248例急性手外伤患者术后康复影响因素调查

Investigation of the influence factors of postoperative rehabilitation in 248 patients with acute hand injuries

目的探讨急性手外伤患者心理及社会因素与术后康复的相关性。方法对2013年8月至2015年8月于佛山市南海区第二人民医院手术治疗的248例住院患者进行调查随访,根据Carroll手功能评定标准、视觉模拟评分(VAS)评价患者术后手功能恢复情况及疼痛缓解程度,采用抑郁自评量表、汉密顿焦虑量表、临床医师专用创伤后应激障碍(PTSD)量表及社会支持度评估来观察患者术后康复期的心理状态和社会支持情况,对患者术后康复与心理状态、社会支持之间的关系进行统计分析。结果 248例患者中PTSD 101例、焦虑56例、抑郁91例。手功能恢复与焦虑、抑郁、PTSD密切相关(P<0.05),与社会支持相关性差异无统计学意义(P>0.05);术后康复期VAS评分与焦虑、抑郁、PTSD、社会支持中的客观支持维度密切相关(P<0.05)。结论急性手外伤患者术后康复期焦虑、抑郁、PTSD发病率较高;其手功能恢复与心理因素密切相关,心理因素及客观支持社会因素亦对疼痛症状的明显缓解有一定影响,提示急性手外伤患者康复期心理干预、社会支持对提高手术疗效的重要意义。

Objective To explore the correlations between psychological, social factors and postoperativerehabilitation in patients with acute hand injuries. Methods From August 2013 to August 2015, 248 hospitalizedpatients with acute hand injuries were treated surgically in Foshan Nanhai second people's Hospital, and wereinvestigated and followed up. According to Carroll evaluation standard of hand function, visual analogue scale(VAS), postoperative hand function status and pain symptom were assessed, at the same time, psychologicalstatus and social support during the postoperative rehabilitation were observed based on self rating depressionscale, Hamilton anxiety scale, clinician-administered post-trauma stress disorder (PTSD) scale and social support assessment. The relations among postoperative recovery and psychological status, social support were analyzedstatistically. Results There were PTSD in 101 cases, anxiety in 56 cases and depression in 91 cases. Recovery ofhand function was closely related to anxiety, depression and PTSD (P <0.05), while there was no statisticalcorrelation with social support (P >0.05). VAS scores were closely related to anxiety, depression, PTSD andobjective support (P <0.05). Conclusions For patients with acute hand injuries, the incidences of anxiety,depression and PTSD during postoperative rehabilitation were relative high. Patients' hand functional recovery isclosely related to psychological factors, psychological factors and social factor of objective support also influenceon the improvement of pain symptoms, which reveals the important significance of psychological interventionand social support for enhancing surgical effects.