终末期骨关节炎患者关节置换术前疼痛灾难化水平及其影响因素分析  

Analysis of pain catastrophizing levels and related factors in end-stage osteoarthritis patients undergoing joint replacement surgery

作　　者：罗培培[1] 方蘅英[2] 杨叶香[3] 吴美娥[3] 黄甜[3] 陈美红[3] 林小玲 LUO Pei-pei;FANG Heng-ying;YANG Ye-xiang;WU Mei-e;HUANG Tian;CHEN Mei-hong;LIN Xiao-lin(Baby-Friendly Ward,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,Guangdong,China)

机构地区：[1]中山大学附属第三医院爱婴区,广东广州510630 [2]中山大学附属第三医院护理部,广东广州510630 [3]中山大学附属第三医院关节外科,广东广州510630 [4]中山大学护理学院,广东广州510080

出　　处：《广东医学》2024年第10期1343-1349,共7页Guangdong Medical Journal

基　　金：中山大学护理青年人才培育基金(N2022Y03);中山大学附属第三医院护理科研基金重点项目(2021HLZD01)。

摘　　要：目的调查终末期骨关节炎患者行关节置换术前疼痛灾难化水平及其影响因素。方法采用便利抽样法,选取2021年10月至2023年2月骨科入院待行关节置换术的179例终末期骨关节炎患者进行手术前调查,采用一般资料调查表、关节功能评分表、疼痛数字评定量表、医院焦虑抑郁量表、疼痛自我效能问卷、社会支持评定量表进行调查。结果终末期骨关节炎患者术前疼痛灾难化总分均分为(22.07±11.68)分,疼痛灾难化发生率为25.69%。不同性别、文化程度患者的术前疼痛灾难化水平差异有统计学意义(P<0.05);患者的疼痛程度(r=0.563)、焦虑(r=0.673)、抑郁水平(r=0.563)与疼痛灾难化呈正相关(P<0.001);患者的关节功能状态(r=-0.427)、疼痛自我效能(r=-0.467)、社会支持水平(r=-0.184)与疼痛灾难化呈负相关(P<0.05)。多元线性回归结果显示,性别、焦虑、疼痛评分、疼痛自我效能是患者术前疼痛灾难化的主要影响因素,可解释总变异的59.6%(P<0.05)。结论终末期骨关节炎患者行关节置换手术前的疼痛灾难化发生率较高,应重点关注术前疼痛评分高、焦虑程度高、女性、文化程度低和疼痛自我效能低的患者,给予针对性的干预措施,从而降低疼痛灾难化的水平。Objective To investigate the levels of pain catastrophizing and analyze the influencing factors in end-stage osteoarthritis(OA)patients undergoing joint replacement surgery.Methods A convenience sampling method was used to survey 179 patients with end-stage OA admitted to the orthopedic departments of two tertiary hospitals in Guangzhou,who were scheduled for joint replacement surgery between October 2021 and February 2023.The survey tools included a general demographic questionnaire,joint function score,Numerical Rating Scale(NRS)for pain,Hospital Anxiety and Depression Scale(HADS),Pain Self-Efficacy Questionnaire(PSEQ),and Social Support Rating Scale(SSRS).Results The average preoperative pain catastrophizing score in end-stage OA patients was 22.07±11.68,with a pain catastrophizing incidence rate of 25.69%.Significant differences were found in preoperative pain catastrophizing levels between patients of different genders and education levels(P<0.05).Pain catastrophizing was positively correlated with pain intensity(r=0.563),anxiety(r=0.673),and depression(r=0.563)(P<0.001),and negatively correlated with joint function status(r=-0.427),pain self-efficacy(r=-0.467),and social support level(r=-0.184)(P<0.05).Multiple linear regression analysis showed that gender,anxiety,pain intensity,and pain self-efficacy were the primary factors influencing preoperative pain catastrophizing,accounting for 59.6%of the total variance(P<0.05).Conclusion The incidence of pain catastrophizing is relatively high in end-stage OA patients prior to joint replacement surgery.Special attention should be given to patients with high pain scores,high anxiety levels,female gender,lower education levels,and low pain self-efficacy.Targeted interventions are recommended to reduce pain catastrophizing levels in these patients.

关 键 词：骨关节炎 关节置换 疼痛 疼痛灾难化 影响因素 

分 类 号：R684.3[医药卫生—骨科学] R473.74[医药卫生—外科学]