胸腰段脊柱骨折后下肢慢性疼痛患者术前护理干预的研究

Preoperative nursing intervention on patients with chronic pain of lower limbs after thoracolumbar spinal fracture

摘要:

目的: 探讨胸腰段脊柱骨折后下肢慢性疼痛患者行脊髓背根入髓区毁损术前采用聚焦解决模式联合个性化疼痛护理对焦虑情绪及睡眠质量的影响。方法: 选取2012年1月至2018年1月在首都医科大学宣武医院功能神经外科行脊髓背根入髓区（dorsal root entry zone, DREZ）毁损术的胸腰段脊柱骨折后下肢慢性疼痛患者42例，按照随机数字表法分为对照组和观察组，各21例。对照组术前采用常规护理，观察组术前在对照组护理的基础上，采用聚焦解决模式联合个性化疼痛护理。采用焦虑自评量表（self-rating anxiety scale, SAS）及匹兹堡睡眠质量指数问卷（Pittsburgh sleep quality index, PSQI）分别对两组患者护理干预前（入院第1天）及干预后（入院第8天）焦虑情绪及睡眠质量进行评估并比较。结果: 与干预前比较，对照组干预后SAS评分与PSQI评分差异均无统计学意义（P＞0.05），观察组干预后SAS评分及PSQI评分均降低（P＜0.05）。干预前，对照组与观察组SAS评分及PSQI评分比较差异均无统计学意义（P＞0.05）；干预后，观察组SAS评分及PSQI评分均较对照组降低（P＜0.05）。结论: 将聚焦解决模式联合个性化疼痛护理用于胸腰段脊柱骨折后下肢慢性疼痛患者，能够改善患者行DREZ毁损术前焦虑情绪及睡眠状态，有利于做好术前心理准备，增强治疗疾病信心。

Abstract:

Objective: To explore the effect of preoperative application of solution focused approach combined with individual pain nursing to intervene anxiety and sleep disorders in patients undergoing dorsal root entry zone ablation with chronic pain of lower limbs after thoracolumbar spinal fracture. Methods: We selected 42 patients with chronic pain of lower limbs after thoracolumbar spine fracture, who would be accepted the operation of dorsal root entry zone(DREZ) ablation，from Jan 2012 to Jan 2018 in Functional Neurosurgery in Xuanwu hospital of the Capital University of Medical Sciences. 42 patients were divided into control group and observation group according to random number table, 21 cases in the control group with routine nursing care, 21 cases in observation group with solution focused approach and individual pain nursing, The self-rating anxiety scale (SAS) scores and the Pittsburgh sleep quality index (PSQI) scores before and after intervention were evaluated and compared between the two groups. Results: Before intervention, there was no significant difference in SAS and PSQI scores between the control group and the observation group (P>0.05). After intervention, there was no statistically significant difference in the SAS and PSQI scores of the control group before and after intervention (P>0.05), while the SAS and PSQI scores of the observation group were lower than those before intervention (P< 0.05). After the intervention, the SAS and PSQI scores in the observation group were lower than those in the control group (P< 0.05). Conclusion: The application of solution focused approach combined with individual pain nursing intervention for patients with chronic pain of lower limbs after thoracolumbar spinal fracture can improve the preoperative anxiety and sleep state, which is conducive to the preoperative psychological preparation, enhance the confidence in the treatment of diseases.