术前抑郁对行全膝关节表面置换术患者术后疼痛的影响

Influence of preoperative depression on postoperative pain in patients undergoing total knee arthroplasty

目的探讨术前抑郁对行全膝关节表面置换术(total knee arthroplasty,TKA)治疗的膝关节骨性关节炎(knee osteoarthritis,KOA)患者术后疼痛的影响。方法行TKA治疗的KOA患者102例,依据术前汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分分为抑郁组43例,非抑郁组59例。分别于术前、术后7d采用简化McGill疼痛问卷(short-form McGill pain questionnaire,SF-MPQ)评估患者疼痛程度;Pearson法分析术前、术后7dSF-MPQ评分与术前HAMD评分的相关性。结果抑郁组术前HAMD评分[(23.21±6.00)分]高于非抑郁组[(5.92±4.47)分](P<0.05);抑郁组、非抑郁组术后7dSF-MPQ评分[(23.93±5.35)、(12.46±4.74)分]均低于术前[(25.84±6.15)、(17.97±4.79)分](P<0.05),且抑郁组术前、术后7dSF-MPQ评分均高于非抑郁组(P<0.05);Pearson相关分析结果显示,术前、术后7dSF-MPQ评分与术前HAMD评分均呈正相关(r=0.445,P<0.001;r=0.654,P<0.001)。结论术前抑郁可加重行TKA治疗KOA患者的术后疼痛。

Objective To explore the influence of preoperative depression on postoperative pain in patients undergoing total knee arthroplasty （TKA） for knee osteoarthritis （KOA）. Methods Totally 102 patients undergoing TKA for KOA were divided into depression group （n= 43） and no-depression group （n= 59） according to Hamilton Depression Scale （HAMD） before operation. The short-form McGill pain questionnaire （SF-MPQ） was adopted to evaluate the pain degree before and by day 7 after operation. Pearson correlation method was used to analyze the correlation of SF-MPQ score before and by day 7 after operation with the preoperative HAMD score. Results HAMD score was significantly higher in depression group （23.21±6.00） than that in no-depression group （5. 92±4.47） （P〈0.05）. The SF-MPQ scores were significantly lower by day 7 after operation （23. 934±5.35, 12. 46±4. 74） than those before operation （25.84 ±6. 15, 17. 97±4.79） both in depression and no-depression groups （P〈0.05）, and higher in depression group than those in nodepression group both before and by day 7 after operation （P〈0.05）. Pearson correlation analysis showed that SF-MPQ scores before and by day 7 after operation were positively correlated with the preoperative HAMD score （r=0. 445, P〈 0. 001; r= 0. 654, P〈0. 001）. Conclusion Preoperative depression might increase the pain in patients undergoing TKA for KOA.