糖尿病足溃疡患者疼痛状况的横断面调查及影响因素分析

A cross-sectional survey and analysis of the pain status and its influencing factors in diabetic foot ulcer patients

目的调查糖尿病足溃疡(DFU)患者的疼痛状况并分析其影响因素。方法采用单中心横断面调查研究方法。选择2021年5月—2022年2月收入解放军总医院第四医学中心且符合入选标准的DFU患者作为调查对象。应用简明疼痛量表评估患者疼痛程度中最重疼痛、最轻疼痛、平均疼痛、当前疼痛的得分和总得分及疼痛的相关影响中对日常生活、情绪、行走能力、日常工作、与他人关系、睡眠、生活兴趣的影响的得分及总得分。应用自行设计的一般资料调查问卷,调查患者性别、年龄、文化程度、体重指数、自理能力、糖尿病病程、创面Wagner分级、创面标本细菌培养结果,以及糖化血红蛋白、白蛋白、前白蛋白、血红蛋白水平和白细胞计数等资料。将患者按照一般资料分类,统计患者疼痛程度和疼痛的相关影响的总得分。对数据行Kruskal-Wallis检验、Mann-Whitney U检验。选取单因素分析中差异有统计学意义的指标进行广义线性模型分析,筛选DFU患者疼痛程度和疼痛的相关影响的独立危险因素。结果共发放调查问卷44份,收回有效问卷42份,有效回收率为95.45%。DFU患者的最重疼痛、最轻疼痛、平均疼痛、当前疼痛得分分别为5(0,10)、2(0,6)、3(0,8)、2(0,8)分,疼痛程度总得分为11(0,24)分;疼痛对患者日常生活、情绪、行走能力、日常工作、与他人关系、睡眠、生活兴趣的影响得分分别为4(0,10)、4(0,10)、5(0,10)、5(0,10)、3(0,10)、4(0,10)、4(0,10)分,疼痛的相关影响总得分为30(0,63)分。42例DFU患者以男性居多,年龄39~87(67±10)岁,大多数为初中学历,糖尿病病程20年以上者居多,半数患者创面Wagner分级为4级,大多数患者体重指数和白细胞计数在正常范围内,大多数患者自理能力存在部分依赖,绝大多数患者创面标本细菌培养结果为阳性,约半数患者白蛋白水平异常,大多数患者糖化血红蛋白、前白蛋白和血红蛋白水平异常。前述一般资料的单因素分析显示,不同血红蛋白水平、白细胞计数患者的疼痛程度总得分比较,差异均有统计学意义(Z值分别为-2.05、-2.55,P<0.05);不同血红蛋白水平、白细胞计数、创面标本细菌培养结果患者的疼痛的相关影响总得分比较,差异均有统计学意义(Z值分别为-2.66、-2.02、-2.12,P<0.05)。广义线性模型分析显示,白细胞计数是42例DFU患者疼痛程度和疼痛的相关影响的独立危险因素(95%置信区间分别为0.28~11.87、5.67~36.99,标准化回归系数分别为6.17、21.33,P值均<0.05),创面标本细菌培养结果是42例DFU患者疼痛的相关影响的独立危险因素(95%置信区间为2.92~39.09,标准化回归系数为21.00,P<0.05)。结论DFU患者常伴发疼痛,创面标本细菌培养结果和白细胞计数是DFU患者疼痛的主要影响因素。

Objective To investigate the pain status in diabetic foot ulcer(DFU)patients and analyze its influencing factors.Methods A single-center cross-sectional survey research method was used.From May 2021 to February 2022,DFU patients who were admitted to the Fourth Medical Center of PLA General Hospital and met the inclusion criteria were selected and investigated.The scores of the heaviest pain,the least pain,the average pain,and the current pain in pain degree and the total score and the scores of influence on patients'daily life,mood,walking ability,daily work,relationship with others,sleep,and life interest in pain-related effects and the total score of patients were evaluated by the brief pain inventory.A self-designed general data questionnaire was used to collect the data including patients'gender,age,education level,body mass index,self-care ability,diabetes course,wound Wagner grade,bacterial culture result of wound specimen,and the levels of glycated hemoglobin,albumin,prealbumin,hemoglobin,and leukocyte count.Patients were classified according to general data,and the total scores of pain degree and pain-related effects were counted.Data were statistically analyzed with Kruskal-Wallis test and Mann-Whitney U test.The indicators with statistically significant differences in univariate analysis were selected for generalized linear model analysis to screen the independent risk factors of pain severity and pain-related effects in DFU patients.Results A total of 44 questionnaires were sent out,and 42 valid questionnaires were collected,with effective recovery of 95.45%.The scores of the heaviest pain,the least pain,the average pain,and the current pain in DFU patients were 5(0,10),2(0,6),3(0,8),and 2(0,8),respectively,and the total score of the pain severity was 11(0,24);the scores of pain-related effects on patients'daily life,mood,walking ability,daily work,relationship with others,sleep,and life interest were 4(0,10),4(0,10),5(0,10),5(0,10),3(0,10),4(0,10),and 4(0,10),respectively,and the total score of pain-related effects was 30(0,63).In 42 DFU patients,most patients were male,aged 39-87(67±10)years,most patients had education level of junior high school,most patients had diabetes for more than 20 years,half of patients'wounds were Wagner grade 4,most patients had body mass index and leukocyte count within normal limits,most patients had partial dependence on self-care ability,the bacterial culture results of wound specimen in the vast majority of patients were positive,about half of the patients had abnormal level of albumin,and most patients had abnormal levels of glycosylated hemoglobin,prealbumin,and hemoglobin.Univariate analysis of the above general data showed that total scores of pain severity among patients with different hemoglobin levels and leukocyte counts were statistically significant different(with Z values of-2.05 and-2.55,respectively,P<0.05),and the total scores of pain-related effects on patients with different hemoglobin levels,leukocyte counts,and bacterial culture results of wound specimen were statistically significant different(with Z values of-2.66,-2.02,and-2.12,respectively,P<0.05).Generalized linear model analysis showed that leukocyte count was an independent risk factor for pain severity and pain-related effects in 42 DFU patients(with 95%confidence intervals of 0.28-11.87 and 5.67-36.99,respectively,standardized regression coefficient values of 6.17 and 21.33,respectively,both P values<0.05).The bacterial culture result of wound specimen was an independent risk factor for pain-related effects in 42 DFU patients(with 95%confidence interval of 2.92-39.09,standardized regression coefficient value of 21.00,P<0.05).Conclusions DFU patients often suffer pain,and the bacterial culture results of wound specimen and leukocyte count are the main factors affecting the pain of DFU patients.