急性术后疼痛的风险因素和保护因素：德国一所大学医院的横断面和纵向住院数据观察性研究。
Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data.
机构信息
Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany.
Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany.
出版信息
BMJ Open. 2023 May 8;13(5):e069977. doi: 10.1136/bmjopen-2022-069977.
OBJECTIVES
Surgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological risk and resilience factors of postoperative pain and validated the German version of the Surgical Fear Questionnaire (SFQ).
SETTING
University Hospital of Marburg, Germany.
DESIGN
Single-centre observational study and cross-sectional validation study.
PARTICIPANTS
Data for validating the SFQ were obtained from a cross-sectional observational study (N=198, mean age 43.6 years, 58.8% female) with persons undergoing different kinds of elective surgery. A sample of N=196 (mean age 43.0 years, 45.4% female) undergoing elective (orthopaedic) surgery was analysed to investigate somatic and psychological predictors of relevant acute postsurgical pain (APSP).
OUTCOME MEASURES
Participants completed preoperative and postoperative assessments at postoperative days 1, 2 and 7. Presurgical pain, age, gender, pain expectation, surgical setting, physical status, anaesthesia, surgical fear, pain catastrophising, depression, optimism and self-efficacy were examined as predictors.
RESULTS
Confirmatory factor analysis confirmed the original two-factor structure of the SFQ. Correlation analyses indicated good convergent and divergent validity. Internal consistency (Cronbach's α) was between 0.85 and 0.89. Blockwise logistic regression analyses for the risk of APSP revealed outpatient setting, higher preoperative pain, younger age, more surgical fear and low dispositional optimism as significant predictors.
CONCLUSIONS
The German SFQ is a valid, reliable and economical instrument with which the important psychological predictor surgical fear can be assessed. Modifiable factors that increase the risk of postoperative pain were higher pain intensity before surgery and being fearful about negative consequences of the surgery whereas positive expectations seem to buffer against postsurgical pain.
TRIAL REGISTRATION NUMBERS
DRKS00021764 and DRKS00021766.
目的
手术恐惧是术后疼痛最重要的心理风险因素之一，但对保护因素的了解较少。本研究调查了术后疼痛的躯体和心理风险及恢复力因素，并验证了德语版手术恐惧问卷（SFQ）。
地点
德国马尔堡大学医院。
设计
单中心观察性研究和横断面验证性研究。
参与者
用于验证 SFQ 的数据来自一项横断面观察性研究（N=198，平均年龄 43.6 岁，58.8%为女性），纳入了接受不同类型择期手术的患者。对 N=196（平均年龄 43.0 岁，45.4%为女性）接受择期（骨科）手术的样本进行分析，以研究躯体和心理预测因素与相关急性术后疼痛（APSP）的关系。
结果
参与者在术后第 1、2 和 7 天进行了术前和术后评估。术前疼痛、年龄、性别、疼痛预期、手术环境、身体状况、麻醉、手术恐惧、疼痛灾难化、抑郁、乐观和自我效能被作为预测指标进行了检查。
结论
德国 SFQ 是一种有效、可靠且经济的工具，可评估手术恐惧这一重要的心理预测指标。门诊手术环境、较高的术前疼痛、较年轻的年龄、更高的手术恐惧和较低的倾向性乐观是增加术后疼痛风险的显著预测指标。
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