慢性疼痛患者的失眠情况及影响因素

Influencing Factors Contributing to Insomnia Among Patients with Chronic Pain

目的了解疼痛科慢性疼痛初诊且尚未治疗者失眠现状,分析发生失眠的相关影响因素。方法2019年1月至6月对玉溪市人民医院疼痛科住院患者开展问卷调查,收集并统计分析431例患者基本信息,用日本尼普洛知觉痛觉定量分析装置NIPRO Painvision(PS-2100)及视觉模拟评分法(VAS)了解疼痛程度,用焦虑自评量表、抑郁自评量表分别了解焦虑、抑郁的发生率,用阿森斯失眠量表评估睡眠质量。结果431例慢性疼痛病人中226例最近1周失眠,失眠率52.44%(95%CI:47.72%~57.15%)。多因素logistic回归分析女性失眠风险是男性的1.832倍;≥60岁的病人失眠风险是18~30岁的6.821倍;轻度、中度和重度抑郁病人分别是无抑郁病人的4.181、19.381和21.688倍;重度疼痛患者失眠风险是轻度疼痛病人的13.954倍;疼痛部位>1个的患者失眠风险是仅有1个疼痛部位病人的3.762倍;慢性肌肉骨骼疼痛、慢性内脏/头/面部神经疼痛、慢性神经病理性疼痛和癌性相关疼痛病人的失眠风险分别是慢性创伤和术后疼痛的2.150、2.670、25.067和38.052倍;相较于疼痛病程<1 a的患者,疼痛病程为1 a~和3 a~的患者失眠风险分别降低67.00%和69.70%。结论慢性疼痛患者常常伴发焦虑、抑郁,导致失眠,对易于出现失眠的人群,需特别加以关注和心理疏导,及时缓解、控制疼痛以减少失眠发生。

Objective To investigate the status of insomnia and the related influencing factors among patients with chronic pain in department of pain.Methods A total of 431 patients were recruited from department of pain and a questionnaire survey was performed between January and June 2019,the general information were collected,the assessment of anxiety,depression,insomnia and the measurement of pain level and were conducted by self-rating anxiety scale(SAS),self-rating depression scale(SDS),athens insomnia scale(AIS)and visual analogue scale(VAS)and NIPRO painvision respectively,the rates of insomnia were statistically analyzed.Results Among 431 patients,there were 226 patients experienced insomnia(52.44%,95%CI:47.72%~57.15%).Data from the multiple logistic regression analysis indicated that males were 1.832 times more likely to suffer from insomnia than females,those more than 60 years'age were 1.832 times more likely to suffer from insomnia than those 18-30 years'age,patients with mild,moderate and severe depression were 4.181,19.381 and 21.688 times more likely to suffer from insomnia than those than those without depression respectively,patients with severe pain had a 13.954 times higher risk of insomnia than those with mild pain,patients with more than one site of pain had a 3.762 times higher risk of insomnia than patients with only 1 site of pain,patients with type 2/3/4/5 pain were 2.150,2.670,25.067 and 38.052 times more likely to suffer from insomnia than patients with type 1 pain,while patients with pain duration of 1 year and 3 years while no likely suffer insomnia.Conclusion The chronic pain patients are always concomitant with depressive and anxiety symptoms and suffer from insomnia,meanwhile,it is urgently needed to pay close attention and mentality guidance to patients easily suffer from insomnia,relief and control pain timely to avoid insomnia.