疼痛耐受性与脑出血患者术后疼痛的相关性：睡眠质量和焦虑抑郁的中介效应-现代医学

疼痛耐受性与脑出血患者术后疼痛的相关性：睡眠质量和焦虑抑郁的中介效应

单位：1. 泸州市人民医院神经脊柱外科, 四川泸州 646000;
2. 泸州市人民医院急诊医学部, 四川泸州 646000

分类号：R743.34

出版年·卷·期（页码）：2023·51·第八期（1052-1056）

摘要：

目的：探讨疼痛耐受性与脑出血患者术后疼痛的相关性以及睡眠质量和焦虑抑郁的中介效应。方法：选取2018年4月至2022年10月于我院接受外科手术治疗的143例脑出血患者作为研究对象，记录患者术后压力性耐痛阈值(PTO)、疼痛视觉模拟量表(VAS)评分、匹兹堡睡眠质量指数量表(PSQI)评分以及医院焦虑抑郁量表(HADS)评分，采用Pearson相关分析PTO与术后VAS评分及相关影响因素的相关性，通过Process分析睡眠质量和焦虑抑郁的中介效应，并通过Bootstarp技术进行中介效应检验。结果：143例脑出血患者的术后PTO(5.34±1.33)kg·cm^-2，VAS评分(6.45±1.43)分，PSQI量表评分(14.45±3.19)分，HADS量表评分(30.15±4.57)分；术后PTO与VAS、PSQI、HADS评分均呈负相关(均P＜0.05)；Process分析显示，PTO对VAS、PSQI和HADS评分均存在显著影响，VAS、PSQI和HADS评分对PTO的也均有影响效果；通过Bootstarp技术对睡眠质量和焦虑抑郁在模型中的中介作用进行检验可以看出，间接效应值分别为-0.063(95%CI-0.146~-0.003)和-0.036(95%CI-0.052~-0.013)，直接效应值分别为-0.399(95%CI-0.563~-0.235)和-0.426(95%CI-0.607~-0.246)。结论：疼痛耐受性越强，术后疼痛感越弱，且睡眠质量和焦虑抑郁状态可发挥部分中介效应，影响术后疼痛感。

Objective: To explore the correlation between pain tolerance and postoperative pain in patients with cerebral hemorrhage as well as the intermediary effects of sleep quality, anxiety and depression. Methods: A total of 143 patients with cerebral hemorrhage who were treated in our hospital from April 2018 to October 2022 were selected as the research subjects. The postoperative pain tolerance threshold(PTO), Visual Analogue Scale(VAS), Pittsburgh Sleep Quality Index(PSQI) and Hospital Anxiety and Depression Scale(HADS) scores were recorded. Pearson correlation analysis was used to analyze the correlation between PTO value and postoperative VAS score and related influencing factors. Process was used to analyze the mediating effect of sleep quality and anxiety and depression, and Bootstarp technology was used to test the mediating effect. Results: The postoperative PTO values of 143 patients with cerebral hemorrhage were(5.34±1.33) kg·cm^-2, VAS score(6.45±1.43), PSQI score(14.45±3.19) and HADS score(30.15±4.57). Postoperative PTO was negatively correlated with VAS score(r=-0.448, P<0.05), while PTO was negatively correlated with PSQI(r=-0.381, P<0.05) and HADS(r=-0.525, P<0.05);Process analysis showed PTO had a significant impact on VAS, PSQI, and HADS scores, meanwhile VAS, PSQI, and HADS scores also had a significant impact on PTO(P<0.05);Testing the mediating effects of sleep quality and anxiety and depression in the model using Bootstarp technique, the indirect effects were -0.063(95%CI-0.146- -0.003)and -0.036(95%CI-0.052- -0.013)respectively, the direct effects were -0.399(95%CI-0.563~-0.235)and -0.426(95%CI-0.607~-0.246)respectively. Conclusion: The stronger the pain tolerance is, the weaker the postoperative pain is. In addition, sleep quality and anxiety and depression can play a part of the intermediary effect affecting the postoperative pain.

参考文献：

[1] MAGID-BERNSTEIN J,GIRARD R,POLSTER S,et al.Cerebral hemorrhage:pathophysiology,treatment,and future directions[J].Circ Res,2022,130(8):1204-1229.
[2] MONTAÑO A,HANLEY D F,HEMPHILL J C 3rd.Hemorrhagic stroke[J].Handb Clin Neurol,2021,176:229-248.
[3] WONG Y S,TSAI C F,ONG C T.Risk factors for stroke recurrence in patients with hemorrhagic stroke[J].Sci Rep,2022,12(1):17151.
[4] 焦可然,朱文娜.基于Snyder希望理论的护理对脑出血患者神经功能、再出血率及生活能力的影响[J].现代医学,2021,49(2):205-208.
[5] DE OLIVEIRA MANOEL A L.Surgery for spontaneous intracerebral hemorrhage[J].Crit Care,2020,24(1):45.
[6] AMIRI M,ALAVINIA M,SINGH M,et al.Pressure pain threshold in patients with chronic pain:a systematic review and Meta-analysis[J].Am J Phys Med Rehabil,2021,100(7):656-674.
[7] KEILANI M,CREVENNA R,DORNER T E.Sleep quality in subjects suffering from chronic pain[J].Wien Klin Wochenschr,2018,130(1-2):31-36.
[8] MICHAELIDES A,ZIS P.Depression,anxiety and acute pain:links and management challenges[J].Postgrad Med,2019,131(7):438-444.
[9] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[10] HARDY J D,WOLFF H G,GOODELL H.Studies on pain.a new method for measuring pain threshold:observations on spatial summation of pain[J].J Clin Invest,1940,19(4):649-657.
[11] BUYSSE D J,REYNOLDS C F 3rd,MONK T H,et al.The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(2):193-213.
[12] ZIGMOND A S,SNAITH R P.The hospital anxiety and depression scale[J].Acta Psychiatr Scand,1983,67(6):361-370.
[13] 姚远,蔡斌,徐丽丽,等.颞下颌关节紊乱病患者颈部压力疼痛阈值和头前伸姿势的相关性研究[J].中华口腔医学杂志,2021,56(8):759-763.
[14] MACHADO N,COSTA Y M,QUEVEDO H M,et al.The association of self-reported awake bruxism with anxiety,depression,pain threshold at pressure,pain vigilance,and quality of life in patients undergoing orthodontic treatment[J].J Appl Oral Sci,2020,28:e20190407.
[15] KOVACEVIC M,KLICOV L,VUKLIS D,et al.Test-retest reliability of pressure pain threshold and heat pain threshold as test stimuli for evaluation of conditioned pain modulation[J].Neurophysiol Clin,2021,51(5):433-442.
[16] 王玉娜,周霞,李艺,等.癌症住院患者的睡眠质量及其与神经质人格、负性情绪关系的中介效应分析[J].东南大学学报(医学版),2020,39(5):619-623.
[17] BATISTA A R,SILVA S,LENCASTRE L,et al.Biopsychosocial correlates of quality of life in multiple sclerosis patients[J].Int J Environ Res Public Health,2022,19(21):14431.
[18] SCHMITZ A K,VIERHAUS M,LOHAUS A.Pain tolerance in children and adolescents:sex differences and psychosocial influences on pain threshold and endurance[J].Eur J Pain,2013,17(1):124-131.
[19] BOYE LARSEN D,LAURSEN M,SIMONSEN O,et al.The association between sleep quality,preoperative risk factors for chronic postoperative pain and postoperative pain intensity 12 months after knee and hip arthroplasty[J].Br J Pain,2021,15(4):486-496.
[20] ATABAKI S,HAGHANI S,DORRI S,et al.The effect of rehabilitation education on anxiety in knee replacement patients[J].J Educ Health Promot,2020,9:115.

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