Desbiens N A, Mueller-Rizner N, Connors A F, Wenger N S
Marshfield Clinic and Marshfield Medical Research Foundation, WI 54449, USA.
Pain. 1997 Jun;71(2):149-56. doi: 10.1016/s0304-3959(97)03353-8.
To describe the hospital symptom experience of seriously ill patients with common illnesses. To assess the independent association of nausea and dyspnea to level of pain.
Cross-sectional study.
Five tertiary care academic centers in the US.
1556 patients admitted between June 1989 and June 1991 in SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) who answered questions concerning frequency and severity of pain, nausea and dyspnea, and the depression and anxiety subscales of the Profile of Mood States.
Seriously ill patients were interviewed a median of 8 days after hospitalization concerning the frequency and severity of their pain, nausea and dyspnea. Frequencies of symptoms and symptom combinations were tabulated. Ordinal logistic regression was used to test the independent association of level of pain with nausea and dyspnea. The analysis was adjusted for 22 additional demographic, psychological, chronic and acute illness measures.
At least some level of anxious mood was reported by 85.2% of patients, depressed mood by 72.3% of patients, pain by 51.2% of patients, dyspnea by 48.6% of patients and nausea by 23.9% of patients. At least some degree of one of the five symptoms was reported by 94.2% of patients. Multivariable analysis controlling for demographic, psychological, and chronic and acute illness variables revealed that nausea and dyspnea were independently related to level of pain. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) nausea had odds ratios (OR) for higher levels of pain of 1.62 (1.24, 2.12) (95% confidence interval), 2.36 (1.39, 4.00), 2.57 (1.29, 5.12) and 2.22 (1.08, 4.53), respectively. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) dyspnea had odds ratios (OR) for higher levels of pain of 1.49 (1.17, 1.90), 1.92 (1.21, 3.04), 2.73 (1.83, 4.07) and 1.95 (1.39, 2.73), respectively.
Seriously ill patients have a high symptom burden. Patients who have nausea and dyspnea experience more pain than patients without these symptoms, even after adjustment for depression, anxiety, disease type, disease severity and demographic and psychological measures. The causal association between these symptoms and pain remains to be determined. Though pain may cause dyspnea and nausea, the intriguing possibility remains that, in addition to relieving suffering, treating dyspnea and nausea may relieve pain.
描述患有常见疾病的重症患者的医院症状体验。评估恶心和呼吸困难与疼痛程度的独立关联。
横断面研究。
美国的五个三级医疗学术中心。
1556名于1989年6月至1991年6月期间入住SUPPORT（了解治疗结果和风险的预后及偏好研究）的患者，他们回答了有关疼痛、恶心和呼吸困难的频率及严重程度，以及情绪状态剖面图中的抑郁和焦虑分量表的问题。
在患者住院中位数8天后，对重症患者进行访谈，询问他们疼痛、恶心和呼吸困难的频率及严重程度。将症状及症状组合的频率制成表格。采用有序逻辑回归来检验疼痛程度与恶心和呼吸困难的独立关联。分析针对另外22项人口统计学、心理、慢性和急性疾病指标进行了调整。
85.2%的患者报告至少有某种程度的焦虑情绪，72.3%的患者报告有抑郁情绪，51.2%的患者报告有疼痛，48.6%的患者报告有呼吸困难，23.9%的患者报告有恶心。94.2%的患者报告至少有这五种症状中的一种达到某种程度。对人口统计学、心理以及慢性和急性疾病变量进行多变量分析后发现，恶心和呼吸困难与疼痛程度独立相关。与没有这些症状的患者相比，报告轻度（2级）、中度（3级）、重度（4级）和极重度（5级）恶心的患者，疼痛程度较高的优势比（OR）分别为1.62（1.24，2.12）（95%置信区间）、2.36（1.39，4.00）、2.57（1.29，5.12）和2.22（1.08，4.53）。与没有这些症状的患者相比，报告轻度（2级）、中度（3级）、重度（4级）和极重度（5级）呼吸困难的患者，疼痛程度较高的优势比（OR）分别为1.49（1.17，1.90）、1.92（1.21，3.04）、2.73（1.83，4.07）和1.95（1.39，2.73）。
重症患者症状负担较重。有恶心和呼吸困难的患者比没有这些症状的患者经历更多疼痛，即使在对抑郁、焦虑、疾病类型、疾病严重程度以及人口统计学和心理指标进行调整之后也是如此。这些症状与疼痛之间的因果关联仍有待确定。虽然疼痛可能导致呼吸困难和恶心，但有趣的是，除了减轻痛苦之外，治疗呼吸困难和恶心可能还会缓解疼痛这一可能性仍然存在。
