【摘要】：研究目的: 描述阻塞性睡眠呼吸暫停低通氣綜合癥(OSAHS)患兒知覺教養(yǎng)方式、氣質(zhì)、術(shù)后疼痛強(qiáng)度特征;分析兒童術(shù)后疼痛強(qiáng)度與上述其它三種因素的關(guān)系,篩選兒童術(shù)后疼痛強(qiáng)度的影響因素;探討兒童術(shù)后疼痛強(qiáng)度的預(yù)測因素,建立預(yù)測方程。 研究方法: 采用橫斷面研究設(shè)計(jì),應(yīng)用目的抽樣方法,調(diào)查了廣州市某兒童醫(yī)療機(jī)構(gòu)的220例OSAHS患兒及其父母。采用兒童知覺教養(yǎng)方式問卷、中國3-7歲兒童氣質(zhì)量表、Wong-Baker面部表情疼痛量表分別調(diào)查OSAHS患兒知覺教養(yǎng)方式分布特征、氣質(zhì)特征(氣質(zhì)類型分布特征、氣質(zhì)維度得分水平)和術(shù)后疼痛強(qiáng)度水平。采用統(tǒng)計(jì)方法包括:描述性分析、Wilcoxon符號(hào)秩和檢驗(yàn)、t檢驗(yàn)、logistic回歸。選用SPSS 13.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。 研究結(jié)果: (1)OSAHS患兒知覺教養(yǎng)方式分布比例最高者為專制權(quán)威型(45.00%),最低者為忽視冷漠型(5.91%); (2)OSAHS患兒五種氣質(zhì)類型分布比例由高到低依次為:中間偏易型、平易型、中間偏煩型、麻煩型、發(fā)動(dòng)緩慢型;心境(t=3.032,p=0.003)、注意分散(t=5.794,p0.001)、活動(dòng)水平(t=2.410,p=0.017)、適應(yīng)性(t=4.844,p0.001)、節(jié)律性(t=2.192,p=0.029)、趨避性(t=3.833,p0.001)、持久性(t=6.917,p0.001)七個(gè)氣質(zhì)維度得分均高于健康兒童水平;反應(yīng)強(qiáng)度、反應(yīng)閾兩個(gè)維度得分在健康兒童范圍內(nèi); (3)OSAHS患兒術(shù)后4h和6h不伴隨吞咽動(dòng)作,疼痛評分≥3分的人數(shù)比例分別為13.18%和11.36%;伴隨吞咽動(dòng)作的術(shù)后4h和6h疼痛評分≥3分的患兒人數(shù)比例分別為60.45%和68.18%; (4)父母職業(yè)等級、兒童年齡、上學(xué)狀況、知覺教養(yǎng)方式、氣質(zhì)類型和氣質(zhì)維度中的心境、注意分散、活動(dòng)水平、適應(yīng)性、反應(yīng)強(qiáng)度、趨避性對兒童術(shù)后疼痛強(qiáng)度的影響具有統(tǒng)計(jì)學(xué)意義(P0.05); (5)氣質(zhì)類型、氣質(zhì)維度中的心境、注意分散、活動(dòng)水平、適應(yīng)性存在于患兒術(shù)后疼痛強(qiáng)度的預(yù)測方程中(P0.05)。 研究結(jié)論: (1)父母職業(yè)、學(xué)歷、對子女性別滿意度和患兒年齡、上學(xué)狀況、知覺教養(yǎng)方式、氣質(zhì)是兒童術(shù)后疼痛強(qiáng)度的獨(dú)立影響因素;手術(shù)方式、麻醉方式、診斷等疾病特征以及兒童性別、家庭類型對其的影響無統(tǒng)計(jì)學(xué)意義; (2)氣質(zhì)類型是兒童術(shù)后疼痛強(qiáng)度的預(yù)測因素。麻煩型氣質(zhì)的兒童術(shù)后出現(xiàn)Ⅱ級疼痛風(fēng)險(xiǎn)最高,平易型的兒童術(shù)后出現(xiàn)Ⅱ級疼痛風(fēng)險(xiǎn)最低,其它氣質(zhì)類型兒童的風(fēng)險(xiǎn)性位于兩者之間; (3)氣質(zhì)維度中的注意分散、活動(dòng)水平、心境、適應(yīng)性是兒童是術(shù)后疼痛強(qiáng)度的預(yù)測因子。具有高注意分散,低活動(dòng)水平、負(fù)向心態(tài)、適應(yīng)性差特征的兒童,出現(xiàn)Ⅱ級術(shù)后疼痛強(qiáng)度的風(fēng)險(xiǎn)高�？梢酝ㄟ^分散注意力、適當(dāng)提高活動(dòng)水平、樹立正向心境等方法降低兒童術(shù)后疼痛風(fēng)險(xiǎn); (4)在組成氣質(zhì)類型的五個(gè)氣質(zhì)維度中,心境穩(wěn)定的存在于四個(gè)疼痛采集點(diǎn)的預(yù)測方程中,是氣質(zhì)類型對兒童術(shù)后疼痛強(qiáng)度預(yù)測作用的重要因素; (5)研究從統(tǒng)計(jì)學(xué)方法上有效的控制了混雜因素,建立的兒童術(shù)后疼痛強(qiáng)度預(yù)測模型穩(wěn)健性好、可靠性高。
[Abstract]:Research purposes:
To describe the characteristics of perceptual rearing style, temperament and postoperative pain intensity in children with obstructive sleep apnea hypopnea syndrome (OSAHS); to analyze the relationship between postoperative pain intensity and the other three factors, to screen the influencing factors of postoperative pain intensity in children; to explore the predictive factors of postoperative pain intensity in children, and to establish a predictive equation.
Research methods:
A cross-sectional study was designed to investigate 220 children with OSAHS and their parents in a children's medical institution in Guangzhou. The distribution and temperament characteristics of children with OSAHS were investigated by the Children's Perceptual Rearing Style Questionnaire, Chinese Children's Temperament Quality Scale and Wong-Baker Facial Expression Pain Scale. Statistical methods included descriptive analysis, Wilcoxon symbolic rank sum test, t test and logistic regression. SPSS 13.0 software was used to analyze the data.
Research findings:
(1) The highest proportion of children with OSAHS was authoritarian (45.00%) and the lowest was neglected indifference (5.91%).
(2) The proportion of five temperament types in OSAHS children from high to low was middle-easy temperament type, easy temperament type, middle-boring temperament type, trouble temperament type, slow-moving temperament type, mood (t = 3.032, P = 0.003), attentional dispersion (t = 5.794, P 0.001), activity level (t = 2.410, P = 0.017), adaptability (t = 4.844, P 0.001), rhythm (t = 2.192, P = 0.029), avoidance (t = 3.833, P = 0.001), persistence. The scores of seven temperament dimensions of persistence (t = 6.917, p0.001) were higher than those of healthy children, and the scores of reaction intensity and reaction threshold were within the range of healthy children.
(3) The proportion of children with OSAHS who had no swallowing movement at 4 h and 6 h after operation was 13.18% and 11.36% respectively, while the proportion of children with OSAHS who had pain score greater than 3 at 4 h and 6 h after operation was 60.45% and 68.18% respectively.
(4) The influence of parents'occupational grade, children's age, school status, perceptual rearing style, temperament type and temperament dimension on children's postoperative pain intensity was statistically significant (P 0.05).
(5) Temperament type, mood in temperament dimension, attentional dispersion, activity level and adaptability existed in the predictive equation of postoperative pain intensity (P 0.05).
Research conclusions:
(1) Parental occupation, educational background, gender satisfaction with children, age, school status, parenting style, temperament are independent factors of postoperative pain intensity in children; surgical methods, anesthesia methods, diagnosis and other characteristics of the disease and children's gender, family type has no significant impact on it;
(2) Temperament type is a predictor of postoperative pain intensity in children.
(3) Attention dispersion, activity level, mood and adaptability in temperament dimension are predictors of postoperative pain intensity. Children with high attentional dispersion, low activity level, negative mentality and poor adaptability have a high risk of developing grade II postoperative pain intensity. Environment and other methods to reduce postoperative pain risk in children.
(4) Among the five dimensions of temperament types, mood stability exists in the prediction equations of four pain collection points, which is an important factor in predicting the postoperative pain intensity of children with temperament types.
(5) The study effectively controlled the confounding factors from the statistical method, and established a predictive model of postoperative pain intensity in children with good robustness and reliability.
【學(xué)位授予單位】：廣州醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R766

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