【作者】 刘宇；

【导师】 李瑞玲； 田松焕；

【作者基本信息】 河南大学 ， 护理（专业学位）， 2019， 硕士

【摘要】 目的了解乳腺癌根治术后患者的疼痛现状及其疼痛自我管理的水平,探讨乳腺癌根治术后患者疼痛自我管理行为与疼痛程度之间的关系,深入了解其影响因素。为乳腺癌根治术后疼痛及其疼痛的自我管理方面的研究提供一些基础数据支持,为患者疼痛管理提供科学的依据。提出管理疼痛新的应对角度和对策及建议。方法采取横断面研究的方法,于2018年1月—2018年10月之间,选取了河南省郑州市内两家三级医院乳腺外科的140例女性乳腺癌根治术患者作为本研究的研究对象。采用一般资料调查表、术后疼痛自我管理行为问卷(PPSMB)、简明疼痛评估量表(BPI)进行问卷调查。数据录入部分使用Epidata 3.1软件,数据分析部分使用SPSS 22.0软件。均数、标准差描述计量资料;频数、百分比描述计数资料。采用独立样本t检验、方差分析比较不同资料及疼痛水平。对乳腺癌根治术患者疼痛程度、自我管理行为做Pearson相关分析。对乳腺癌根治术患者疼痛自我管理行为影响因素做多元逐步回归分析。结果1乳腺癌患者术后疼痛现状乳腺癌患者术后三天疼痛现状评分如下:目前疼痛程度24 h内、24~48 h内、48~72h内分别为(1.37±1.24)、(1.82±1.33)、(1.04±1.02);最痛疼痛程度24 h内、24~48 h、48~72 h分别为(2.81±1.20)、(4.07±1.72)、(3.00±1.71);最轻疼痛程度24 h内、24~48h、48~72 h分别为(1.09±1.26)、(1.31±1.40)、(0.69±1.00);平均疼痛程度24 h内、24~48 h、48~72 h分别为(1.97±1.66)、(2.98±2.41)、(2.06±2.16)。术后24 h内平均疼痛程度达到中度、重度的患者占比17.9%、0.7%;术后24~48 h内平均疼痛程度达到中度、重度的患者占比27.1%、9.3%;术后48~72 h内平均疼痛程度达到中度、重度的患者占比22.1%、3.6%。2乳腺癌术后患者疼痛对患者生活的影响术后三天,疼痛对乳腺癌术后患者生活的影响呈逐渐下降的趋势,对生活的影响调查主要包括日常生活、情绪、行走能力、日常工作、人际关系、睡眠、生活兴趣。术后24 h内疼痛对患者生活的影响总体处于较高水平;术后24~48 h影响程度下降至中低等;术后48~72 h影响降至低水平。3乳腺癌患者术后疼痛自我管理行为现状乳腺癌根治术患者术后疼痛自我管理行为得分总分为24.78±7.77,处于不够理想的状态;其中“主动向医护人员了解疼痛控制知识”“主动通过书本、互联网等了解疼痛控制知识”“主动学习镇痛泵使用方法”“采用非药物法缓解疼痛”“康复活动如翻身、咳嗽等活动前,按压镇痛泵给药键”都处于较低得分。“能够正确评估疼痛强度”处于最高得分(3.44±0.85)。4乳腺癌患者术后疼痛自我管理行为的单因素分析结果表明,患者的社会人口学资料中,年龄、文化程度、婚姻状况、工作状态、付费方式不同,其术后疼痛自我管理行为均有差异,且差异有统计学意义(P<0.05);患者的疾病相关资料中,诊断、手术部位、是否有术前放化疗、是否接受过疼痛教育、是否接受过疼痛治疗、来院就诊时机影响其术后疼痛自我管理行为,且差异有统计学意义(P<0.05)。其中年龄<45岁、文化程度为高中/中专、未婚、在职、自费的患者术后疼痛自我管理行为得分更高。左乳患病、单侧乳房手术、术前没有过放化疗、接受过疼痛教育、接受过疼痛治疗、发现患病后1~3个月来院就诊的患者术后疼痛自我管理行为得分较高。5乳腺癌患者术后疼痛程度与疼痛自我管理行为的相关性结果显示,过去24小时最痛疼痛程度与自我管理行为各维度均呈负相关关系;过去24小时最轻疼痛程度与自我管理行为各维度均呈负相关关系(P<0.05);过去24小时平均疼痛程度与自我管理行为各维度均呈负相关关系;目前疼痛程度与自我管理行为各维度均呈负相关关系。6乳腺癌患者术后疼痛自我管理行为的多元逐步回归分析由多元逐步回归分析结果可知,乳腺癌患者术后疼痛自我管理水平的独立影响因素包括年龄、文化程度、最轻疼痛程度、是否接受过疼痛教育、婚姻状况。结论1乳腺癌患者术后疼痛自我管理水平普遍较差。2年龄、文化程度、最轻的疼痛程度、是否接受过疼痛教育、婚姻状况是乳腺癌术后患者疼痛自我管理水平的主要影响因素。3乳腺癌患者术后目前的疼痛程度、过去24 h内最痛程度和最轻疼痛程度、平均疼痛程度与术后疼痛自我管理行为中各维度的评分均呈负相关关系。更多还原

【Abstract】 ObjectivesTo understand the pain status of patients after radical mastectomy and the level of pain self-management,to explore the relationship between pain self-management behavior and pain degree of patients after radical mastectomy,and to further understand its influencing factors.To provide some basic data support for the research on pain and pain self-management after radical mastectomy,and to provide scientific basis for pain management of patients.To propose new coping angles,countermeasures and suggestions for pain management.MethodsUsing the method of cross-sectional study,140 patients with breast cancer undergoing radical mastectomy from January 2018 to October 2018 in two tertiary hospitals in Zhengzhou city of Henan province were selected as the research object.General data questionnaire,PPSMB and BPI were used to investigate.Epidata 3.1 software is used for data entry and SPSS 22.0 software is used for data analysis.Mean and standard deviation describe the measurement data;Frequency and percentage describe counting data.Independent sample T test and variance analysis were used to compare different data and pain levels.Pearson correlation analysis was made on pain degree and self-management behavior of patients undergoing radical mastectomy.The influencing factors of pain self-management behavior of breast cancer patients undergoing radical mastectomy were analyzed by multiple stepwise regression.Results1Current Situation of Postoperative Pain in Breast Cancer PatientsThe pain score of breast cancer patients three days after operation is as follows: the current pain degree is(1.37±1.24),(1.82±1.33),(1.04±1.02)within 24 hours,24-48 hours and 48-72 hours respectively;Within 24 hours,24 ~ 48 hours and 48~72 hours,the most painful pain was(2.81±1.20),(4.07±1.72)and(3.00 1.71)respectively.The lightest pain was(1.09±1.26),(1.31±1.40),(0.69±1.00)within 24 hours,24~48 hours and 48~72 hours respectively.The average pain degree was(1.97±1.66),(2.98±2.41),(2.06±2.16)within 24 hours,24~48 hours and 48~72 hours respectively.The proportion of patients with moderate or severe pain within 24 hours after operation was 17.9% and 0.7%.27.1% and 9.3% of patients experienced moderate or severe pain within 24~48 hours after operation.The proportion of patients with moderate or severe pain within 48~72 hours after operation was 22.1% and 3.6%.2Influence of Pain on Patients’ Life after Breast Cancer SurgeryThree days after the operation,the influence of pain on the life of breast cancer patients showed a decreasing trend.The investigation of the influence on life mainly included daily life,emotion,walking ability,daily work,interpersonal relationship,sleep and interest in life.The effect of pain on patients’ life within 24 hours after operation is generally at a high level.The degree of influence decreased to medium and low level 24~48 h after operation.The influence dropped to a low level 48~72 hours after operation.3Current situation of pain self-management behavior of breast cancer patients after operationThe total score of pain self-management behavior of patients undergoing radical mastectomy was 24.78±7.77,which was not satisfactory.Among them,"actively learn pain control knowledge from medical staff," "actively learn pain control knowledge through books,internet,etc." "actively learn the use method of analgesic pump," "adopt non-drug method to relieve pain," "press the analgesic pump administration key before rehabilitation activities such as turning over and coughing" all scored lower.The score of "being able to correctly evaluate pain intensity" was the highest(3.44±0.85).4Univariate Analysis of Postoperative Pain Self-management Behavior of Breast Cancer PatientsThe results showed that the patients’ self-management behaviors of postoperative pain were different with statistical significance(P<0.05)due to different age,educational level,marital status,working status and payment methods in their socio-demographic data.In the disease-related data of patients,diagnosis,surgical site,preoperative radiotherapy and chemotherapy,pain education,pain treatment,and visiting time affect their postoperative pain self-management behavior,and the difference is statistically significant(P<0.05).Among them,patients younger than 45 years old,with high school/technical secondary school education,unmarried,employed and self-funded scored higher in pain self-management behavior.Patients with left breast disease,unilateral breast surgery,preoperative radiotherapy and chemotherapy,received pain education,received pain treatment,and came to the hospital 1-3 months after the disease were found to have higher scores in postoperative pain self-management behavior.5Correlation between postoperative pain degree and pain self-management behavior in breast cancer patientsThe results showed that the most painful pain degree in the past 24 hours was negatively correlated with all dimensions of self-management behavior.The lightest pain degree in the past 24 hours was negatively correlated with all dimensions of self-management behavior(P<0.05).The average pain level in the past 24 hours was negatively correlated with all dimensions of self-management behavior.At present,the degree of pain is negatively correlated with all dimensions of self-management behavior.6Multivariate stepwise regression analysis of self-management behavior of postoperative pain in breast cancer patientsAccording to the results of multiple stepwise regression analysis,the independent influencing factors of postoperative pain self-management level of breast cancer patients include age,education level,lightest pain level,whether they have received pain education or not,and marital status.Conclusions1The self-management level of postoperative pain in patients with breast cancer was generally poor.2Age,educational level,marital status,the lightest degree of pain and whether or not they have received pain education are the main influencing factors of pain self-management level of breast cancer patients after operation.3The present pain degree,the most pain degree and the lightest pain degree in the past 24 hours,and the average pain degree of breast cancer patients after operation are negatively correlated with the scores of all dimensions in postoperative pain self-management behavior.更多还原