轻中度阿尔茨海默病患者的慢性疼痛表现及影响因素分析

Analysis of chronic pain presentation and influencing factors in patients with mild to moderate Alzheimer's disease

目的调查轻中度阿尔茨海默病(AD)患者的疼痛现状,包括临床特征、干预情况,分析疼痛的影响因素。方法选择2019年1月至2021年6月在嘉兴市第二医院神经内科治疗的轻中度AD患者160例,采用词语描述量表评估患者有无合并疼痛,据此分为观察组93例和对照组67例。统计观察组因疼痛而就诊的就诊记录以及疼痛诊治方法。采用简易智力状态检查(MMSE)量表评估认知功能,采用中文版阿尔茨海默病生命质量(QOL-AD Chinese)量表评估生活质量,采用17项汉密尔顿抑郁量表(HAMD-17)评估抑郁,采用汉密尔顿焦虑量表(HAMA)评估焦虑,采用神经精神(NPI)量表评估对照料者影响情况。结果观察组女性、睡眠障碍比例高于对照组,差异有统计学意义(P<0.01)。观察组53例(57.0%)有疼痛就诊记录,疼痛诊治主要采用口服止痛药物、外用止痛膏药和中医理疗3种治疗形式。观察组QOL-AD评分低于对照组,HAMD-17、HAMA、NPI的行为学评分以及照料者痛苦度高于对照组,差异均有统计学意义(均P<0.05)。两组患者MMSE比较,差异无统计学意义(P>0.05)。女性、睡眠障碍、NPI行为学是患者发生疼痛的影响因素(均P<0.05)。结论轻中度AD患者的疼痛症状普遍,但诊治率较低,生活质量较差,女性AD患者有睡眠障碍及神经精神症状者更容易发生疼痛。

Objective To investigate the current status of pain in patients with mild to moderate Alzheimer's disease(AD),including clinical characteristics,interventions,and to analyze the factors influencing pain.Methods A total of 160 patients with mild to moderate AD treated at the Department of Neurology,Jiaxing Second Hospital from January 2019 to June 2021 were selected and assessed for the presence of comorbid pain using the verbal description scale(VDS),according to which they were divided into 93 cases in the observation group and 67 cases in the control group.The attendance records of the observation group for pain and the pain management methods were counted.The cognitive function was evaluated with mini-mental state examination(MMSE);the quality of life was evaluated with Chinese quality of life-Alzheimer’s disease(QOL-AD);the depression was evaluated with the 17-item Hamilton depression scale(HAMD-17);the anxiety was evaluated with the Hamilton anxiety scale(HAMA);and the neuropsychiatric inventory(NPI)was divided into behavioral scores and caregiver distress,respectively,to assess the impact on caregivers.Results The proportion of women and sleep disorders in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.01).In the observation group,53 cases(57.0%)had pain consultation records,and the pain consultation and treatment mainly used three forms of treatment:oral pain medication,topical pain relief cream and Chinese physiotherapy.The QOL-AD scores of the observation group were lower than those of the control group,and the behavioral scores of HAMD-17,HAMA,and NPI as well as the caregiver distress were higher than those of the control group,and the differences were statistically significant(all P<0.05).There were no significant differences in MMSE scores between the two groups(P>0.05).Female gender,sleep disturbance,and NPI behaviorology were risk factors for the development of pain in patients(all P<0.05).Conclusion Pain symptoms are common in patients with mild to moderate AD,but the consultation rate is low and the quality of life is poor;female patients and those with sleep disorders and neuropsychiatric symptoms are more likely to have pain symptoms.