焦虑抑郁、疼痛灾难化水平对剖宫产术后镇痛不全的影响  

The influence of anxiety,depression and pain catastrophization level on analgesia insufficiency after cesarean section

作　　者：李美玲 任贇虹 杜娟[1,2] 何玲 黄雪梅[1,2] 卢琴 孙宝侠[1,2] 冯海霞 Li Meiling;Ren Yunhong;Du Juan;He Ling;Huang Xuemei;Lu Qin;Sun Baoxia;Feng Haixia(Department of Anesthesiology,Mianyang Central Hospital;Mianyang Key Laboratory Anesthesia and Neuromodulation,Mianyang Sichuan 621000,P.R.China)

机构地区：[1]绵阳市中心医院麻醉科,四川绵阳621000 [2]绵阳市麻醉与神经调控重点实验室,四川绵阳621000

出　　处：《中国计划生育和妇产科》2025年第2期108-112,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：绵阳市中心医院2023年院内护理科研项目(项目编号:MCHHL2023YB10)。

摘　　要：目的探讨剖宫产产妇术前焦虑抑郁、疼痛灾难化与术后镇痛效果的关系,为制定有针对性的镇痛策略提供依据。方法选取2023年1月1日至2023年8月30日在绵阳市中心医院住院的778例剖宫产产妇作为研究对象,采用一般资料问卷、医院焦虑抑郁量表、疼痛灾难化量表、数字评分量表对产妇的焦虑抑郁、疼痛灾难化现状、术后镇痛效果进行评估,采用单因素、多因素逻辑回归及相关性分析探讨焦虑抑郁、疼痛灾难化对剖宫产产妇术后镇痛不全的影响。结果剖宫产产妇术后镇痛不全的发生率为89.8%。单因素分析显示生育史、ASA分级、24 h镇痛泵按压次数、24 h镇痛泵用量、镇痛满意度是术后镇痛不全的影响因素;相关性分析显示,疼痛灾难化、焦虑抑郁与术后镇痛不全呈正相关性(r=0.624,P<0.001;r=0.471,P<0.001;r=0.510,P<0.001)。Logistic回归分析显示疼痛灾难化(OR=1.428,95%CI:1.299-1.569)、焦虑(OR=1.742,95%CI:1.593-1.929)、抑郁(OR=1.415,95%CI:1.175-1.703)、术后24 h镇痛泵用量(OR=1.913,95%CI:1.881-1.946)及术后24 h镇痛泵按压次数(OR=2.078,95%CI:1.626-2.655)是剖宫产术后镇痛不全的影响因素。矫正后显示疼痛灾难化(OR=1.745,95%CI:1.117-2.343)、焦虑(OR=1.943,95%CI:1.566-3.876)、抑郁(OR=1.117,95%CI:1.634-2.176)是产妇术后镇痛不全的独立风险因素。结论剖宫产产妇术后镇痛不全发生率较高,焦虑抑郁、疼痛灾难化是术后镇痛不全的独立风险因素,医务人员可通过制定改善剖宫产产妇的心理状况及疼痛灾难化水平的措施改善术后镇痛效果。Objective To explore the relationship between anxiety,depression,pain catastrophization and postoperative analgesia effect,and to provide evidence for the formulation of targeted analgesia strategies.Methods 778 women with cesarean section who were hospitalized in Mianyang Central Hospital from January 1,2023 to August 30,2023 were selected as the study objects.General data questionnaire,Hospital anxiety and depression scale,Pain catastrophization scale and Number pain score scale were used to evaluate the current situation of anxiety and depression,pain catastrophization and analgesic effects.Using single factor,multiple factor logistic regression,and correlation analysis to explore the effects of anxiety,depression,and pain catastrophizing on postoperative analgesia insufficiency in cesarean section women.Results The incidence of postoperative analgesia insufficiency after cesarean section was 89.8%.Univariate analysis showed that fertility history,ASA grade,24 h analgesic pump compression times,24 h analgesic pump dosage,analgesic satisfaction were the influential factors of postoperative analgesia insufficiency.Correlation analysis showed that pain catastrophization,anxiety and depression were positively correlated with postoperative analgesia insufficiency(r=0.624,P<0.001;r=0.471,P<0.001;r=0.510,P<0.001).Logistic regression analysis showed pain catastrophization(OR=1.428,95%CI:1.299-1.569),anxiety(OR=1.742,95%CI:1.593-1.929),depression(OR=1.415,95%CI:1.175-1.703),24 h postoperative analgesic pump dosage(OR=1.913,95%CI:1.881-1.946)and 24 h postoperative analgesic pump compression times(OR=2.078,95%CI:1.626-2.655)were the influential factors for postoperative analgesic insufficiency.After correction,pain catastrophization(OR=1.745,95%CI:1.117-2.343),anxiety(OR=1.943,95%CI:1.566-3.876)and depression(OR=1.117,95%CI:1.634-2.176)were independent risk factors for postoperative analgesia insufficiency.Conclusion The incidence of analgesia insufficiency after cesarean section is relatively high.Anxiety,depression and

关 键 词：剖宫产 睡眠 心理 疼痛灾难化 镇痛 

分 类 号：R711.6[医药卫生—妇产科学]