Aceto Paola, Lai Carlo, Perilli Valter, Sacco Teresa, Modesti Cristina, Raffaelli Marco, Sollazzi Liliana
Department of Anesthesiology and Intensive Care, A. Gemelli Universitary Hospital, Largo A. Gemelli 8, 00168 Rome, Italy.
Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy.
Physiol Behav. 2016 Sep 1;163:1-6. doi: 10.1016/j.physbeh.2016.04.032. Epub 2016 Apr 19.
Previous studies performed in non-obese patients undergoing elective surgery have revealed that psychological factors may affect postoperative analgesic requirements. The aim of this observational prospective study was to investigate the extent to which psychopathological dimensions, including anxiety, depression and alexithymia, may influence postoperative pain intensity and analgesics consumption using patient-controlled analgesia (PCA) in patients undergoing bariatric surgery.
120 patients, aged 18-60years, with an ASA physical status I-II, undergoing gastric bypass were enrolled. Anxiety and depression Hamilton scales, and Toronto Alexithymia scale, were administered to patients on the day before surgery. General anesthesia was standardized. After awakening, a PCA pump with intravenous tramadol was immediately made available for a 36-hour postoperative analgesia. Visual analog scale at rest (VASr) and after coughing (VASi), and effective PCA requests number were postoperatively recorded. Pearson's correlations, Anova analyses and multiple linear regression were used for statistical purpose.
Positive correlations were found between anxiety, depression, alexithymia and all pain indicators (p<0.01). Analyses of variance showed that anxious (p<0.001), depressed (p<0.001) and alexithymic (p<0.05) patients had high pain indicators. VASr and VASi were predicted by anxiety and depression (p<0.05), but not by alexithymia; effective PCA requests number was predicted by anxiety, depression and alexithymia (p<0.001).
Obese patients with high depression, anxiety and alexithymia levels rated their pain as more intense and required a larger amount of tramadol. Pain perception intensity was predicted by anxiety and depression but not by alexithymia, whereas analgesics consumption was predicted by all the investigated psychopathological dimensions.
先前针对接受择期手术的非肥胖患者开展的研究表明，心理因素可能会影响术后镇痛需求。这项观察性前瞻性研究的目的是，调查包括焦虑、抑郁和述情障碍在内的精神病理学维度，在接受减肥手术的患者中使用患者自控镇痛（PCA）时，对术后疼痛强度和镇痛药消耗量的影响程度。
纳入120例年龄在18至60岁之间、ASA身体状况为I-II级且正在接受胃旁路手术的患者。在手术前一天，对患者进行焦虑和抑郁汉密尔顿量表以及多伦多述情障碍量表的评估。全身麻醉标准化。苏醒后，立即提供一台配有静脉注射曲马多的PCA泵，用于术后36小时的镇痛。术后记录静息时视觉模拟量表（VASr）、咳嗽后视觉模拟量表（VASi）以及有效的PCA请求次数。采用Pearson相关性分析、方差分析和多元线性回归进行统计学分析。
焦虑、抑郁、述情障碍与所有疼痛指标之间均存在正相关（p<0.01）。方差分析显示，焦虑患者（p<0.001）、抑郁患者（p<0.001）和述情障碍患者（p<0.05）的疼痛指标较高。VASr和VASi可由焦虑和抑郁预测（p<0.05），但不能由述情障碍预测；有效的PCA请求次数可由焦虑、抑郁和述情障碍预测（p<0.001）。
抑郁、焦虑和述情障碍水平较高的肥胖患者将疼痛评定为更强烈，并且需要更多的曲马多。疼痛感知强度可由焦虑和抑郁预测，但不能由述情障碍预测，而镇痛药消耗量可由所有调查的精神病理学维度预测。
