睡眠质量和焦虑抑郁在腹部手术患者术前疼痛灾难化与术后早期疼痛中的作用

姚国美; 姚红瑛; 沈云霞; 曹丽英; 金超杰

doi:10.16766/j.cnki.issn.1674-4152.003290

睡眠质量和焦虑抑郁在腹部手术患者术前疼痛灾难化与术后早期疼痛中的作用

doi: 10.16766/j.cnki.issn.1674-4152.003290

浙江大学医学院附属第二医院临平院区手术室，浙江杭州 311100

基金项目:

浙江省医药卫生科技计划项目 2023XY011

详细信息

通讯作者:
曹丽英，E-mail：1927994946@qq.com

中图分类号: R656 R619
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出版历程
- 收稿日期: 2023-05-24

The role of sleep quality and anxiety-depression on preoperative pain catastrophizing and early postoperative pain in patients undergoing abdominal surgery

Operating Room, Linping Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 311100, China

摘要

摘要: 目的探讨腹部手术患者睡眠质量和焦虑抑郁在术前疼痛灾难化与术后早期疼痛中的中介作用，为制定减轻术后早期疼痛的干预方案提供依据。方法选取浙江大学医学院附属第二医院临平院区2021年1月—2022年1月行腹部手术的患者206例，采用疼痛灾难化量表(PCS)、医院焦虑抑郁量表(HADS)、匹兹堡睡眠质量指数(PSQI)、视觉模拟评分(VAS)进行评估，采用Pearson相关性分析研究腹部手术患者睡眠质量和焦虑抑郁在术前疼痛灾难化和术后早期疼痛间的相关性，并进行中介效应检验。结果共发放206份问卷，回收192例有效问卷，问卷回收率为93.20%，其中男性104例，女性88例，年龄为(54.95±7.89)岁。Pearson相关分析显示：术前疼痛灾难化与术后早期疼痛、焦虑抑郁、睡眠质量呈正相关关系(r=0.813、0.745、0.792，均P < 0.001)，术后早期疼痛与焦虑抑郁、睡眠质量呈正相关关系(r=0.834、0.842，均P < 0.001)。Bootstrap法结果显示：3条路径中介效应值为0.106，总中介效应占总效应的62.35%，其中路径1(术前疼痛灾难化→焦虑抑郁→术后早期疼痛)相对中介占比31.76%，路径2(术前疼痛灾难化→睡眠质量→术后早期疼痛)相对中介占比15.29%，路径3(术前疼痛灾难化→焦虑抑郁→睡眠质量→术后早期疼痛)相对占比为15.29%。结论术前疼痛灾难化与腹部手术患者早期疼痛有关，睡眠质量和焦虑抑郁可影响术前疼痛灾难化和术后早期疼痛。
- 腹部手术 /
- 疼痛灾难化 /
- 早期疼痛 /
- 睡眠质量 /
- 焦虑抑郁
Abstract: Objective To explore the mediating effects of sleep quality, anxiety-depression on pain catastrophizing before surgery and early postoperative pain in patients undergoing abdominal surgery. The findings will contribute to the development of intervention programs aimed at reducing early postoperative pain. Methods A total of 206 patients who underwent abdominal surgery at Linping Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, from January 2021 to January 2022 were selected for evaluation. The evaluation was conducted using the pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), Pittsburgh sleep quality index (PSQI) and visual analog scale (VAS). Pearson correlation analysis was used to investigate the correlation between sleep quality, anxiety-depression in preoperative pain catastrophizing and early postoperative pain in abdominal surgery patients. Additionally, a mediating effect test was conducted. Results A total of 206 questionnaires were distributed, and 192 valid questionnaires were collected, resulting in a response rate of 93.20%. The sample consisted of 104 males and 88 females, with an average age of (54.95±7.89) years. Pearson correlation analysis showed significant positive correlations between preoperative pain catastrophizing and early postoperative pain, anxiety-depression, as well as sleep quality (r=0.813, 0.745, 0.792, all P < 0.001), and early postoperative pain was significantly positively correlated with anxiety-depression and sleep quality (r=0.834, 0.842, all P < 0.001). The results of the Bootstrap method indicated that the mediating effect value for the three pathways was 0.106, according for 62.35% of the total effect. Specifically, the mediating ratio of path 1 (preoperative pain disaster → anxiety-depression → early postoperative pain) was 31.76%, and the mediating ratio of path 2 (preoperative pain disaster → sleep quality → early postoperative pain) was 15.29%. Path 3 (preoperative pain disaster → anxiety-depression → sleep quality → early postoperative pain) accounted for 15.29% of the total mediating effect. Conclusion Preoperative pain catastrophizing is associated with early pain in patients undergoing abdominal surgery. Additionally, sleep quality, anxiety-depression have an influence on both preoperative pain catastrophizing and early postoperative pain.
- Abdominal surgery /
- Pain catastrophizing /
- Early pain /
- Sleep quality /
- Anxiety-depression
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表 1 192例行腹部手术的患者人口学特征情况

Table 1. Demographic profile of 192 patients undergoing abdominal surgery

项目	类别	例数(%)
性别	男性	104(54.17)
	女性	88(45.83)
年龄	＜60岁	112(58.33)
	≥60岁	80(41.67)
受教育年限	＜9年	108(56.25)
	≥9年	84(43.75)
吸烟史	是	98(51.04)
	否	94(48.96)
疾病类型	胃肠道疾病	66(34.38)
	肝胆疾病	52(27.08)
	妇科疾病	48(25.00)
	其他	26(13.54)
腹部手术类型	腹腔镜	122(63.54)
	开腹	70(36.46)
ASA分级	1~2级	104(54.17)
	3~4级	88(45.83)
经济收入	< 5 000元/月	98(51.04)
	≥5 000元/月	94(48.96)

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表 2 术前疼痛灾难化与术后早期疼痛、焦虑抑郁、睡眠质量间的相关分析(r值)

Table 2. Correlation analysis of preoperative pain catastrophizing with early postoperative pain, anxiety, depression, and sleep quality(rvalue)

变量	术前疼痛灾难化	焦虑抑郁	睡眠质量	术后早期疼痛
术前疼痛灾难化	1
焦虑抑郁	0.745^a	1
睡眠质量	0.792^a	0.824^a	1
术后早期疼痛	0.813^a	0.834^a	0.842^a	1
注：^aP < 0.001。

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表 3 腹部手术患者焦虑抑郁和睡眠质量在术前疼痛灾难化和术后早期疼痛间的中介效应检验

Table 3. Mediating effects of anxiety, depression, and sleep quality on pain catastrophizing before and after abdominal surgery in patients

效应	路径	Bootstrap检验分析结果		95% CI
效应	路径	B	SE	95% CI
直接效应	X→Y	0.064	0.012	0.009~0.119
间接效应	X→M1→Y	0.054	0.017	0.021~0.089
	X→M2→Y	0.026	0.010	0.007~0.049
	X→M1→M2→Y	0.026	0.010	0.009~0.049
注：X为术前疼痛灾难化；M1为焦虑抑郁；M2为睡眠质量；Y为术后早期疼痛。

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