【作者】 徐俊；

【导师】 朱婉儿；

【作者基本信息】 浙江大学 ， 精神病与精神卫生， 2009， 硕士

【摘要】 研究背景:疼痛特别是慢性疼痛,不单纯是生理学的感觉问题,也是心理学的复杂情绪表现,这种复杂的生理心理反应,总伴随情绪反应,临床经验表明,慢性疼痛和抑郁症常交织在一起,可以加重、甚至引起抑郁症的发生。研究目的本研究需探讨精神、心理因素与慢性疼痛的关系及帕罗西汀(赛乐特)对慢性退行性关节疼痛合并抑郁状态的临床疗效。研究方法对228例慢性退行性关节疼痛患者进行Zung氏抑郁症状自评量表(SDS)评分筛选出具有抑郁状态者,在疼痛治疗的基础上加用帕罗西汀片(赛乐特),观察其疼痛视觉模拟评分(VAS)评分、Zung氏抑郁症状自评量表(SDS)评分及生活满意度评分并作临床疗效评价。研究结果1、Zung氏抑郁症状自评量表(SDS)标准分=53为抑郁。本次调查SDS=53的人数,合计有71例。所占比例为33.1%(71/228)。2、这71例中排除妊娠或哺乳者:继发于其他疾病的抑郁;正在采用其他抗抑郁剂治者;具有严重心、肝、肾功能障碍;有脑器质性病变和癫痫;具有严重自杀企图、攻击行为、幻觉、妄想等症状患者,并进入治疗研究最终获得结果的患者为61例。3、这61例患者按随机数字表法随机分为对照组和帕罗西汀组,分别接受治疗。治疗后,帕罗西汀组及对照组的Zung氏抑郁症状自评量表(SDS)评分、生活满意度评分及疼痛视觉模拟(VAS)评分,均较治疗前明显降低(P＜0.05);但治疗后2,4,6周帕罗西汀组Zung氏抑郁症状自评量表(SDS)评分、生活满意度评分及疼痛视觉模拟(VAS)评分,改善程度均明显优于对照组(P＜0.05)。4、对照组和帕罗西汀组分别于第6周末评价临床总体疗效。帕罗西汀组总有效率(痊愈率+显著有效率+有效率)为86.67%,对照组总有效率为58.06%。帕罗西汀组明显优于对照组(P＜0.05)。研究结论慢性疼痛与精神心理因素相关,对其中具有抑郁情绪的患者使用抗抑郁剂治疗能显著改善精神和躯体两方面症状。更多还原

【Abstract】 BackgroundPain, especially the chronic pain, not only is the feeling of physiology, but also the performance of complex emotions in Psychology. This complex physiological and psychological reaction always appears with emotional responses. Clinical experience shows that chronic pain and depression often intertwines with each other. It can aggravate and even induce the depression.ObjectiveThis study aims to explore the relationship between psychological factors and chronic pain. Besides it also explore the clinical curative effect of Paroxetine on the chronic degenerative arthritic pains mergered with the depression.MethodsSDS was used for 228 chronic pain patients and the depressives were screened for study through the result of SDS. On the basis of pain therapy, Paroxetine were given to the subjects and then recorded the scores of VAS, SDS and LSS and evaluated the clinical curative effect.Results1. People who have the scores of SDS above 53 were regarded as depressives and the total number of these people was 71 in this investigation, covering 33.1 % ( 71/228) of the whole subjects.2. These people were eliminated in these 71 cases. They are pregnancy or breastfeeding, secondary depression patients, people who are adopting other antidepressant ,people who with serious heart, liver, kidney disorders, people who suffer from organic brain lesions and epilepsy and people who with severe suicide attempts, aggression ,illusion, and delusion. At last, 61 people suited for this study and produced experimental results3. These 61 people were randomly divided into two groups-control group and Paroxetine group, according to Random digital form. The two groups accepted therapy respectively .After treatment, the scores of SDS,LSS,VAS in Paroxetine group and control group were lower than before obviously(P<0.05).But after treatment, and two, four and six weeks later, the scores of SDS, LSS, and VAS in Paroxetine group improved more than that of control group significantly(P < 0.05).4. At the end of the sixth week evaluated the clinical curative effect of control group and Paroxetine group respectively. The total effective rate of Paroxetine group is 86.67 % , while control group is 58.06% . Paroxetine group was vastly superior to the control group (P < 0.05).ConclusionsChronic pain is relevant to psychological factors. For patients with depression, antidepressant therapy can significantly improve mental and physical symptoms.更多还原