养方式、气质是儿童术后疼痛强度的独立影响因素;手术方式、麻醉方式、诊断等疾病特征以及儿童性别、家庭类型对其的影响无统计学意义; (2)气质类型是儿童术后疼痛强度的预测因素。麻烦型气质的儿童术后出现Ⅱ级疼痛风险最高,平易型的儿童术后出现Ⅱ级疼痛风险最低,其它气质类型儿童的风险性位于两者之间; (3)气质维度中的注意分散、活动水平、心境、适应性是儿童是术后疼痛强度的预测因子。具有高注意分散,低活动水平、负向心态、适应性差特征的儿童,出现Ⅱ级术后疼痛强度的风险高。可以通过分散注意力、适当提高活动水平、树立正向心境等方法降低儿童术后疼痛风险; (4)在组成气质类型的五个气质维度中,心境稳定的存在于四个疼痛采集点的预测方程中,是气质类型对儿童术后疼痛强度预测作用的重要因素; (5)研究从统计学方法上有效的控制了混杂因素,建立的儿童术后疼痛强度预测模型稳健性好、可靠性高。
[Abstract]:Research purposes:
To describe the characteristics of perceptual rearing style, temperament and postoperative pain intensity in children with obstructive sleep apnea hypopnea syndrome (OSAHS); to analyze the relationship between postoperative pain intensity and the other three factors, to screen the influencing factors of postoperative pain intensity in children; to explore the predictive factors of postoperative pain intensity in children, and to establish a predictive equation.
Research methods:
A cross-sectional study was designed to investigate 220 children with OSAHS and their parents in a children's medical institution in Guangzhou. The distribution and temperament characteristics of children with OSAHS were investigated by the Children's Perceptual Rearing Style Questionnaire, Chinese Children's Temperament Quality Scale and Wong-Baker Facial Expression Pain Scale. Statistical methods included descriptive analysis, Wilcoxon symbolic rank sum test, t test and logistic regression. SPSS 13.0 software was used to analyze the data.
Research findings:
(1) The highest proportion of children with OSAHS was authoritarian (45.00%) and the lowest was neglected indifference (5.91%).
(2) The proportion of five temperament types in OSAHS children from high to low was middle-easy temperament type, easy temperament type, middle-boring temperament type, trouble temperament type, slow-moving temperament type, mood (t = 3.032, P = 0.003), attentional dispersion (t = 5.794, P 0.001), activity level (t = 2.410, P = 0.017), adaptability (t = 4.844, P 0.001), rhythm (t = 2.192, P = 0.029), avoidance (t = 3.833, P = 0.001), persistence. The scores of seven temperament dimensions of persistence (t = 6.917, p0.001) were higher than those of healthy children, and the scores of reaction intensity and reaction threshold were within the range of healthy children.
(3) The proportion of children with OSAHS who had no swallowing movement at 4 h and 6 h after operation was 13.18% and 11.36% respectively, while the proportion of children with OSAHS who had pain score greater than 3 at 4 h and 6 h after operation was 60.45% and 68.18% respectively.
(4) The influence of parents'occupational grade, children's age, school status, perceptual rearing style, temperament type and temperament dimension on children's postoperative pain intensity was statistically significant (P 0.05).
(5) Temperament type, mood in temperament dimension, attentional dispersion, activity level and adaptability existed in the predictive equation of postoperative pain intensity (P 0.05).
Research conclusions:
(1) Parental occupation, educational background, gender satisfaction with children, age, school status, parenting style, temperament are independent factors of postoperative pain intensity in children; surgical methods, anesthesia methods, diagnosis and other characteristics of the disease and children's gender, family type has no significant impact on it;
(2) Temperament type is a predictor of postoperative pain intensity in children.
(3) Attention dispersion, activity level, mood and adaptability in temperament dimension are predictors of postoperative pain intensity. Children with high attentional dispersion, low activity level, negative mentality and poor adaptability have a high risk of developing grade II postoperative pain intensity. Environment and other methods to reduce postoperative pain risk in children.
(4) Among the five dimensions of temperament types, mood stability exists in the prediction equations of four pain collection points, which is an important factor in predicting the postoperative pain intensity of children with temperament types.
(5) The study effectively controlled the confounding factors from the statistical method, and established a predictive model of postoperative pain intensity in children with good robustness and reliability.
【学位授予单位】：广州医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766

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