药物-心理联合镇痛对退变性脊柱侧弯患者术前疼痛及心理状况的影响

Effect of drug-psychology combined with analgesia on preoperative pain and psychological state in patients with degenerative scoliosis

目的 探讨药物-心理联合镇痛对退变性脊柱侧弯患者术前疼痛及心理状况的影响.方法 对32例成人退变性脊柱侧弯患者术前采用药物-心理联合镇痛的方法,并采用疼痛视觉模拟评分法（VAS）、焦虑自评量表（SAS）及医学应对量表（MCMQ）,对其镇痛前后疼痛及心理状况进行调查分析.结果 入院时患者疼痛评分为（5.23±1.74）分,焦虑评分为（32.60±3.71）分,经联合镇痛后,患者的疼痛评分为（2.34±1.22）分,焦虑评分为（25.50±3.70）分,镇痛前后比较,差异均有统计学意义（t分别为-5.23,-4.42;P ＜0.01）.对焦虑因素的进一步调查显示：前3位（占50％以上）的是患者对手术、麻醉及预后的担心以及相关疾病知识的缺乏及对术后监护病房的恐惧.入院时医学应对方式调查结果显示,面对、屈服、回避维度的评分分别为（19.52±3.04）,（17.16±2.17）,（11.98±4.75）分,镇痛后面对、屈服、回避维度的评分分别为（23.52±3.46）,（14.16±2.14）,（8.98±1.75）分,差异均有统计学意义（t分别为5.09,-4.92,-4.16;P ＜0.01）,患者大多能采取面对的积极应对方式.结论 药物-心理联合镇痛方法有效缓解了成人脊柱侧弯患者术前疼痛及因疼痛而产生的焦虑、消极的医学应对方式,使患者能采用积极面对的应对方式,促进了患者身心康复.

Objective To explore the effect of drug-psychology combined with analgesia on preoperative pain and psychological state in patients with degenerative scoliosis.Methods Thirty-two patients with degenerative scoliosis from January 2010 to December 2012 received the drug-psychology combined with analgesia before the operation,and were surveyed by the Visual Analogue Scale （VAS）,Self-Rating Anxiety Scale （SAS）,Medical Coping Modes Questionnaire （MCMQ） in order to analyze the pain status and psychological state before and after the analgesia.Results The scores of VAS and SAS were respectively （5.23 ± 1.74）,（32.60 ± 3.71） at admission,and were （2.34 ± 1.22）,（25.50 ± 3.70） after the combined analgesics,and the differences were statistically significant （t =-5.23,-4.42,respectively;P 〈0.01）.The further investigation on the anxiety showed that the top three factors were respectively the worry about operation,anesthesia and prognosis,the lack of the disease-related knowledge and the fear of intensive care unit after the operation.The scores of MCMQ including face,yield,avoidance were respectively （19.52 ± 3.04）,（17.16 ± 2.17）,（11.98 ± 4.75） at admission,and were （23.52 ± 3.46）,（14.16 ± 2.14）,（8.98 ± 1.75） after the analgesics,and the differences were statistically significant （t =5.09,-4.92,-4.16,respectively ; P 〈 0.01）.Most of patients could take active coping mode.Conclusions Drug-psychology combined with analgesia can effectively alleviate pain,anxiety and negative medical coping modes induced by preoperative pain,and make patients take active coping modes,and promote the physical and psychological rehabilitation of patients with degenerative scoliosis.