本文選題：關(guān)節(jié)炎 + 焦慮��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景膝關(guān)節(jié)炎癥中最常見的病因是骨性關(guān)節(jié)炎(OA),在老年人中最為常見。長(zhǎng)期的慢性疼痛及行動(dòng)功能障礙使得膝關(guān)節(jié)骨性關(guān)節(jié)炎患者的情感、認(rèn)知、生理多種功能受到影響,患者社會(huì)活動(dòng)受限,與外界溝通交流減少,晚期膝關(guān)節(jié)骨性關(guān)節(jié)炎患者常需要家人照料生活起居,加之醫(yī)療效果較差,患者常常出現(xiàn)情緒低落、焦慮、抑郁、自責(zé)等心理障礙。目前對(duì)于TKA來說,關(guān)節(jié)假體設(shè)計(jì)較前明顯提高,手術(shù)技術(shù)相當(dāng)成熟,并發(fā)癥的發(fā)生率較前明顯減少。然而在臨床工作中,有一部分患者TKA手術(shù)成功,X線檢查未見假體松動(dòng)或下肢力線不良情況,在其復(fù)診的過程中往往抱怨手術(shù)部位仍存在疼痛或者關(guān)節(jié)功能不能滿足其日常生活需要。在我國,由于人文醫(yī)學(xué)發(fā)展的限制,國內(nèi)大多臨床醫(yī)生較少關(guān)注患者心理因素對(duì)疾病的影響。目的觀察接受單側(cè)TKA手術(shù)的KOA患者術(shù)前心理因素對(duì)TKA術(shù)后疼痛和生活質(zhì)量的影響,為臨床工作提供一定的參考價(jià)值,進(jìn)一步完善TKA術(shù)后管理工作。方法選擇我院2015年1月到2016年1月間行單側(cè)全膝關(guān)節(jié)置換術(shù)(TKA)101例KOA患者,排除未完成隨訪患者9例,共觀察92例因KOA而接受單側(cè)TKA手術(shù)患者。患者同意進(jìn)入本研究并簽署知情同意書后,首先采用醫(yī)院焦慮抑郁量表(HADS)評(píng)估患者術(shù)前心理狀態(tài),22例患者HADS≥9分納入心理組;術(shù)前、術(shù)后7天、術(shù)后1月、術(shù)后6月采用視覺模擬評(píng)分法評(píng)分(VAS)評(píng)估患者疼痛;術(shù)前、術(shù)后1月、術(shù)后6月采用美國膝關(guān)節(jié)協(xié)會(huì)評(píng)分(KSS)評(píng)估患者膝關(guān)節(jié)功能;術(shù)前、術(shù)后6月采用36條簡(jiǎn)明健康問卷(SF-36)評(píng)估患者生活質(zhì)量。同時(shí)記錄患者年齡、病史、是否留守、體重指數(shù)(BMI)、術(shù)前血沉(ESR)、C-反應(yīng)蛋白(CRP)指標(biāo)。結(jié)果1、經(jīng)評(píng)估,術(shù)前HADS≥9分共有共有22例患者,其中男性5例,女性17例,納入心理組,剩余70例患者納入對(duì)照組;本研究共有留守老年人49例,其中術(shù)前HADS≥9分共20例患者。2、心理組和對(duì)照組患者在術(shù)前、術(shù)后7天、術(shù)后1月和術(shù)后6月經(jīng)VAS評(píng)分評(píng)估:心理組術(shù)前VAS評(píng)分6.50±0.28,對(duì)照組6.07±0.14,兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后7天、術(shù)后1月、術(shù)后6月心理組VAS評(píng)分分別為3.86±0.15、3.09±0.13、2.23±0.11,對(duì)照組分別為3.09±0.08、2.24±0.07、1.00±0.08,兩組術(shù)后隨訪差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);3、心理組和對(duì)照組KSS膝關(guān)節(jié)評(píng)分與膝功能評(píng)分對(duì)比:術(shù)前關(guān)節(jié)評(píng)分心理組為25.32±0.69,對(duì)照組25.60±0.51;功能評(píng)分心理組為42.05±1.50,對(duì)照組41.93±0.85差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。在術(shù)后1月和術(shù)后6月對(duì)比中,關(guān)節(jié)評(píng)分心理組分別為76.50±0.70、80.55±0.31,對(duì)照組分別為81.46±0.42、84.63±0.19;功能評(píng)分心理組分別為60.00±0.74、81.82±0.70,對(duì)照組分別為65.57±0.45、88.21±0.53,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);4、心理組和對(duì)照組SF-36評(píng)分對(duì)比:術(shù)前PHC中生理功能、軀體疼痛、總體健康、MHC中活力的差異無統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)前生理職能及心理健康內(nèi)容包括社會(huì)功能、情感職能、心理健康的對(duì)比具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后SF-36評(píng)分對(duì)比中,生理健康內(nèi)容和心理健康內(nèi)容的8個(gè)維度對(duì)比差異均具有統(tǒng)計(jì)學(xué)意義(P0.05);5、本研究中有53%(49/92)的患者為留守老年人口。在老年人口中,心理組(n=20)在術(shù)后7天、術(shù)后1月和術(shù)后6月VAS評(píng)分分別為3.50±0.19、2.60±0.23、1.75±0.22,對(duì)照組(n=29)分別為3.03±0.12、2.10±0.10、1.24±0.12,兩組相比差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1月、術(shù)后6月KSS膝關(guān)節(jié)評(píng)分心理組分別為77.95±0.59、80.50±0.30,對(duì)照組分別為81.34±0.58、84.66±0.29;膝功能評(píng)分心理組分別為61.75±1.16、81.75±0.75,對(duì)照組分別為64.83±0.63、89.14±0.90。兩組對(duì)比差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1、術(shù)前存在焦慮、抑郁的患者TKA術(shù)后疼痛的程度較重,膝關(guān)節(jié)功能的恢復(fù)較無心理疾病的患者差,生活質(zhì)量較差,在留守老年患者中更為突出。2、術(shù)前患者存在焦慮、抑郁預(yù)示著患者特別是留守老年人術(shù)后較差的膝關(guān)節(jié)功能和生活質(zhì)量,且術(shù)后疼痛癥狀的緩解達(dá)不到患者期望值。
[Abstract]:Background: the most common cause of inflammation of the knee joint is osteoarthritis (OA), which is the most common in the elderly. Chronic pain and dysfunction of the knee are affected by the emotional, cognitive, physiological functions of the patients with osteoarthritis of the knee and the limited communication and communication with the outside world, and the late knee joint osteoarthritis. The patient often needs family care to live and live, and the medical effect is poor. Patients often have mental disorders such as depression, anxiety, depression and self blame. For TKA, the design of joint prosthesis is obviously improved, the surgical technique is quite mature and the incidence of complications is significantly reduced. However, there are some patients in clinical work. TKA was successful in operation. X-ray examination showed no prosthesis loosening or poor lower extremity force line. In the process of re diagnosis, it was often complained that there was still pain in the surgical site or the joint function could not meet the needs of daily life. In our country, most clinicians in China are less concerned about the psychological factors of the patients because of the limitations of the development of humanities. Objective To observe the effect of preoperative psychological factors on the pain and quality of life of KOA patients undergoing unilateral TKA surgery, to provide some reference value for clinical work, and to further improve the management of TKA after operation. Methods 101 cases of KOA patients were selected from January 2015 to January 2016 in our hospital, and 101 cases of KOA patients were excluded. 9 cases of uncompleted follow-up patients were observed and 92 patients received unilateral TKA surgery for KOA. The patients agreed to enter this study and signed informed consent. First, the hospital anxiety and Depression Scale (HADS) was used to evaluate the psychological state of the patients before operation, and 22 patients were included in the psychological group with HADS or more than 9 points. Before operation, 7 days after operation, January, and June after the operation, visual models were used. The score (VAS) was used to evaluate the pain of patients. Preoperative, January, and June after the operation, the American Knee association score (KSS) was used to evaluate the patients' knee joint function. Before operation, 36 simple health questionnaire (SF-36) was used to evaluate the quality of life in June, and the patient's age, medical history, body mass index (BMI), preoperative ESR (ESR), C- were recorded. Reactivity protein (CRP) index. Results 1, there were 22 patients with HADS > 9 scores before operation, including 5 males and 17 females, and 70 patients were included in the control group. There were 49 left behind elderly patients in this study. There were 20 patients with HADS more than 9 before operation and.2, 7 days after operation, 7 days after operation, and January after operation. The VAS score of 6 menstruation after operation was evaluated: the VAS score of the psychological group was 6.50 + 0.28 before operation, and the control group was 6.07 + 0.14. The difference between the two groups was not statistically significant (P0.05). The VAS score of the psychological group was 3.86 + 0.15,3.09 + 0.11 + 0.11 after the operation on 7 days after the operation, and the control group was 3.09 + 0.08,2.24 + 0.07,1.00 + 0.08 respectively in the control group, and the follow-up differences were all in the two groups after the operation. Statistical significance (P0.05); 3, the comparison between the psychological group and the control group KSS knee score and the knee function score: the preoperative joint score was 25.32 + 0.69, the control group was 25.60 + 0.51, the functional score was 42.05 + 1.50 and the control group was 41.93 + 0.85 (P0.05). In the January and postoperative June post operation comparison, the joint score psychology The group was 76.50 + 0.70,80.55 + 0.31 respectively, the control group was 81.46 + 0.42,84.63 + 0.19, the functional score group was 60 + 0.74,81.82 + 0.70, the control group was 65.57 + 0.45,88.21 + 0.53 respectively, the difference was statistically significant (P0.05); 4, the psychological group and the control group were compared with the SF-36 score: the physiological function, somatic pain, the total in PHC before the operation. There was no significant difference in the difference of vitality in MHC (P0.05). The pre operation physiological function and mental health content included social function, emotional function and psychological health (P0.05). The comparison of the 8 dimensions of physical health content and mental health content were statistically significant (P0.05) in the comparison of the SF-36 score after the operation (P0.05); 5 In this study, 53% (49/92) of the patients were left behind the elderly. In the elderly population, the psychological group (n=20) was 3.50 + 0.19,2.60 + 0.23,1.75 + 0.22 after operation in January and June after operation, and the control group (n=29) was 3.03 + 0.12,2.10 + 0.10,1.24 + 0.12 respectively. The difference between the two groups was statistically significant (P0.05). In January, the group was statistically significant (P0.05). The psychological group of KSS knee joint score in June was 77.95 + 0.59,80.50 + 0.30, the control group was 81.34 + 0.58,84.66 + 0.29, and the psychological group of the knee function score was 61.75 + 1.16,81.75 + 0.75 respectively. The contrast group was 64.83 + 0.63,89.14 0.90. two, respectively, the difference was statistically significant (P0.05). Conclusion 1. There was anxiety and depression before operation. After TKA, the degree of pain was heavier, the recovery of knee function was worse than those without mental illness, poor quality of life, more prominent.2 in the elderly patients left behind, anxiety in the patients before operation, and depression in the patients, especially the poor knee function and quality of life after the operation, and the relief of postoperative pain symptoms was reached. No expected value of the patient.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.4

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本文編號(hào)：2060758