许云霞,郝丽,裴晓璐,吴承东,徐国丽,石春红,李宇栋
XU Yunxia,HAO Li,PEI Xiaolu,WU Chengdong,XU Guoli,SHI Chunhong,LI Yudong

• 1:首都医科大学附属北京中医医院肛肠科
• 2:首都医科大学附属北京中医医院质控小组
• 3:首都医科大学附属北京中医医院肿瘤外科
• 4:首都医科大学附属北京中医医院疮疡血管外科

摘要(Abstract)：

目的 分析混合痔患者术后不同心理状态与疼痛评分、疼痛应激水平及换药依从性的关系。方法 混合痔术后患者162例，于术后第3天采用自制问卷进行调查，内容包括患者性格、年龄、月收入、文化程度、婚姻状况等一般资料和换药依从性情况；采用凯斯勒10量表(Kessler 10)评价患者术后心理状况(Ⅰ～Ⅳ级),将Ⅰ级、Ⅱ级患者纳入心理状态良好组，Ⅲ、Ⅳ级患者纳入心理状态不良组；比较两组患者病程、内痔分度、外痔分类、手术方式等病情及治疗情况；于术后第3天，采用视觉模拟评分法(VAS)评价两组患者的疼痛程度，同时抽取患者空腹静脉血检测血清前列腺激素E_2(PGE_2)、P物质(SP)及C反应蛋白(CRP)来评价患者疼痛应激水平；多因素logistic逐步回归分析术后患者心理状态与VAS评分、疼痛应激水平、换药依从性的关系。结果 调查问卷回收率为96.91%(157/162),Kessler 10量表平均(21.46±5.85)分，其中Ⅰ～Ⅱ级73例患者纳入心理状态良好组，Ⅲ～Ⅳ级84例患者纳入心理状态不良组；两组性别、年龄、文化水平、家庭月收入、婚姻状况、病程、内痔分度、外痔分类及手术方式比较，差异无统计学意义(P>0.05);心理状态不良组视觉模拟评分法(VAS)评分、血清PGE_2、SP、CRP水平均高于良好组(P<0.05),心理状态不良组换药依从性评分低于良好组(P<0.05);多因素logistic逐步回归分析结果显示，VAS评分、疼痛应激水平、换药依从性是术后患者心理状态不良的危险因素(P<0.05)。结论 混合痔患者术后不同心理状态与VAS评分、疼痛应激和换药依从性有关。
Objective To analyze the relationship of postoperative psychological state with pain stress and compliance to dressing change in patients with mixed hemorrhoids. Methods A total of 162 patients with mixed hemorrhoids were investigated on Day 3 after operation through self-designed questionnaire, involving general data and the compliance to dressing change. Kessler 10 Rating Scale was used to evaluate the patients' postoperative psychological state(Grade Ⅰ-Ⅳ). Patients of Grade Ⅰ and Ⅱ were defined as the good psychological state group, while patients of Grade Ⅲ and Ⅳ as the poor psychological state group. The conditions and treatments of the two groups were comparatively analyzed. The Visual Analogue Scale(VAS) was used to evaluate the pains of the two groups on Day 3 after operation. Fasting venous blood samples were collected to measure serum prostaglandinE_2(PGE_2), substance P(SP), and C-reactive protein(CRP). Multivariate logistic stepwise regression analysis was performed to detect the relationship of postoperative psychological state with VAS score, pain stress and compliance to dressing change. Results The recovery rate of questionnaires was 96.91%(157/162), and the average Kessler 10 score was(21.46±5.85)points. There were 73 patients in the good state group and 84 patients in the poor state group. There was no statistically significant difference in gender, age, education level, family monthly income, marital status, course of disease, the grade of internal hemorrhoid, external hemorrhoid classification, and operation method between the two groups(P>0.05). The VAS score, serum PGE_2, SP, and CRP levels in the poor state group were higher than those in the good state group(P<0.05). The compliance score of dressing change in the poor state group was lower than that in the good state group(P<0.05). Multivariate logistic stepwise regression analysis results showed that VAS score, pain stress level, and compliance to dressing change were risk factors for poor postoperative psychological state(P<0.05). Conclusion The VAS score, pain stress level, and compliance to dressing change are risk factors for poor postoperative psychological state of patients with mixed hemorrhoids.

关键词(KeyWords)： 混合痔;术后心理状态;疼痛应激;换药依从性
mixed hemorrhoids;postoperative psychological state;pain stress;compliance to dressing change

Abstract:

Keywords:

基金项目(Foundation): 北京市医院管理中心创新梦工场经费资助(202122);; 北京市属医院科研培育项目(PZ2021021);; 首都医科大学附属北京中医医院职工助推项目(ZT202111)

作者(Author): 许云霞,郝丽,裴晓璐,吴承东,徐国丽,石春红,李宇栋
XU Yunxia,HAO Li,PEI Xiaolu,WU Chengdong,XU Guoli,SHI Chunhong,LI Yudong

DOI: 10.19367/j.cnki.2096-8388.2023.02.021

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