本文選題：性疼痛 + 焦慮�。� 參考：《中國人民解放軍醫(yī)學(xué)院》2013年碩士論文

【摘要】：第一部分慢性疼痛患者焦慮、抑郁和睡眠質(zhì)量的研究 目的：了解慢性疼痛患者焦慮、抑郁水平及睡眠質(zhì)量狀況，探討其相關(guān)因素。方法：隨機(jī)抽取2012年8月至12月于我院疼痛科門診就診的慢性疼痛患者308例，評估工具采用簡式McGill疼痛問卷（SF-MPQ）、綜合醫(yī)院焦慮抑郁量表（HAD）和匹茨堡睡眠質(zhì)量指數(shù)（PSQI）。所有數(shù)據(jù)錄入EXCEL，采用SPSS17.0軟件進(jìn)行統(tǒng)計分析。結(jié)果：回收有效問卷301例（有效率97.93%）。其中共檢出伴有焦慮癥狀患者106例（占35.22%），檢出伴有抑郁癥狀患者83例（占27.57%），同時伴有焦慮抑郁癥狀患者57例（占18.94%），檢出睡眠質(zhì)量差患者137例（占45.51%）；單因素分析發(fā)現(xiàn)：患者焦慮、抑郁水平與性別、年齡、文化程度、職業(yè)、婚姻狀況和疼痛持續(xù)時間無關(guān)（p＞0.05），而與疼痛強(qiáng)度（p＜0.01）、疼痛部位的數(shù)目（p＜0.05）、感覺項(xiàng)計數(shù)（p＜0.01）和情感項(xiàng)計數(shù)（p＜0.01）有關(guān)；多因素回歸分析發(fā)現(xiàn)：慢性疼痛患者焦慮、抑郁水平與其疼痛強(qiáng)度（p＜0.05）和情感項(xiàng)計數(shù)相關(guān)有關(guān)(p＜0.001)；患者睡眠質(zhì)量(PSQI)主要與疼痛強(qiáng)度（p＜0.01）及是否伴有焦慮有關(guān)（p＜0.001）。結(jié)論：慢性疼痛患者焦慮、抑郁患病率較高，睡眠質(zhì)量較差，，與疼痛特征有關(guān)。 第二部分對慢性疼痛患者注意偏向的事件相關(guān)電位研究 目的:探討慢性疼痛患者對痛覺相關(guān)信息是否存在注意偏向及其機(jī)制。方法:采用E-prime2.0程序編寫情緒Stroop范式，記錄并比較慢性疼痛患者16例（實(shí)驗(yàn)組）及健康志愿者16例（對照組）對3類詞匯（包括中性、痛覺、威脅）顏色命名的反應(yīng)時及正確率，同時記錄其32通道的ERP。結(jié)果:慢性疼痛患者對痛覺相關(guān)詞匯、威脅性詞匯的顏色命名反應(yīng)時均長于中性詞匯；健康對照組威脅相關(guān)詞匯反應(yīng)時長于中性詞匯。威脅性詞匯在兩組被試各腦區(qū)誘發(fā)P200幅值顯著高于中性詞匯；慢性疼痛患者疼痛相關(guān)詞匯誘發(fā)P300幅值顯著高于中性詞匯。 結(jié)論:慢性疼痛患者存在對痛覺相關(guān)信息的注意偏向，其產(chǎn)生機(jī)制可能與情緒控制加工有關(guān)；兩組對威脅性信息均存在注意偏向可能與情緒的自動加工有關(guān)。 第三部分慢性疼痛患者生活質(zhì)量及其相關(guān)因素研究 目的：了解慢性疼痛患者的生活質(zhì)量狀況，并探討其影響因素。方法：隨機(jī)抽取就診于我院疼痛科門診301例患者為研究對象，研究工具采用生活質(zhì)量指數(shù)問卷（QL-Index）測量慢性疼痛患者生活質(zhì)量狀況。統(tǒng)計分析采用t檢驗(yàn)、單因素方差分析、Pearson相關(guān)分析、多元線性逐步回歸分析等方法探討慢性疼痛患者生活質(zhì)量與疼痛、焦慮、抑郁及其睡眠質(zhì)量的關(guān)系。結(jié)果：①不伴焦慮的慢性疼痛患者生活質(zhì)量顯著高于伴焦慮者(p＜0.001)；不伴抑郁的慢性疼痛患者生活質(zhì)量顯著高于伴抑郁者(p＜0.001)；無失眠者的生活質(zhì)量顯著高于失眠者(p＜0.001)；②重度疼痛患者生活質(zhì)量指數(shù)總分顯著低于輕度、中度組(p＜0.001)；感覺項(xiàng)數(shù)目不同患者生活質(zhì)量有顯著差異(p＜0.01)；情感項(xiàng)數(shù)目不同患者生活質(zhì)量有顯著差異(p＜0.001)；③慢性疼痛患者生活質(zhì)量總分與SF-MPQ總分、感覺項(xiàng)總分、情感項(xiàng)總分、VAS評分、PPI、感覺項(xiàng)計數(shù)、情感項(xiàng)計數(shù)、焦慮評分、抑郁評分和PSQI評分均呈顯著負(fù)相關(guān)(r=-0.195-0.433,p＜0.01)；④多元線性逐步回歸分析模型可解釋慢性疼痛患者生活質(zhì)量指數(shù)改變的49.1%，自變量情感項(xiàng)總分、抑郁、VAS評分對患者生活質(zhì)量改變有影響，尤其以情感項(xiàng)總分對患者生活質(zhì)量的影響最為顯著。結(jié)論：焦慮、抑郁、失眠、疼痛特征（疼痛程度、感覺項(xiàng)計數(shù)、情感項(xiàng)計數(shù)）對慢性疼痛患者的生活質(zhì)量有影響，尤其以情感項(xiàng)總分、抑郁及VAS評分對患者生活質(zhì)量的影響最為顯著。 第四部分：結(jié)構(gòu)式放松訓(xùn)練對慢性疼痛患者焦慮、抑郁和睡眠質(zhì)量的干預(yù)研究 目的：探討放松訓(xùn)練對緩解慢性疼痛患者焦慮、抑郁水平及改善睡眠質(zhì)量的作用；方法：選取我院疼痛科住院慢性疼痛患者70例，隨機(jī)分為干預(yù)組和對照組（各35例），干預(yù)組33例和對照組30例完成實(shí)驗(yàn)觀察。對照組患者接受疼痛科常規(guī)治療和護(hù)理，干預(yù)組患者在常規(guī)治療和護(hù)理的同時接受放松訓(xùn)練。結(jié)果：兩組患者干預(yù)1周后焦慮、抑郁和睡眠質(zhì)量評分均有所下降,并且干預(yù)組的焦慮、抑郁和睡眠質(zhì)量評分低于對照組。經(jīng)重復(fù)測量方差分析結(jié)果顯示,不同測量時間的焦慮、抑郁和睡眠質(zhì)量評分差異均有統(tǒng)計學(xué)意義(P0.01)。干預(yù)組經(jīng)干預(yù)2周、4周后焦慮、抑郁和睡眠質(zhì)量評分隨時間變化呈下降趨勢（p＜0.01），對照組經(jīng)干預(yù)2周、4周后焦慮、抑郁和睡眠質(zhì)量評分無明顯改變（p＞0.05）。 結(jié)論：放松訓(xùn)練對緩解慢性疼痛患者焦慮抑郁水平，改善其睡眠質(zhì)量有效。
[Abstract]:Part one research on anxiety, depression and sleep quality of patients with chronic pain
Objective: to understand the anxiety, depression and quality of sleep in patients with chronic pain, and to explore the related factors. Methods: 308 patients with chronic pain were randomly selected from August 2012 to December in the clinic of pain department of our hospital. The assessment tools used the simplified McGill pain questionnaire (SF-MPQ), the comprehensive hospital anxiety and Depression Scale (HAD) and Pittsburgh sleep. Mass index (PSQI). All data were recorded in EXCEL, and SPSS17.0 software was used for statistical analysis. Results: 301 cases of effective questionnaires were recovered (97.93%). Among them, 106 cases (35.22%) accompanied with anxiety symptoms were detected, 83 cases (27.57%) with depressive symptoms were detected, and 57 patients (18.94%) with anxiety and depressive symptoms were detected, and sleep was detected. There were 137 patients with poor quality of sleep (45.51%), and single factor analysis found that anxiety, depression level was not related to sex, age, education, occupation, marital status and duration of pain (P > 0.05), but with the intensity of pain (P < 0.01), the number of pain sites (P < 0.05), sensory count (P < 0.01) and emotional count (P < 0.01). Multiple regression analysis showed that the anxiety, depression level of the patients with chronic pain was related to the intensity of pain (P < 0.05) and the count of emotional items (P < 0.001); the quality of sleep (PSQI) was mainly related to the intensity of pain (P < 0.01) and anxiety (P < 0.001). Conclusion: the anxiety of chronic pain patients, the high incidence of depression, and sleep quality The poor quantity is related to the characteristics of pain.
The second part is an event related potential study on attentional bias in patients with chronic pain.
Objective: To investigate whether there is attention bias and mechanism of pain related information in patients with chronic pain. Methods: the E-prime2.0 program was used to write the emotional Stroop paradigm, and to record and compare 16 cases of chronic pain (experimental group) and 16 healthy volunteers (control group), the reaction and positive of the 3 categories of words (including neutral, pain, threat) color naming. At the same time, the ERP. results of the 32 channels were recorded. The color naming reaction of the patients with chronic pain was longer than that in the neutral vocabulary while the color naming reaction of the threatened vocabulary was longer than that of the neutral vocabulary. The healthy control group threatened the related lexical response longer than the neutral vocabulary. The P200 amplitude in each brain area of the subjects was significantly higher than the neutral vocabulary; the chronic pain was chronic pain. The amplitude of P300 evoked by pain related words in pain patients was significantly higher than that in neutral words.
Conclusion: Patients with chronic pain have attention bias to pain related information, and their mechanism may be related to emotional control processing; the two groups of threatening information may be related to the automatic processing of emotion.
The third part is the quality of life and its related factors in patients with chronic pain.
Objective: to understand the quality of life of patients with chronic pain and to explore its influencing factors. Methods: 301 patients in the clinic of pain department of our hospital were selected randomly. The quality of life of patients with chronic pain was measured by means of quality of life questionnaire (QL-Index). The statistical analysis was made by t test and single factor variance. The relationship between quality of life and pain, anxiety, depression and sleep quality in patients with chronic pain was analyzed by Pearson correlation analysis and multiple linear stepwise regression analysis. Results: (1) the quality of life of patients with chronic pain without anxiety was significantly higher than those with anxiety (P < 0.001); the quality of life of patients with chronic pain without depression was significantly higher. In patients with depression (P < 0.001), the quality of life of those without insomnia was significantly higher than those of insomnia (P < 0.001). The total score of quality of life index of patients with severe pain was significantly lower than that of mild, moderate group (P < 0.001), and the quality of life of patients with different sensory items was significantly different (P < 0.01), and the quality of life of patients with different emotional terms was significantly different. (P < 0.001); (3) the total score of life quality and total score of SF-MPQ, total score of sensory items, total score of emotion, VAS score, PPI, feeling item count, emotional item count, anxiety score, depression score and PSQI score were all significantly negative correlation (r=-0.195-0.433, P < 0.01); (4) multivariate linear stepwise regression analysis model could explain chronic pain. The changes in the quality of life index were 49.1%, the total score of affective variables, depression and VAS score had an influence on the quality of life of the patients, especially the effect of the total score of emotion on the quality of life of the patients. Conclusion: anxiety, depression, insomnia, and pain characteristics (pain degree, feeling item count, emotional item count) on the life of patients with chronic pain Quality is influential, especially the total score of emotion. Depression and VAS score have the most significant effect on patients' quality of life.
The fourth part: intervention study of structural relaxation training on anxiety, depression and sleep quality of patients with chronic pain.
Objective: To explore the effect of relaxation training on anxiety, depression and improvement of sleep quality in patients with chronic pain. Methods: 70 patients with chronic pain in hospital pain department were randomly divided into intervention group and control group (35 cases each), 33 cases in the intervention group and 30 cases in the control group. The control group received the routine treatment of pain department. Results: the anxiety, depression and sleep quality score of the two groups were decreased after 1 weeks of intervention, and the anxiety, depression and sleep quality score of the intervention group were lower than those in the control group. The results of repeated measurements of variance analysis showed that the anxiety of different time of measurement was different. The differences in depression and sleep quality score were statistically significant (P0.01). After intervention for 2 weeks, the anxiety, depression and sleep quality score decreased with time (P < 0.01) after intervention (P < 0.01). The control group had 2 weeks of intervention and no significant changes in anxiety, depression and sleep quality score after 4 weeks (P > 0.05).
Conclusion: relaxation training is effective in relieving anxiety and depression level and improving sleep quality in patients with chronic pain.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.4

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