术前疼痛对关节镜下肩袖撕裂手术患者创伤后应激障碍的影响

Effect of preoperative pain on post-traumatic stress disorder in patients undergoing arthroscopic rotator cuff tears

摘要:

目的 探讨术前疼痛对关节镜下肩袖撕裂手术患者创伤后应激障碍（PTSD）的影响。方法 回顾性分析2019年1月－2020年12月该院286例行关节镜下肩袖撕裂手术患者的临床资料。依据患者入院后疼痛视觉模拟评分（VAS）情况，分为A组（1～3分，n = 16）、B组（4～6分，n = 34）和C组（7～10分，n = 236），比较3组患者手术前后的焦虑自评量表（SAS）、抑郁自评量表（SDS）和PTSD自评量表（PTSD-SS）评分。依据患者术后是否出现PTSD分为PTSD组（n = 85）和对照组（n = 201），对关节镜下肩袖撕裂手术患者PTSD的相关因素进行单因素和Logistic多因素分析。结果 3组患者术前SAS评分和SDS评分比较，差异均无统计学意义（P > 0.05）；3组患者术后SAS评分和SDS评分较术前降低，B组和C组的SAS评分和SDS评分较A组升高，且C组高于B组，差异均有统计学意义（P < 0.05）。3组患者术前的PTSD-SS评分中，重现、回避、警觉性增高、其他和总分比较，差异均无统计学意义（P > 0.05）；3组患者术后的PTSD-SS评分中，重现、回避、警觉性增高、其他和总分均较术前降低，B组和C组较A组升高，且C组高于B组，差异均有统计学意义（P < 0.05）。多因素Logistic分析显示，年龄 ≤ 60岁、合并心脑血管疾病、合并糖尿病、既往存在应激事件、术前VAS评分为7～10分和合并术后并发症为关节镜下肩袖撕裂手术患者发生PTSD的危险因素（P < 0.05）。结论 术前疼痛可加重关节镜下肩袖撕裂手术患者的焦虑、抑郁情绪，加重PTSD，且年龄、合并心脑血管疾病、合并糖尿病、既往存在应激事件、术前疼痛和合并术后并发症均为关节镜下肩袖撕裂手术患者发生PTSD的危险因素，应加强临床监控和干预。

Abstract:

Objective To analyze the effect of preoperative pain on post-traumatic stress disorder (PTSD) in patients underwent arthroscopic rotator cuff tears.Methods The clinical data of 286 patients with rotator cuff tears from January 2019 to December 2020 were retrospectively analyzed. Group A (1 ~ 3, n = 16), group B (4 ~ 6, n = 34) and group C (7 ~ 10, n = 236) were divided according to the visual analogue pain (VAS) scores after admission. The SAS, SDS and PTSD-SS scores of the three groups before and after operation were compared. According to whether the patients had PTSD or not, they were divided into PTSD group (n = 85) and control group (n = 201).Results There were no significant difference in the SAS and SDS scores of the three groups before operation (P > 0.05); compared the SAS and SDS scores of the three groups before and after operation, the scores were decreased; and compared with group A, the SAS and SDS scores of group B and group C were increased, and group C was higher than group B, the difference was statistically significant (P < 0.05). There were no significant difference in the PTSD-SS scores of recurrence, avoidance, increased alertness, others and total scores among the three groups before operation (P > 0.05); Compared the PTSD-SS scores of recurrence, avoidance, increased alertness, others and total scores of the three groups before and after operation, the scores were decreased, and compared with group A, the PTSD-SS scores of group B and group C were increased, and group C was higher than that of group B, the difference were statistically significant (P < 0.05). Logistic multivariate analysis showed that age ≤ 60 years old, combined with cardiovascular and cerebrovascular diseases, combined with diabetes, previous stress events, preoperative VAS score of 7~10, combined with postoperative complications were the risk factors of PTSD in patients with arthroscopic rotator cuff tears (P < 0.05).Conclusion Preoperative pain can aggravate anxiety and depression in patients underwent arthroscopic rotator cuff tear surgery, aggravate post-traumatic stress disorder, age, combined cardiovascular and cerebrovascular diseases, combined diabetes, previous stress events, preoperative pain, postoperative complications are risk factors for post-traumatic stress disorder in patients undergoing arthroscopic rotator cuff tear surgery, and clinical monitoring and intervention should be strengthened.