手术后住院患者疼痛和止痛药信念的现状分析

Survey on pain and analgesics beliefs in postoperative hospitalized patients

目的评估手术后住院患者疼痛和止痛药信念现状,为制定手术后患者疼痛健康教育方案提供参考。方法于2019年9月至12月采用方便抽样法,收集青岛大学附属医院住院手术患者240例,入组标准:年龄≥18岁,汉族,无宗教信仰,无意识障碍及沟通障碍,无慢性疼痛病史,无精神异常,非产妇及癌症患者。部分修改我国台湾学者赖裕和开发的疼痛和阿片类止痛药信念量表(POABS),并对修改版量表的信效度进行测试后应用到临床,分析患者对疼痛及止痛药的信念现状。结果本次研究共发放问卷240份,有效问卷227份,有效回收率94.6%。入组患者年龄21~73岁,平均年龄(45.1±17.4)岁;男111例(48.9%),女116例(51.1%);小学及以下学历79例(34.8%),中学/中专学历65例(28.6%),大专以上学历83例(36.6%);已婚194例(85.5%),未婚或离异33例(14.5%)。修改后POABS与原量表评分相同,分忍耐疼痛和止痛药不良反应两个维度。忍耐疼痛维度、止痛药不良反应维度及整量表的内部一致性信度Cronbach'sα分别是0.755、0.811、0.872,重测信度分别为0.798、0.813、0.884。227例术后患者整量表总分为(24.1±6.3)分,其中忍耐疼痛维度总分(12.2±3.4)分,止痛药不良反应维度总分(11.9±3.4)分。量表各条目得分均趋于负向。单因素分析结果显示,忍耐疼痛维度中,不同文化程度的患者忍耐疼痛的信念得分差异有统计学意义(F=3.049,P=0.049);止痛药不良反应维度中,术后24 h内最大疼痛等级评分不同的患者得分差异有统计学意义(F=3.353,P=0.037)。结论术后患者对忍耐疼痛和止痛药不良反应存在错误的信念,应选择适宜的健康教育方式,帮助患者树立正确的疼痛信念,提高其生活质量。

Objective To evaluate the status of pain and analgesics beliefs in postoperative hospitalized patients,and provide a reference for the postoperative patient health education programs.Methods From September to December 2019,a convenient sampling method was used to collect 240 inpatients in the Affiliated Hospital of Qingdao University,inclusion criteria:age≥18 years,Han nationality,no religious beliefs,no consciousness disorder and no communication barriers,no chronic pain history,no mental abnormalities,non-parturient and non-cancer patients.Partially modified pain and opioid analgesics beliefs scale(POABS)developed by Lai Yuhe,a Chinese Taiwan scholar,was used to analyse the patients'belief of pain and analgesics.Results In 240 questionnaires,227 were valid(94.6%).The enrolled patients ranged in age from 21 to 73(45.1±17.4)years;111 males(48.9%)and 116 females(51.1%);primary school education and below 79 cases(34.8%),secondary school/technical secondary school education 65 cases(28.6%),college degree or above 83 cases(36.6%);194 cases married(85.5%),33 cases unmarried or divorced(14.5%).The scores of revised POABS was the same as the original scale,with two dimensions as pain tolerance and adverse effects of analgesics.The internal consistency reliability Cronbach'sαfor pain tolerance dimension,adverse effect dimension of analgesics,and the whole scale were 0.755,0.811,and 0.872,and the retest reliability were 0.798,0.813,and 0.884.The total score of the whole scale in 227 postoperative patients was(24.1±6.3),the pain tolerance dimension score was(12.2±3.4),and the analgesic adverse effect dimension score was(11.9±3.4).Each item on the scale tends to be negative.Univariate analysis results showed that in the pain tolerance dimension,patients with different education levels had statistically significant differences in the score of pain tolerance(F=3.049,P=0.049);in the dimension of analgesic adverse effects,patients with different maximum pain intensity of NRS at 24 h after surgery had statistically significant differences in the score of analgesic adverse effect dimension(F=3.353,P=0.037).Conclusion Postoperative patients have wrong beliefs about pain tolerance and adverse effects of analgesics,and medical staff should choose appropriate health education methods to help patients for establishment of correct pain beliefs and improve their quality of life.