心理因素对术后疼痛的影响

THE EFFECT OF PSYCHOLOGICAL FACTORS ON POSTOPERATIVE PAIN AND ITS CLINICAL SIGNIFICANCE

本课题采用问卷的形式调查了 1 0 0例接受硬膜外麻醉单纯胆囊切除术、术后肌注度冷丁镇痛的患者 ,分析心理因素对术后疼痛的影响。单因素分析的结果表明神经质个性、焦虑情绪 (状态焦虑和特性焦虑 )、认知 (患者对手术的担心、术前心理准备、对术后疼痛的惧怕、对康复的信心 )、周围病人的暗示和患者对疼痛的注意力等心理因素均与术后疼痛有关 ;多因素分析的结果提示在多因素综合作用中 ,状态焦虑对术后疼痛的影响作用最强 ,其次是周围病人的暗示和患者对疼痛的注意力 ,而其它因素的作用则相对较小。据此 ,作者提出在药物镇痛的基础上 ,辅以心理疗法 (以控制焦虑为重点 ) 。

In this prospective observational study,we investigated 100 patients using epidural anesthesia for simple cholecystectomy and received intramuscular dolantin analgesia. A self reported psychological questionnaire and Wong Baker faces pain rating scale were used in order to reveal the influence of psychological factors on postoperative pain.The result of monovariate analysis suggested that neuroticism,anxiety(state anxiety and trait anxiety),cognition(patients' worrying about the operation,mental preparation,fear of postoperative pain,confidence of recovery),attention to pain and other patients' suggestion were all correlated with postoperative pain respectively. The result of multivariate analysis suggested that among the above mentioned psychological factors,state anxiety had the highest correlation with postoperative pain,the second were other patients' suggestion and patients' attention to pain. Accordingly,we put forward a proposal of applying psycho therapy in which the key point is anxiety controlling to assist postoperative analgesia.