本文選題：腹部手術(shù) + 抑郁　； 參考：《山東大學(xué)》2015年碩士論文

【摘要】：目的：通過對腹部手術(shù)患者術(shù)前抑郁程度及術(shù)后疼痛程度的評(píng)估,分析手術(shù)患者術(shù)后疼痛程度與術(shù)前抑郁程度的變化趨勢和相關(guān)關(guān)系。方法：腹部手術(shù)患者術(shù)前采用抑郁自評(píng)量表(Self-rating depression scale, SDS)進(jìn)行抑郁評(píng)估,將患者分為抑郁組(60例)、對照組(20例)。兩組術(shù)后采用經(jīng)靜脈自控鎮(zhèn)痛(patient controlled intravenous analgesia, PCIA)。術(shù)后12、24、48小時(shí)分別對兩組患者進(jìn)行術(shù)后疼痛程度評(píng)估,評(píng)估方法為：視覺模擬量表評(píng)分(VAS)、簡化MeGill疼痛問卷(SF-MPQ)、患者自控鎮(zhèn)痛按壓次數(shù)。評(píng)價(jià)患者術(shù)前抑郁程度和術(shù)后疼痛程度的變化趨勢和相關(guān)性。結(jié)果：(1)抑郁組和對照組兩組患者一般資料(如性別構(gòu)成、年齡構(gòu)成、文化程度、婚姻狀況、職業(yè)及家庭收入等)比較,兩組差別無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)抑郁組和對照組兩組患者術(shù)前SDS評(píng)分的比較,對照組SDS評(píng)分為46.0+6.6,而抑郁組SDS評(píng)分為66.0+7.3,抑郁組明顯高于對照組(P0.01)；其中抑郁組中輕度患者24例,SDS評(píng)分59.0±6.3,中度患者23例,SDS評(píng)分62.0±7.3,重度患者13例,SDS評(píng)分73.0±7.7。(3)抑郁組和對照組兩組患者術(shù)后12、24小時(shí)VAS分值的比較,抑郁組分別為8.2±2.4、6.7±1.9,較對照組7.3±2.1和5.3±1.5明顯升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。而術(shù)后48小時(shí),兩組的VAS值(3.7±1.3和2.3±1.0)差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)術(shù)后12、24和48小時(shí)間不同時(shí)間點(diǎn)比較顯示,隨著術(shù)后時(shí)間的延長疼痛程度逐漸降低。(4)抑郁組和對照組兩組患者術(shù)后SF-MPQ分值的比較,抑郁組術(shù)后12、24小時(shí)SF-MPQ分值(10.44±3.7,8.9±2.9),較對照組7.3±2.2、6.9±1.5顯著升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)；而術(shù)后48小時(shí),兩組的SF-MPQ分值差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)比較提示,術(shù)后隨著時(shí)間的延長兩組SF-MPQ分值逐漸降低。(5)抑郁組和對照組兩組患者術(shù)后24小時(shí)內(nèi)PCIA泵的按壓次數(shù)的比較,抑郁組患者手術(shù)后24小時(shí)內(nèi)PCIA泵的按壓次數(shù)(15.4+3.4)明顯高于對照組的按壓次數(shù)(6.7+2.2),兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。(6)患者術(shù)后疼痛評(píng)分與術(shù)前抑郁程度的相關(guān)性分析發(fā)現(xiàn),手術(shù)后12小時(shí)、24小時(shí),患者術(shù)前抑郁程度越高,術(shù)后疼痛程度越高,抑郁程度和疼痛程度呈正相關(guān)(VAS:r=0.826,0.746,P=0.014,0.023;SF-MPQ:r=0.878,0.759,P=0.012, 0.019)。結(jié)論：手術(shù)患者術(shù)前抑郁程度會(huì)影響其術(shù)后的疼痛程度,術(shù)后疼痛評(píng)分與術(shù)前抑郁程度呈正相關(guān),即術(shù)前抑郁程度越高術(shù)后疼痛評(píng)分越高。
[Abstract]:Objective: to evaluate the degree of preoperative depression and postoperative pain in patients undergoing abdominal surgery, and to analyze the relationship between the degree of postoperative pain and the degree of preoperative depression. Methods: Self-rating depression scale, SDS) was used to evaluate depression in patients undergoing abdominal surgery. Patients were divided into depression group (n = 60) and control group (n = 20). Patient controlled intravenous analgesia, PCIA was used after operation in both groups. The degree of postoperative pain was evaluated by visual analogue scale (VAS), simplified MeGill pain questionnaire (SF-MPQ) and patient controlled analgesia (PCEA). To evaluate the trend and correlation of preoperative depression and postoperative pain. Results the general data (such as sex, age, education, marital status, occupation and family income) were compared between the depression group and the control group. There was no significant difference between the two groups (P0.05U. 2) the comparison of preoperative SDS score between the depression group and the control group, The SDS score of the control group was 46.06, while that of the depression group was 66.07.3, which was significantly higher in the depression group than that in the control group (P 0.01), in which 24 patients with mild depression had a SDS score of 59.0 鹵6.3, 23 patients with moderate depression had a SDS score of 62.0 鹵7.3, and 13 patients with severe depression had a SDS score of 73.0 鹵7.7.3). Comparison of VAS scores between the control group and the control group at 24 hours after operation. Compared with the control group (7.3 鹵2.1 and 5.3 鹵1.5), the depression group was significantly higher than that of the control group (8.2 鹵2.4 鹵6.7 鹵1.9). The difference was statistically significant (P 0.05). However, there was no significant difference in VAS between the two groups (3.7 鹵1.3,2.3 鹵1.0) at 48 hours postoperatively (P 0.05). The comparison of postoperative SF-MPQ scores between the depression group and the control group at different time points at 24 and 48 hours after operation showed that the pain degree decreased gradually with the prolongation of postoperative time, and the comparison between the depression group and the control group showed that there was no significant difference in postoperative SF-MPQ scores between the depression group and the control group. The SF-MPQ score of the depression group was 10.44 鹵3.7 鹵8.9 鹵2.9 at 24 hours postoperatively, which was significantly higher than that of the control group (7.3 鹵2.2 鹵6.9 鹵1.5), and the difference was statistically significant (P 0.01), but there was no significant difference in the SF-MPQ score between the two groups at 48 hours after operation (P 0.05). The comparison between the two groups showed that the scores of SF-MPQ in the two groups decreased gradually as the time went on. (5) the comparison of the times of PCIA pump pressing within 24 hours after operation between the depression group and the control group. The pressure times of PCIA pump in the depression group within 24 hours after operation were 15.4 3.4) significantly higher than that in the control group (6.7 2.2%). The difference between the two groups was statistically significant (P 0.01) and the correlation between the postoperative pain score and the degree of depression before operation was found. 12 hours after operation and 24 hours after operation, the degree of depression was higher before operation and the degree of postoperative pain was higher. There was a positive correlation between the degree of depression and the degree of pain. There was a positive correlation between the degree of depression and the degree of pain. Conclusion: the degree of preoperative depression will affect the degree of postoperative pain, and the postoperative pain score is positively correlated with the degree of preoperative depression, that is, the higher the degree of preoperative depression, the higher the postoperative pain score.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614

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