疼痛管理干预在三叉神经痛患者治疗期间的应用

Application of pain management intervention in patients with trigeminal neuralgia during treatment

目的探讨基于慢性疼痛综合评估结果为基础的疼痛管理干预在三叉神经痛患者治疗期间的应用价值。方法选取2022年10月至2023年4月郑州大学第一附属医疼痛科住院治疗的80例三叉神经痛患者作为研究对象,按随机数表法分为对照组和观察组各40例。对照组患者采用常规护理干预方案,观察组患者采用常规护理+以慢性疼痛综合评估结果为基础的疼痛管理干预方案。两组患者均护理至出院,出院后均随访12个月。随访12个月后,比较两组患者干预前和随访1个月、3个月、6个月、12个月时的数字评分量表(NRS)评分及匹兹堡睡眠质量指数(PSQI)评分,并分析两组患者NPS评分和PSQI评分时间因素及时间因素与组间的交互作用;随访3个月后,比较两组患者干预前及随访3个月时的综合性医院焦虑抑郁量表(HADS)评分[包含焦虑分量表(HADS-a)和抑郁分量表(HADS-d)]和社会支持评定量表(SSRS)评分;随访12个月后,比较两组患者干预前及随访12个月时的三叉神经痛生活质量量表评分。结果重复测量数据方差分析显示,两组患者NPS评分和PSQI评分时间因素及时间因素与组间的交互作用比较差异均有统计学意义(P<0.05),两组患者NPS评分、PSQI评分随着时间变化呈下降趋势,且时间因素的作用随着分组的不同而不同;随访1个月、3个月、6个月、12个月时,两组患者的NRS、PSQI评分较干预前均显著降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05);干预前,两组患者的HADS评分比较差异无统计学意义(P>0.05),随访3个月后,观察组患者HADS评分中的HADS-a和HADS-d评分分别为(8.68±1.29)分、(6.59±1.72)分,明显低于对照组的(10.54±2.17)分、(7.96±2.24)分,差异均有统计学意义(P<0.05);干预前,两组患者的SSRS评分比较差异无统计学意义(P>0.05),随访3个月后,观察组患者SSRS评分中的客观支持、主观支持、对社会支持利用度评分分别为(11.78±2.39)分、(21.64±3.69)分、(9.71±1.82)分,明显高于对照组的(10.55±2.64)分、(20.06±3.16)分、(8.86±1.67)分,差异均有统计学意义(P<0.05);干预前,两组患者的三叉神经痛生活质量量表评分比较差异无统计学意义(P>0.05),随访12个月后,三叉神经痛生活质量量表评分中的疾病症状、躯体症状、心理功能、社会功能评分分别为(12.81±3.27)分、(24.54±4.34)分、(10.69±4.26)分、(16.91±2.17)分,明显低于对照组的(14.36±3.07)分、(26.49±4.11)分、(12.74±4.62)分、(18.01±2.32)分,差异均有统计学意义(P<0.05)。结论基于慢性疼痛综合评估结果为基础的疼痛管理干预措施可有效缓解三叉神经痛患者的远期疼痛,提高其睡眠质量,并通过改善患者心理状态,提升患者社会支持程度,进而促进患者预后生活质量提高。

Objective To explore the application value of pain management intervention based on the comprehensive evaluation results of chronic pain in patients with trigeminal neuralgia during treatment.Methods Eighty patients with trigeminal neuralgia hospitalized in the Department of Pain,the First Affiliated Hospital of Zhengzhou University from October 2022 to April 2023 were selected and divided into a control group and an observation group according to random number table,with 40 patients in each group.The control group adopted routine nursing intervention scheme,while the observation group adopted pain management intervention scheme based on the comprehensive evaluation results of chronic pain plus routine nursing.Both groups of patients were cared until discharge and followed up for 12 months after discharge.After 12 months of follow-up,the scores of Numeric Rating Scale(NRS)and Pittsburgh Sleep Quality Index(PSQI)were compared between the two groups before intervention and after 1 month,3 months,6 months,and 12 months of follow-up.The time factors of the NPS score and PSQI score of the two groups and interaction between the factors and grouping.After 3 months of follow-up,the Hospital Anxiety and Depression Scale[HADS,including Anxiety Scale(HADS-a)and Depression Scale(HADS-d)]and Social Support Rating Scale(SSRS)were compared between the two groups before intervention and after 3 months of follow-up.After 12 months of follow-up,the quality of life scale of trigeminal neuralgia before intervention and after 12 months of follow-up were compared between the two groups.Results Analysis of variance of repeated measurement data showed that there were significant differences in NPS score,PSQI score,time factor,and the interaction between time factor and grouping(P<0.05);the NPS score and PSQI score of the two groups showed a downward trend with the change of time,and the role of time factor was different with different grouping;after 1 month,3 months,6 months,and 12 months of follow-up,the scores of NRS and PSQI in the two groups were significantly lower than those before intervention,and the differences in the observation group were significantly lower than those in the control group(P<0.05).Before the intervention,there was no significant difference in the HADS scores between the two groups(P>0.05);after 3 months of follow-up,the HAD-a and HAD-d scores in the observation group were(8.68±1.29)points and(6.59±1.72)points,which were significantly lower than(10.54±2.17)points and(7.96±2.24)points those in the control group(P<0.05).Before intervention,there was no statistically significant difference in SSRS scores between the two groups(P>0.05);after 3 months of follow-up,the scores of objective support,subjective support,and utilization of social support in the SSRS scores of the observation group were(11.78±2.39)points,(21.64±3.69)points,and(9.71±1.82)points,which were significantly higher than(10.55±2.64)points,(20.06±3.16)points,(8.86±1.67)points in the control group(P<0.05).Before intervention,there was no significant difference in the scores of Quality of Life Scale for trigeminal neuralgia between the two groups(P>0.05);after 12 months of follow-up,the scores of disease symptoms,physical symptoms,psychological function,and social function in the scale in the observation group were(12.81±3.27)points,(24.54±4.34)points,(10.69±4.26)points,and(16.91±2.17)points,which were significantly lower than(14.36±3.07)points,(26.49±4.11)points,(12.74±4.62)points,(18.01±2.32)points in the control group(P<0.05).Conclusion Pain management intervention based on the comprehensive evaluation results of chronic pain can effectively relieve long-term pain in patients with trigeminal neuralgia,improve the sleep quality,improve the social support by improving their psychological state,and thus promote the improvement of patients'prognosis and quality of life.