裴莹莹,王秀红,汪俊华,邹惠美
PEI Yingying,WANG Xiuhong,WANG Junhua,ZOU Huimei

• 1:贵州医科大学护理学院
• 2:贵州医科大学公共卫生学院

摘要(Abstract)：

目的 采用结构方程模型探讨贵阳市社区老年慢性疼痛患者的轻、中度疼痛与重度疼痛组其衰弱影响路径及效应量。方法 采用多阶段分层整群随机抽样方法，对贵阳市630例社区老年慢性疼痛患者采用一般情况调查表、Tilburg衰弱量表(TFI)、疼痛数字评价量表(NRS)、社会支持评定量表(SSRS)、简版流调中心抑郁量表(CESD-10)以及慢性病自我管理行为量表(CDSMS),所涉项目以面对面逐一询问并填写的方式进行问卷调查；采用AMOS 23.0建立结构方程模型，分析轻、中度疼痛组(NRS得分≤6分)和重度疼痛组(NRS得分≥7分)衰弱影响因素作用路径及效应量的改变。结果 共发放643份问卷，回收有效问卷630份，有效回收率为98.0%;社区老年慢性疼痛患者TFI得分为(5.71±3.58)分，检出率为53.2%;SSRS得分为(35.36±7.90)分，CESD-10得分为(7.92±5.69)分，CDSMS得分为(38.38±10.78)分；相关分析结果显示，TFI与SSRS、CDSMS呈负相关(r=-0.407、-0.586,P<0.01),与CESD-10呈正相关(r=0.494,P<0.01);CDSMS与SSRS呈正相关(r=0.353,P<0.01),与CESD-10呈负相关(r=-0.289,P<0.01);结构方程模型显示，χ~2/df、CFI、RFI、IFI、TLI、RMSEA两组拟合指数均达到适配标准；轻、中度疼痛与重度疼痛组相比TFI影响路径未发生改变，SSRS、CESD-10、CDSMS直接影响衰弱(P<0.05),同时SSRS和CESD-10能通过CDSMS间接作用于衰弱(P<0.05),但重度疼痛组SSRS对TFI直接和间接作用效应量分别下降0.288、0.031;CESD-10对TFI直接和间接作用效应量分别增加0.082、0.145;CDSMS对TFI直接作用效应量增加0.078。结论 老年慢性疼痛患者衰弱检出率较高，重度疼痛组社会支持直接效应量和抑郁间接效应量变化幅度较大，自我管理行为直接效应量增加。
Objective To explore the influencing path and effect size that mild, moderate and severe pain degree affect the frailty of elderly patients with chronic pain in Guiyang community using structural equation model. Methods A multi-stage stratified cluster random sampling was employed to carry out a questionnaire survey on 630 elderly patients with chronic pain in Guiyang community. This survey included General Situation Questionnaire, Tilburg Frailty Scale(TFI), Pain Numeric Rating Scale(NRS), Social Support Rating Scale(SSRS), Center for Epidemiologic Studies Depression Scale(CESD-10),and Chronic Disease Self-Management Support(CDSMS). All involved items in the questionnaire were investigated and filled by face-to-face inquiry. AMOS 23.0 was used to establish a structural equation model to analyze the action paths of the factors influencing the frailty in elderly patients with chronic pain in mild-moderate pain degree(NRS score≤6 points) and severe pain degree(NRS score≥7 points) groups and effect sizes. Results A total of 643 questionnaires were sent out and 630 questionnaires were effectively received with an effective recovery rate of 98.0%. TFI score of the elderly patients with chronic pain in the community was(5.71±3.58) points with 53.2% detection rate. The score of SSRS was(35.36±7.90) points, CESD-10 with(7.92±5.69) points, CDSMS with(38.38±10.78)points. Correlation analysis showed that TFI was negatively associated with SSRS and CDSMS(r=-0.407,-0.586;P<0.01) and positively with CESD-10(r=0.494,P<0.01). CDSMS was positively with SSRS(r=0.353,P<0.01) and negatively with CESD-10(r=-0.289,P<0.01). The structural equation mode showed that two fitting indexes of χ~2/df,CFI, RFI, IFI, TLI, and RMSEA met the fitting standard. There was no change in TFI-influenced path between mild-moderate pain and severe pain groups. SSRS, CESD-10, and CDSMS directly influenced the frailty(P<0.05). SSRS and CESD-10 indirectly acted on frailty through CDSMS(P<0.05), but the direct and indirect effects of SSRS on TFI in severe pain group were decreased by 0.288 and 0.031, respectively. The direct and indirect effects of CESD-10 on TFI were increased by 0.082 and 0.145, respectively. The direct effect of CDSMS on TFI was increased by 0.078. Conclusion The detection rate of frailty in elderly with chronic pain is high. The direct effect of social support and the indirect effect of depression in severe pain group vary greatly, and the direct effect of self-management behavior is increased.

关键词(KeyWords)： 疼痛程度;老年人;慢性疼痛;衰弱;影响因素分析;结构方程模型
pain degree;elderly;chronic pain;frailty;influencing factor analysis;structural equation model

Abstract:

Keywords:

基金项目(Foundation): 全国医学专业学位研究生教育指导委员会(中国学位与研究生教育学会医学专业工作委员会)立项资助(YX2019-03-02);; 贵州医科大学护理学科教学与科学研究专项课题项目(YJ20058)

作者(Author): 裴莹莹,王秀红,汪俊华,邹惠美
PEI Yingying,WANG Xiuhong,WANG Junhua,ZOU Huimei

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