Barthelsson Cajsa, Nordström Gun, Norberg Åke
Department of Clinical Science, Intervention and Technology, Karolinska Institutet Stockholm, Sweden.
Scand J Caring Sci. 2011 Mar;25(1):143-50. doi: 10.1111/j.1471-6712.2010.00804.x.
Pain is the most common symptom following laparoscopic cholecystectomy (LC) and might delay discharge from hospital after day surgery. A patient's ability to manage stressful situations can be assessed by the sense of coherence (SOC) and has been proposed to predict health. The aim of this study was to investigate predictors of average pain the first postoperative week after LC, and predictors of changes in perceived health, with special reference to individual coping resources measured by the Sense of Coherence Scale. Furthermore, a test-re-test was performed on SOC to evaluate the stability in the context of LC surgery.
Seventy-three patients completed questionnaires about SOC, health status, pain, anxiety, symptom occurrence and symptom distress preoperatively, postoperative day 1-7 and after 1 and 6 months following LC.
By multiple regression, 23% of the variability in pain intensity could be explained by the variables age, SOC and education. Age was the strongest predictor. Further, 19% of the change in health between day 7 and 1 month could be explained by the two variables symptom distress the first postoperative day and SOC. The test-re-test of SOC had a correlation coefficient (r) of 0.55. Forty-six patients (63%) remained within ±10% of their preoperative SOC score at 6 months, 11 patients (15%) decreased and 16 patients (22%) increased their SOC values.
SOC was found to be a significant but weak predictor of pain intensity the first week after LC. Furthermore, patients scoring low SOC values experienced a delay in their health improvement. SOC was more unstable over time than previously suggested. Further, interventional studies are needed to clarify if SOC might be a clinically useful measure to identify vulnerable patients undergoing LC surgery.
疼痛是腹腔镜胆囊切除术（LC）后最常见的症状，可能会延迟日间手术后的出院时间。患者应对压力情况的能力可通过连贯感（SOC）进行评估，并且有人提出连贯感可预测健康状况。本研究的目的是调查LC术后第一周平均疼痛的预测因素，以及感知健康变化的预测因素，特别参考通过连贯感量表测量的个体应对资源。此外，对SOC进行了重测，以评估其在LC手术背景下的稳定性。
73名患者在术前、术后第1 - 7天以及LC术后1个月和6个月完成了关于SOC、健康状况、疼痛、焦虑、症状出现和症状困扰的问卷调查。
通过多元回归分析，疼痛强度变异的23%可由年龄、SOC和教育程度等变量解释。年龄是最强的预测因素。此外，术后第1天的症状困扰和SOC这两个变量可解释术后第7天至1个月期间健康状况变化的19%。SOC的重测相关系数（r）为0.55。46名患者（63%）在6个月时其SOC得分保持在术前得分的±10%以内，11名患者（15%）得分降低，16名患者（22%）得分升高。
研究发现SOC是LC术后第一周疼痛强度的一个显著但较弱的预测因素。此外，SOC得分低的患者健康状况改善延迟。随着时间推移，SOC比之前认为的更不稳定。此外，需要进行干预性研究，以明确SOC是否可能是一种临床上有用的措施，用于识别接受LC手术的脆弱患者。
