老年多发性肋骨骨折患者术后疼痛及生活质量的相关因素

Factors related to postoperative pain and quality of life in elderly patients with multiple rib fractures

【摘要】目的 分析老年多发性肋骨骨折患者术后疼痛及生活质量的相关因素。方法 纳入2019年3月至2023年10月安徽省宿州市第一人民医院122例老年多发性肋骨骨折手术患者,采用视觉模拟评分法(VAS)调查术后7d疼痛情况,采用36项健康调查问卷(SF-36)调查患者术后生活质量,采用多元线性回归模型分析术后疼痛及生活质量的独立相关因素。采用SPSS 22.0软件进行数据分析。根据数据类型,分别采用t检验及χ²检验。结果 老年多发性肋骨骨折术后7d的VAS评分(3.63±0.76)分,轻度疼痛73例,中度疼痛40例,重度疼痛9例；患者术后SF-36各维度及总分均低于国内常模(P<0.05)；多元线性回归分析显示,术前重度疼痛(β=0.285；P<0.001)、手术时长>3h(β=0.169；P=0.009)、心理弹性差(β=3.482；P=0.001)可正向预测老年多发性肋骨骨折术后疼痛,术前重度疼痛(β=-0.322；P<0.001)、手术时长>3h(β=-0.189；P=0.003)、心理弹性差(β=-0.238；P=0.001)、低社会支持度(β=-0.167；P=0.017)可负向预测老年多发性肋骨骨折术后生活质量,回归方程显著(F=12.834、16.497；P<0.001)；Pearson相关性分析显示,老年多发性肋骨骨折患者术后SF-36总分与VAS评分呈负相关(r=-0.507；P<0.001),与社会支持评测表、心理弹性量表评分均呈正相关(r=0.479,0.524；P<0.001)。结论 老年多发性肋骨骨折术前重度疼痛、手术时长超过3h、心理弹性差均可显著影响患者术后疼痛和生活质量。此外,患者生活质量还受社会支持的影响,与术后疼痛程度、社会支持及心理弹性水平有关。

基金项目:安徽省宿州市科技计划项目(SZSKJJZC062);安徽省重点研发计划(202204J07020008)

【Abstract】Objective To analyze the factors related to postoperative pain and quality of life in elderly patients with multiple rib fractures. Methods A total of 122 elderly patients undergoing surgery for multiple rib fracture in Suzhou First People′s Hospital, Anhui Province from March 2019 to October 2023 were included. The visual analogue scale (VAS) was used to investigate the pain at seven days after surgery, and the 36-item short-form health questionnaire (SF-36) was used to investigate the postoperative quality of life. Multivariate linear regression model was used to analyze the independent factors related to postoperative pain and quality of life. SPSS 22.0 was used for statistical analysis. Data comparison was performed using t test or χ² test depending on data type. Results The VAS score in elderly patients with multiple rib fractures at seven days after surgery was (3.63±0.76) points. There were 73 cases with mild pain, 40 cases with moderate pain and 9 cases with severe pain. The scores of dimensions and total score of SF-36 after surgery were lower than those of the domestic norms (P<0.05). Multivariate linear regression analysis showed that preoperative severe pain (β=0.285; P<0.001), duration of surgery >3 hours (β=0.169; P=0.009) and poor psychological resilience (β=3.482; P=0.001) positively predicted postoperative pain, and that preoperative severe pain (β=-0.322; P<0.001), duration of surgery >3 hours (β=-0.189; P=0.003), poor psychological resilience (β=-0.238; P=0.001), and low social support (β=-0.167; P=0.017) negatively predicted postoperative quality of life in elderly patients with multiple rib fractures, and the regression equation was significant (F=12.834,16.497; P<0.001). Pearson correlation analysis revealed that the total score of postoperative SF-36 was negatively correlated with VAS score (r=-0.507; P<0.001) and was positively correlated with social support rate scale score and connor-davidson resilience scale score (r=0.479,0.524; P<0.001) in elderly patients with multiple rib fractures. Conclusion Preoperative severe pain, surgical duration >3 hours and poor psychological resilience can significantly affect postoperative pain and quality of life in elderly patients with multiple rib fractures. In addition, the quality of life of the patients is also affected by social support and is related to the degree of postoperative pain, social support and psychological resilience.

The work was supported by Science and Technology Program of Suzhou City, Anhui Province ( SZSKJJZC062) and Key Research andDevelopment Program of Anhui Province (202204J07020008).