本文選題：視覺模擬評分量表　切入點(diǎn)：電流感知閾值　出處：《山東大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：研究背景疼痛是臨床中十分常見的癥狀,它不僅會讓患者身體痛苦,還會影響患者心理狀況,損害機(jī)體的各項機(jī)能,對機(jī)體造成不良的影響,可以說,疼痛已經(jīng)成為危害人類健康的主要“殺手”之一,也是降低人們勞動能力,降低和減少出勤日最常見、最直接的因素之一。根據(jù)持續(xù)時間,疼痛可分為急性疼痛和慢性疼痛,其中慢性疼痛是疼痛診療的重要內(nèi)容,其持續(xù)時間長,病因和發(fā)病過程復(fù)雜,臨床表現(xiàn)多樣化,嚴(yán)重影響患者的生活質(zhì)量。在疼痛的診斷和治療過程中,對于疼痛的評估一直困擾著臨床工作者。傳統(tǒng)的測量和評估疼痛的方法包括詞語和數(shù)字的自我評定量表、行為觀察量表和生理學(xué)方法等,其中視覺模擬評分量表(VAS)和簡化的Mcgill疼痛問卷表(SF-Mcgill)是目前疼痛評估最常用的手段,正被廣泛用于臨床,另外,還有數(shù)字分級睡眠干擾評分法(NRSSIS)等,這些評估方式都有各自利弊,但這些傳統(tǒng)的量表均是患者對自身疼痛的一種主觀判斷,個體差異較大,且不能將疼痛程度進(jìn)行良好的量化測量。因此,我們需要一種客觀、量化的疼痛評估方法。疼痛定量測量儀PainVision是一種末梢神經(jīng)電刺激裝置,可以準(zhǔn)確、定時、反復(fù)刺激末梢神經(jīng),用于定量分析感覺和疼痛。目的本研究通過應(yīng)用疼痛定量測量儀PainVision對慢性疼痛患者治療前、癥狀明顯好轉(zhuǎn)時及出院時三個時間點(diǎn)的疼痛程度進(jìn)行評估,并和傳統(tǒng)的評價方法相比較,探討疼痛定量測量儀PainVision在疼痛評估中應(yīng)用的意義。同時,通過觀察正常人感覺閾值的變化,對于不同年齡段的正常人在不同部位感覺閾值的測量,探討了年齡和測量部位對感覺閾值的影響。方法研究分兩部分進(jìn)行:第一部分疼痛定量測量儀PainVsion在慢性疼痛治療中的應(yīng)用1.研究對象與分組:回顧性分析自2015年12月至2016年11月,在山東大學(xué)附屬濟(jì)南市中心醫(yī)院疼痛科住院治療的慢性疼痛患者106名,根據(jù)主要診斷分為以下5組:帶狀皰疹后神經(jīng)痛組(PHN組,n=33)、癌性疼痛組(CP組,n=22)、腰椎間盤突出癥組(PLID組,n=30)、復(fù)雜區(qū)域疼痛綜合征組(CRPS組,n=11)、神經(jīng)根型頸椎病組(CSR組,n=10)。2.測量指標(biāo):選擇入院時(TO)、疼痛程度明顯改善且VAS評分降至40mm以下時(T1)、出院時(T2)共3個時間點(diǎn)2.1 PHN組、CP組、PLID組、CRPS組和CSR組5組患者的持續(xù)性疼痛(PP):使用疼痛定量測定儀PainVision測量電流感知閾值(CPT)、疼痛等效電流(PEC),進(jìn)而計算疼痛度(PD-PP)、疼痛率(PR-PP);采用VAS評分法、SF-Mcgill量表、NRSSIS評分法評估疼痛程度;比較疼痛定量測定儀PainVision測量結(jié)果和VAS評分法、SF-Mcgill量表、NRSSIS評分法的相關(guān)性。2. 2 PHN組和CP組2組患者爆發(fā)痛(BTP):使用疼痛定量測定儀PainVision測量電流感知閾值(CPT)、疼痛度(PD-BTP);采用VAS評分法、SF-Mcgill量表、NRSSIS評分法評估疼痛程度;比較疼痛定量測定儀PainVision測量結(jié)果和VAS評分法、SF-Mcgill量表、NRSSIS評分法的相關(guān)性。第二部分疼痛定量測量儀PainVision用于正常人感覺閾值測定的研究1.研究對象與分組:選擇120名正常人,按照不同年齡段不同分為3組:Ⅰ組(18～40 歲,n=40); Ⅱ組:(41 ～60 歲,n=40); Ⅲ組:(61～80 歲,n=40)。2.測量指標(biāo):使用疼痛定量測量儀PainVision測量以下6個部位的CPT:左前臂(LMF)、右前臂(RMF)、左踝前(LFA)、左踝后(LBA)、右踝前(RFA)、右踝后(RBA)。結(jié)果第一部分疼痛定量測量儀PainVsion在慢性疼痛治療中的應(yīng)用1.1各組患者持續(xù)性疼痛PEC結(jié)果:與T0相比,PHN組、CP組、PLID組、CSR組4組在T1、T2時間點(diǎn)時,PEC值均降低,差異具有統(tǒng)計學(xué)意義(P0. 05);CRPS組PEC值T1時變化不明顯(P0.05),但T2時降低,差異具有統(tǒng)計學(xué)意義(P0.05)。與T1相比,CP組、PLID組和CSR組3組患者的PEC值在T2時降低,差異具有統(tǒng)計學(xué)意義(P0.05)。1.2各組患者PR-PP結(jié)果:與T0相比,PHN組、CP組、PLID組、CRPS組和CSR組5組T1、T2時間點(diǎn)PR-PP值均降低,差異具有統(tǒng)計學(xué)意義(P0.05)。與各組T1時間點(diǎn)相比較,CP組、CRPS組和CSR組3組PR-PP值在T2時降低,差異具有統(tǒng)計學(xué)意義,(P0.05)。1.3各組患者PD-PP結(jié)果:與T0相比,PHN組、CP組、PLID組、CSR組4組在T1和T2時間點(diǎn)PD-PP值均降低,差異具有統(tǒng)計學(xué)意義(P0.05); CRPS組在T2時降低,差異具有統(tǒng)計學(xué)意義(P0. 05)。與T1相比較,CP組、CRPS組、PLID組和CSR組4組患者T2時PD-PP值減少,差異具有統(tǒng)計學(xué)意義(P0.05)。1. 4 PHN組和CP組患者PD-BTP結(jié)果:與TO相比,PHN組和CP組PD-BTP值在T1和T2時均降低,差異具有統(tǒng)計學(xué)意義(P0.05)。與T1相比較,PHN組和CP組兩組患者在T2時的PD-BTP的值降低,差異具有統(tǒng)計學(xué)意義(P0. 05)。1.5疼痛度(PD)與VAS、SF-Mcgill和NRSSIS相關(guān)性比較與VAS評分相比,PHN組、PLID組、CRPS組和CSR組的持續(xù)性疼痛的疼痛度(PD-PP)與之存在相關(guān)(P0. 05),而CP組與之無相關(guān)性;PHN組和CP組的爆發(fā)痛的疼痛度(PD-BTP)與之存在相關(guān)性(P0.05)。與SF-Mcgill評分和NRSSIS評分相比,PHN組、CP組、PLID組、CRPS組和CSR組5組的PD-PP、PHN組和CP組的PD-BTP與之均不存在相關(guān)性(P0. 05)。第二部分疼痛定量測量儀PainVision用于正常人感覺閾值測定的研究1.CPT值組內(nèi)比較:Ⅰ組、Ⅱ組、Ⅲ組組內(nèi)比較,LMF和RMF均無明顯差異(P0.05);與LMF相比,LFA、LBA、RFA、RBA四個部位的CPT值明顯增高,差異具有統(tǒng)計學(xué)意義(P0. 05)。2. CPT值組間比較:與Ⅰ組相比,Ⅱ組和Ⅲ組的六個部位的CPT值均明顯增高,差異具有統(tǒng)計學(xué)意義(P0.05)。與Ⅱ組相比,Ⅲ組CPT值明顯增高,差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.疼痛定量測量儀PainVision能夠量化評價持續(xù)性疼痛和爆發(fā)痛,疼痛度能夠以量化的形式表達(dá)。2.疼痛定量測量儀PainVision測量出的慢性疼痛的持續(xù)性疼痛和爆發(fā)痛的疼痛度和視覺模擬評分量表具有正相關(guān)關(guān)系。3.疼痛定量測量儀PainVision能夠定量評價感覺閾值。4.不同年齡和不同測量部位,CPT的結(jié)果不同:隨著年齡的增長CPT逐漸增加,下肢CPT明顯高于上肢。前臂中點(diǎn)偏尺側(cè)是本研究中CPT測量中最敏感部位。
[Abstract]:Background pain is very common in clinical symptoms, it will not only help patients with physical pain, but also affect the psychological status of the patients, damage the function of the body, causing adverse effects on the body, it can be said that the pain has become a major hazard "killer" of human health is one of the people, reduce the labor ability, and reduce attendance on one of the most common, the most direct factor. According to the duration of pain can be divided into acute and chronic pain, chronic pain, which is an important part of diagnosis and treatment of pain, which lasted for a long time, the etiology and disease process is complex and diverse clinical manifestations, seriously affecting the quality of life of patients. In the diagnosis and treatment of pain and for the assessment of pain has been plagued by clinical workers. Methods of measurement and evaluation of the traditional pain include self rating scale of words and numbers, behavior observation scale and students Science methods, including visual analogue scale (VAS) and simplified Mcgill pain questionnaire (SF-Mcgill) is currently the most commonly used means of pain assessment, has been widely used in clinical, in addition, there are digital classification of sleep disturbance score method (NRSSIS), the evaluation method has its own advantages and disadvantages, but these the traditional scale is a kind of subjective judgment of the patients to their own pain, individual differences, and not pain quantitative measurement well. Therefore, we need an objective, quantitative pain assessment methods. The pain quantitative measurement instrument PainVision is a peripheral nerve stimulation device can accurately and timing. Repeated stimulation of nerve endings, for quantitative analysis of sensory and pain. The purpose of this study is through the application of quantitative measurement of PainVision in the treatment of pain in patients with chronic pain before, when the symptoms were improved and discharged at three time points. To assess the degree of pain, and compared with traditional evaluation methods, application of quantitative measuring instrument PainVision pain in pain assessment significance. At the same time, by observing the changes of normal human sensory threshold, for different age groups of normal people in different parts of the sensory threshold measurement, discusses the influence of age and measurement sites on the feeling the threshold method. The study is divided into two parts: the first part of the pain quantitative measurement instrument using PainVsion in treatment of chronic pain in 1. subjects and groups: retrospective analysis from December 2015 to November 2016, in patients with chronic pain pain, Ji'nan Central Hospital Affiliated to Shandong University hospital in 106, according to the diagnosis is mainly divided into the following 5 groups: postherpetic neuralgia group (group PHN, n=33), cancer pain group (group CP, n=22), lumbar disc herniation group (PLID group, n=30), complex regional pain syndrome group (CRP S緇，

本文編號：1626232