摘要
目的:探讨子宫肌瘤患者手术前焦虑情绪与痛阈的关系,以及术前焦虑对手术后镇痛效果的影响。方法:对50例子宫肌瘤患者在子宫切除手术前1天采用焦虑自评量表(Self-rate Anxiety Scale,SAS)测评(<50分为无明显焦虑,50～59分为轻度焦虑,≥60分为中重度焦虑);用感觉定量检测仪(Quantitative Sensory Testing,QST)测量患者热痛阈和冷痛阈;手术均在腰-硬联合麻醉下进行,手术完毕前10min硬膜外给予吗啡2mg术后镇痛;手术结束即刻及术后2h、6h、12h采用视觉模拟评分法(Visual Analgesia Scores,VAS)用0cm～10cm线条对患者疼痛进行评分,并随访术后开始下床活动时间,以观察术后镇痛效果。结果:50例患者手术前SAS评分为(48.7±10.3),其中轻度焦虑13例(26%),中重度焦虑5例(10%);QST测定值热痛阈为(37.8±3.1)℃,冷痛阈为(15.8±3.6)℃;术后即刻及术后2h、6h、12h的VAS评分分别为0、(1.4±1.1)、(3.3±1.6)、(4.4±2.1)。焦虑患者SAS评分与热痛阈、冷痛阈之间呈负相关(r=-0.67,-0.56;Ps<0.001),与术后6h、12h的VAS评分呈正相关(r=0.48,0.55;Ps<0.001)。焦虑者术后初次下地活动时间晚于无明显焦虑者[(46.6±7.1)hvs.(39.8±9.3)h,P<0.05]。结论:子宫肌瘤患者的术前焦虑水平越高,手术后对疼痛的感受越敏感,镇痛效果相对越差,术后恢复需要的时间越长,因此临床工作中应重视患者的术前焦虑评估。
Objective： To evaluate the relation between preoperative anxiety and pain threshold in patients with hysteromyoma, and to investigate the effect of anxiety on postoperative analgesia. Methods： Fifty patients with hysteromyoma were included and evaluated the anxiety level with the Self-Rating Anxiety Scale （ SAS ） 1 day before hysterectomy. Threshold of heat pain and cold pain of all patients were also assessed by quantitative sensory testing （QST） at the same time. All patients received hysterectomy under the combined spinal epidural anesthesia, and 2 mg morphine were injected to their epidural spaces 10 min before the end of surgery. Visual analgesia scores （ VAS, 0 -10） were performed to evaluate the level of pain at 0h, 2h, 6h and 12h after the operation. The time of first ambulation after operation were also recorded to help assess the effect of postoperative analgesia. Results： The average SAS scores of all these 50 patients was （48.7 ± 10. 3 ） . And 13 cases （ 26% } were with mild anxiety （ SAS =50 -59）, whereas 5 cases （ 10% ） were with moderate or severe anxiety （ SAS 〉60） . The threshold of heat pain and cold pain were （ 37.8 ±3.1） ℃and （ 15.8± 3.6 ） ℃. VAS at all investigated time points was 0, （ 1.4 ±1.1 ）, （3.3 ± 1.6 ） and （ 4.4± 2. 1 ） . There was significantly negative correlation between the SAS scores and the pain threshold of all patients with anxiety （r = -0. 67, -0. 56; Ps 〈0. 001 ） . But for these patients, the correlations between the SAS scores and VAS scores at 6h and 12h after the operation were positive （ r = 0.48, 0. 55, Ps 〈0. 001 ） . Furthermore, the average time of first ambulation after operation in those anxious patients was later than that in the patients with no anxiety （ SAS 〈 50 ） [ （ 46. 6 ± 7.1 ） h vs. （ 39. 8 ± 9. 3 ） b, P 〈 0. 05 ] . Conclusion： The higher level of preoperative anxiety in patients with hysteromyoma is correlated to higher level of pain threshold, less effect of analgesia and longer time to recovery. It indicates that it is necessary to assess preoperative anxiety in patients with hysteromyoma.
出处
《中国心理卫生杂志》
CSSCI
CSCD
北大核心
2010年第2期86-88,98,共4页
Chinese Mental Health Journal
关键词
手术
焦虑
疼痛
痛阈
横断面研究
surgery
anxiety
pain
pain threshold
cross-sectional study
作者简介
通信作者E—mail：gongsunwenhua@sina．com
