术前认知行为治疗对骨创伤患者疼痛灾难化的影响  

Effect of preoperative cognitive behavioral therapy on pain catastrophizing in patients with orthopedic trauma

作　　者：陆筱星 王六一 朱杨子 周美艳[1] 张婷[3] 刘舒文 俞又佳 王英伟 王立伟[1] Lu Xiaoxing;Wang Liuyi;Zhu Yangzi;Zhou Meiyan;Zhang Ting;Liu Shuwen;Yu Youjia;Wang Yingwei;Wang Liwei(Department of Anesthesiology,Xuzhou Central Hospital,Xuzhou 221000,China;Jiangsu Province Key Laboratory of Anesthesiology,Xuzhou Medical University,Xuzhou 221000,China;Department of Pain Treatment,Xuzhou Central Hospital,Xuzhou 221000,China;Department of Clinical Psychology,Xuzhou Central Hospital,Xuzhou 221000,China;Department of Anesthesiology,Suzhou Xiangcheng People′s Hospital,Suzhou 215131,China;Department of Anesthesiology,Shanghai Huashan Hospital,Shanghai 200040,China)

机构地区：[1]徐州市中心医院麻醉科,徐州221000 [2]徐州医科大学江苏省麻醉学重点实验室,徐州221000 [3]徐州市中心医院疼痛科,徐州221000 [4]徐州市中心医院临床心理科,徐州221000 [5]苏州市相城人民医院麻醉科,苏州215131 [6]上海华山医院麻醉科,上海200040

出　　处：《中华麻醉学杂志》2022年第8期941-944,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82001169,81870857,82071903)。

摘　　要：目的评价术前认知行为治疗对骨创伤患者疼痛灾难化的影响。方法拟行手术治疗的下肢骨创伤患者120例,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,BMI 18~28 kg/m^(2),入院时疼痛灾难化量表(PCS)评分>16分。基于骨折类型采用分层随机化的方法分为2组(n=60):认知行为治疗组(CBT组)和常规组(R组)。CBT组在入院当天和术前1 d分别通过网络形式进行针对疼痛的认知行为治疗。2组患者均于脊椎-硬膜外联合麻醉下行下肢骨折复位内固定术。于入院即刻(T1)和术日清晨(T2)时记录PCS评分,记录术后48 h内自控镇痛泵有效按压次数、补救镇痛药用量及恶心呕吐发生情况;记录术后3个月时手术部位动态VAS评分及评分>3分的发生情况以及3个月内阿片类药物使用情况。结果与R组比较,CBT组T2时PCS评分降低,术后48 h内镇痛泵按压次数、补救镇痛药用量以及恶心呕吐发生率降低,术后3个月内阿片类药物使用率降低(P<0.05),术后3个月时动态VAS评分以及评分>3分发生率差异无统计学意义(P>0.05)。结论术前认知行为治疗可降低骨创伤患者疼痛灾难化程度,有助于提高术后镇痛质量。Objective To evaluate the effect of preoperative cognitive behavioral therapy(CBT)on pain catastrophizing in the patients with orthopedic trauma.Methods A total of 120 patients with lower extremity bone trauma,aged 18-64 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,with body mass index of 18-28 kg/m^(2),with Pain Catastrophic Scale(PCS)score on admission>16,scheduled for surgical treatment,were enrolled.The patients were divided into 2 groups(n=60 each)by the stratified randomization method based on the type of fracture:CBT group and routine group(group R).Group CBT received CBT for pain through the internet on the day of admission and one day before operation.The patients in both groups underwent reduction and internal fixation of lower extremity fractures under combined spinal-epidural anesthesia.The PCS scores were recorded immediately after admission and on the morning of the operation day.The effective pressing times of the patient-controlled analgesia pump,consumption of analgesics for rescue analgesia,and occurrence of nausea and vomiting within 48 h after operation were recorded.The visual analogue scale score of the surgical site during activity and occurrence of the score>3 at 3 months after operation and use of opioids within 3 months after operation were recorded.Results Compared with group R,the PCS score was significantly decreased on the morning of the operation day,the pressing times of the patient-controlled analgesia pump,consumption of analgesics for rescue analgesia and incidence of nausea and vomiting within 48 h after operation were decreased,the requirement for opioids within 3 months after operation was decreased(P<0.05),and no significant change was found in VAS score during activity and occurrence of the score>3 at 3 months after operation in group CBT(P>0.05).Conclusions Preoperative CBT can reduce the degree of pain catastrophizing and is helpful in increasing the quality of postoperative analgesia in the patients with orthopedic trauma.

关 键 词：疼痛 灾难化 疼痛管理 认知行为疗法 骨折 创伤和损伤 

分 类 号：R687.3[医药卫生—骨科学]