【摘要】：目的：本研究以疼痛患者為研究對象，揭示傳統(tǒng)測驗理論、單維項目反應理論與多維項目反應理論評估其心理障礙的異同，，探討項目反應理論在臨床心理評估中應用的可能性，分析影響疼痛患者心理障礙程度的因素，為構建疼痛管理系統(tǒng)，指導臨床實踐提供依據(jù)。 方法：本研究通過多中心合作，抽取北京、西安、重慶、蘭州等地10家醫(yī)療機構就診的具有疼痛癥狀的患者進行問卷調查。采用醫(yī)院焦慮抑郁量表（HAD）、患病行為問卷（IBQ）評估患者的心理障礙，應用視覺模擬評分法（VAS）、疼痛強度簡易描述量表（VRS）和簡化的麥-吉疼痛問卷（SF-MPQ）評估患者的疼痛程度，并對患者的性別、居住環(huán)境、所患疾病種類等一般因素進行了調查。應用因素分析等方法探討了HAD、IBQ的結構，應用內部一致性系數(shù)評估了信度，進而利用單維IRT模型（GRM和2PL）和多維IRT模型（Bi-factor模型）對其條目和測驗的信息量等進行了分析，并對不同的分析方法進行了對比。同時，也初步評估了三種疼痛程度測量工具的實用性。在此基礎上，我們進一步應用相關分析及多元方差分析，探討了疼痛程度及其他一般因素對于患者心理障礙程度的影響，為臨床診療過程提供參考。 結果： 1. HAD和IBQ各維度的單維性都不太理想，對比CTT、單維IRT和Bi-factor模型的分析結果，我們發(fā)現(xiàn)Bi-factor模型更適合這兩個量表的結構和條目特征，心理測量學指標也更理想； 2.應用Bi-factor模型進行分析，患者心理癥狀之間的關系更為清晰，而且癥狀的獨特特點也得以體現(xiàn)； 3.對于患者疼痛程度的評估VAS量表應用性更好，而SF-MPQ則在患者疼痛性質等方面可以提供更全面的信息； 4.與男性疼痛患者相比，女性疼痛患者情緒的抑制狀態(tài)更為明顯； 5.與居住在城市的疼痛患者相比，居住在鄉(xiāng)鎮(zhèn)或縣城的疼痛患者情緒的主動狀態(tài)更為明顯，而且不恰當?shù)幕疾⌒袨楦鼮槊黠@； 6.在疼痛患者當中，居住在城市的女性癌癥患者和居住在鄉(xiāng)鎮(zhèn)或縣城的女性急性疼痛患者心理障礙程度更為嚴重，診療過程中需要耐心溝通。 結論：IRT可以應用于臨床心理癥狀的評估；多維特征明顯的臨床量表采用多維模型分析效果更好；疼痛患者的心理障礙程度與疼痛程度密切相關；性別、居住環(huán)境和疾病種類在一定程度上影響患者的心理障礙程度。但由于時間和精力有限，本研究僅對疼痛管理綜合系統(tǒng)進行了初步構建，對其它臨床心理評估的適用性還需進一步的論證。
[Abstract]:Objective: to explore the similarities and differences of traditional test theory, single dimensional item response theory and multidimensional item response theory in evaluating psychological disorders in patients with pain, and to explore the possibility of applying item response theory in clinical psychological evaluation. To analyze the factors that affect the degree of psychological disorder of pain patients, and to provide basis for the construction of pain management system and the guidance of clinical practice. Methods: the patients with pain symptoms in 10 medical institutions in Beijing, Xi'an, Chongqing and Lanzhou were investigated by multi-center cooperation. The mental disorders of patients were assessed by (HAD), (Hospital anxiety and Depression scale), (IBQ), (VAS), pain intensity simple description scale (VRS) and simplified Mai Ji pain questionnaire (SF-MPQ), which were used to evaluate the degree of pain of the patients. The general factors such as sex, living environment and kinds of diseases were investigated. The structure of HAD-IBQ is discussed by means of factor analysis, the reliability is evaluated by internal consistency coefficient, and the information content of items and tests is analyzed by using GRM and 2PL model and Bi-factor model. Different analysis methods are compared. At the same time, the practicability of three pain measurement tools was also preliminarily evaluated. On this basis, we further applied correlation analysis and multivariate analysis of variance to explore the influence of pain and other general factors on the degree of psychological disorders of patients, and to provide reference for clinical diagnosis and treatment. Results: 1. Compared with the results of CTT, IRT and Bi-factor models, we found that the Bi-factor model is more suitable for the structure and item characteristics of the two scales, and the psychometrics index is also more ideal. 2. Using Bi-factor model, the relationship between psychological symptoms of patients is more clear, and the unique characteristics of symptoms can be reflected; 3. The evaluation of pain degree of patients using VAS scale is better, while SF-MPQ can provide more comprehensive information on the nature of patients pain. 4. Compared with male pain patients, female pain patients' emotional inhibition was more obvious; 5. 5%. Compared with the pain patients living in the city, the pain patients living in towns or counties have more active emotional state, and the inappropriate disease behavior is more obvious. 6. Among the patients with pain, the psychological disorders of female cancer patients living in cities and women living in towns or counties are more serious, and patient communication is needed in the diagnosis and treatment process. Conclusion the weight IRT can be used to evaluate the clinical psychological symptoms, the multi-dimensional clinical scale with obvious characteristics is more effective, the degree of psychological disorders of pain patients is closely related to the degree of pain, gender, The living environment and the type of disease affect the degree of psychological disorder to some extent. However, due to limited time and energy, this study only preliminarily constructed the pain management system, and the applicability of other clinical psychological evaluation needs further demonstration.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：博士
【學位授予年份】：2012
【分類號】：B841;R395

【引證文獻】

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1 劉莉;譚秦東;郭春華;;右美托咪定對下腹部手術全麻患者蘇醒期影響[J];解放軍醫(yī)藥雜志;2015年02期

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